Photo_Section_Faculty


ASK THE EXPERTS

button






Are there any antidepressants that do not increase sweating or are there medications that can be taken to reduce the sweating?



Answered by: Alexander Glassman

There is something called SweatSolutions.org - the International Hyperhidrosis Society. This is copied from their web-site. I think it is pretty good.

(November/December 2006) Unwanted sweating is a common side effect of treatment with anti-depressants, especially those that modulate serotonin levels in the brain. Prozac, Paxil and Celexa are commonly prescribed members of this group of drugs, known in medical circles as SSRIs (selective serotonin re-uptake inhibitors). Well-designed clinical trials have demonstrated that sweating occurs in 7% to 19% of depressed patients on these medications. In some fraction of these patients the symptoms are severe enough to cause them to stop or change their depression treatment. The exact mechanism by which these medications cause sweating is unknown, but it is thought that activation of the thermoregulatory center of the brain (the hypothalamus) is involved.

Unfortunately, many of the potential alternate antidepressants (such as Effexor, Cymbalta and Elavil) act by similar mechanisms and can have comparable side effects, leaving depressed patients in a bind. Furthermore, recent evidence suggests that interactions with other medications, in particular common migraine medications in the Triptan class (such as Imitrex and Maxalt), can exacerbate the problem and in some cases cause a life-threatening reaction called serotonin syndrome. The FDA issued a warning about this interaction on July 19, 2006. In addition to sweating, other symptoms suggestive of serotonin syndrome are: restlessness, hallucinations, loss of coordination, rapid heart beat, nausea/vomiting, diarrhea, overactive reflexes, and rapid changes in blood pressure.

Because there is not yet a good explanation for why SSRIs cause sweating, it has been difficult to develop effective solutions to the problem. Several small case series have identified potential treatments including the use of the systemic medications clonidine (a drug usually used to control blood pressure), benztropine (an anticholinergic), mirtazapine (brand name Remeron, an atypical antidepressant), and cyproheptadine (brand name Periactin, which is an antihistamine). The latter treatment was described in a case series presented in a letter to the editor in the American Journal of Psychiatry in May of 2002. Five patients taking anti-depressants [three of them on Prozac (fluoxetine), one on Effexor (venlafaxine) and one on Paxil (paroxetine)] were treated with cyproheptadine either 4mg twice a day or once a day at bedtime. The excessive sweating side effect ceased in all five patients. The patients experienced minimal additional side effects and were able to maintain the positive effect over time. Of note, none of these patients lost efficacy of their antidepressant therapy after beginning treatment with cyproheptadine.

(November/December 2006) Unwanted sweating is a common side effect of treatment with anti-depressants, especially those that modulate serotonin levels in the brain. Prozac, Paxil and Celexa are commonly prescribed members of this group of drugs, known in medical circles as SSRIs (selective serotonin re-uptake inhibitors). Well-designed clinical trials have demonstrated that sweating occurs in 7% to 19% of depressed patients on these medications. In some fraction of these patients the symptoms are severe enough to cause them to stop or change their depression treatment. The exact mechanism by which these medications cause sweating is unknown, but it is thought that activation of the thermoregulatory center of the brain (the hypothalamus) is involved.

Unfortunately, many of the potential alternate antidepressants (such as Effexor, Cymbalta and Elavil) act by similar mechanisms and can have comparable side effects, leaving depressed patients in a bind. Furthermore, recent evidence suggests that interactions with other medications, in particular common migraine medications in the Triptan class (such as Imitrex and Maxalt), can exacerbate the problem and in some cases cause a life-threatening reaction called serotonin syndrome. The FDA issued a warning about this interaction on July 19, 2006. In addition to sweating, other symptoms suggestive of serotonin syndrome are: restlessness, hallucinations, loss of coordination, rapid heart beat, nausea/vomiting, diarrhea, overactive reflexes, and rapid changes in blood pressure.

Because there is not yet a good explanation for why SSRIs cause sweating, it has been difficult to develop effective solutions to the problem. Several small case series have identified potential treatments including the use of the systemic medications clonidine (a drug usually used to control blood pressure), benztropine (an anticholinergic), mirtazapine (brand name Remeron, an atypical antidepressant), and cyproheptadine (brand name Periactin, which is an antihistamine). The latter treatment was described in a case series presented in a letter to the editor in the American Journal of Psychiatry in May of 2002. Five patients taking anti-depressants [three of them on Prozac (fluoxetine), one on Effexor (venlafaxine) and one on Paxil (paroxetine)] were treated with cyproheptadine either 4mg twice a day or once a day at bedtime. The excessive sweating side effect ceased in all five patients. The patients experienced minimal additional side effects and were able to maintain the positive effect over time. Of note, none of these patients lost efficacy of their antidepressant therapy after beginning treatment with cyproheptadine.

More questions on this topic

More answers by this expert

Click here for Dr. Glassman's Clinical Trials
 

Alexander Glassman, M.D.
Chief: Clinical Psychopharmacology 

Alexander H. Glassman, M.D., is Chief of Clinical Psychopharmacology at New York State Psychiatric Institute, and Professor of Psychiatry at the College of Physicians and Surgeons of Columbia University. He is an authority on depression and antidepressant drugs, and has altered the standard of care for depressed patients.

He showed that inter-individual differences in metabolism of imipramine influenced clinical outcome and that delusional unipolar depression responded very poorly to antidepressant drugs alone. His work has clarified the safe treatment of depressed patients with cardio...
>>> Read more info



PATH: /depression/DES/ask_the_experts_inquiry.asp
Description: Operation is not allowed when the object is closed.
Help Context: 1240653
Help File: C:\Windows\HELP\ADO270.CHM
Number: 3704
Source: ADODB.Connection



An ERROR had occurred while LOADING the page.
Please inform Application's Administrator for support.
logo_New York State Psychiatric InstituteColumbia University Department of Psychiatry
Designed by: The Web Design Studio