From the Guidelines
Hyperhidrosis in patients with post-traumatic stress disorder (PTSD) should be managed with a dual approach that targets both conditions, prioritizing trauma-focused psychotherapy and medications like SSRIs, alongside treatments for hyperhidrosis such as prescription-strength antiperspirants and oral anticholinergics, as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1.
Key Considerations
- Hyperhidrosis can be exacerbated by PTSD due to heightened sympathetic nervous system activity associated with trauma responses.
- First-line treatments for hyperhidrosis include prescription-strength antiperspirants containing 20% aluminum chloride hexahydrate, applied to affected areas at bedtime and washed off in the morning.
- For severe cases, oral anticholinergics like glycopyrrolate (1-2mg twice daily) or oxybutynin (5-10mg daily) may help, though they can cause side effects like dry mouth and blurred vision.
- For PTSD management, a combination of trauma-focused psychotherapy (such as Cognitive Processing Therapy or EMDR) and medications like SSRIs (sertraline 50-200mg daily or paroxetine 20-50mg daily) is effective, as recommended by the clinical practice guideline 1.
Treatment Approach
- Prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy are recommended over pharmacotherapy for PTSD treatment, according to the guideline 1.
- Medications like paroxetine, sertraline, or venlafaxine can be used in conjunction with psychotherapy.
- Secure video teleconferencing can be used to deliver recommended psychotherapy when validated for use with video teleconferencing or when other options are unavailable.
- Benzodiazepines, cannabis, or cannabis-derived products are not recommended for PTSD treatment, as stated in the guideline 1.
Additional Strategies
- Stress reduction techniques including deep breathing, progressive muscle relaxation, and mindfulness meditation can help manage acute episodes of excessive sweating during PTSD symptoms.
- Prazosin (starting at 1mg at bedtime, gradually increasing to 3-15mg) can specifically help with PTSD-related nightmares and autonomic hyperarousal that contributes to sweating.
From the Research
Hyperhydrosis and PTSD
- There is no direct evidence in the provided studies that links hyperhydrosis and PTSD.
- The studies focus on the treatment options for hyperhydrosis, including topical medications, iontophoresis, botulinum toxin injections, systemic medications, and surgery 2, 3, 4.
- Hyperhydrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions, and it can have significant medical and psychosocial consequences 2.
- The treatment options for hyperhydrosis vary depending on the severity and location of the sweating, and may include lifestyle and behavioral recommendations, antiperspirants, iontophoresis, botulinum toxin injections, oral systemic agents, and surgery 3, 4, 5, 6.
- While the studies do not address the relationship between hyperhydrosis and PTSD, they do highlight the importance of early and effective management strategies for hyperhydrosis to improve quality of life 6.