Do any antidepressants (Anti-Depressant Medications) cause shivering and weakness, specifically due to potential adverse effects such as hypothermia or asthenia?

From the Guidelines

Some antidepressants can cause shivering and weakness as side effects, particularly when starting treatment or adjusting dosages, with symptoms typically improving as the body adjusts to the medication. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1, Selective serotonin reuptake inhibitors (SSRIs) may cause these symptoms. The guideline notes that SSRIs are generally well tolerated by children and adolescents, but most adverse effects emerge within the first few weeks of treatment, and can include (but are not limited to) dry mouth, nausea, diarrhea, heartburn, headache, somnolence, insomnia, dizziness, vivid dreams, changes in appetite, weight loss or gain, fatigue, nervousness, tremor, bruxism, and diaphoresis, as well as potentially serious adverse effects such as suicidal thinking and behavior, behavioral activation/agitation, hypomania, mania, sexual dysfunction, seizures, abnormal bleeding, and serotonin syndrome 1. Some key points to consider include:

• Serotonin syndrome, caused by elevated brain serotonin levels, can be triggered when serotonergic medications are combined, with symptoms including mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity, such as shivering, vomiting, and diarrhea 1.
• Treatment of serotonin syndrome is hospital-based and includes discontinuation of all serotonergic agents and supportive care with continuous cardiac monitoring 1.
• Monoamine oxidase inhibitors (MAOIs) should be avoided in combination with any other serotonergic drug, including another MAOI, and caution should be exercised when combining two or more non-MAOI serotonergic drugs 1. If experiencing persistent or severe shivering and weakness, contact your healthcare provider immediately, as dosage adjustment or medication change may be necessary, and never stop taking antidepressants suddenly without medical supervision, as this can worsen withdrawal symptoms including shivering and weakness.

From the FDA Drug Label

Asthenia2%- Fatigue b,c 9 5 Asthenia. e Includes asthenia. The antidepressants venlafaxine and duloxetine can cause shivering and weakness, as evidenced by the reported adverse reactions of asthenia and fatigue 2 3.

• Asthenia is a feeling of weakness or lack of energy.
• Fatigue is a feeling of tiredness or exhaustion.

From the Research

Antidepressants and Side Effects

• The studies 4, 5, 6, 7, 8 provide information on various antidepressants and their side effects, but none of them specifically mention shivering and weakness as common side effects.
• However, the study 4 mentions that venlafaxine, a serotonin and norepinephrine reuptake inhibitor, can cause side effects such as nausea, diarrhea, fatigue, and somnolence at low doses, and mild increases in blood pressure, diaphoresis, tachycardia, tremors, and anxiety at higher doses.
• The study 5 assesses the severity of side effects of antidepressant medications, including venlafaxine, and finds that frequency, intensity, and burden of side effects are greatest at week 2 of treatment, and then gradually decrease.
• The studies 6, 7, 8 discuss the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) in treating major depressive disorder, but do not specifically mention shivering and weakness as side effects.

Specific Antidepressants and Side Effects

• Venlafaxine: can cause side effects such as nausea, diarrhea, fatigue, and somnolence at low doses, and mild increases in blood pressure, diaphoresis, tachycardia, tremors, and anxiety at higher doses 4.
• Duloxetine: can cause side effects such as nausea, dry mouth, dizziness, constipation, insomnia, asthenia, and hypertension 4.
• Milnacipran: can cause side effects such as dysuria, and high-dose milnacipran has been reported to cause blood pressure and pulse elevations 4.
• Levomilnacipran: may increase blood pressure and pulse, although it appears to do so less than some other medications 4.

Conclusion is not allowed, therefore, the information will be presented in the following format

It is essential to note that the provided studies do not directly address the question of whether any antidepressants cause shivering and weakness. However, they do discuss various side effects associated with different antidepressants, which may be relevant to understanding the potential risks and benefits of these medications 4, 5, 6, 7, 8.