From the Guidelines
Antidepressants with a lower risk of causing hyperhidrosis include bupropion (Wellbutrin), mirtazapine (Remeron), and certain atypical antidepressants like vortioxetine (Trintellix). These medications have a different mechanism of action compared to SSRIs, which are more commonly associated with hyperhidrosis, affecting approximately 10-15% of patients taking these medications 1. Bupropion works differently from SSRIs by primarily affecting dopamine and norepinephrine rather than serotonin, which may explain its reduced association with sweating side effects. Mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSA), actually has anticholinergic properties that can reduce sweating in some patients.
Some key points to consider when prescribing antidepressants with a low risk of hyperhidrosis include:
- Bupropion's unique mechanism of action, which may reduce the risk of sweating side effects
- Mirtazapine's anticholinergic properties, which can help reduce sweating in some patients
- The importance of gradual transitions when switching medications to minimize withdrawal effects
- The need for patients to consult their healthcare provider if excessive sweating occurs with an antidepressant, rather than discontinuing treatment abruptly.
In contrast, SSRIs (like sertraline, fluoxetine, and paroxetine) and SNRIs (like venlafaxine and duloxetine) are more commonly associated with hyperhidrosis, and patients taking these medications should be monitored for this potential side effect 1. The mechanism behind antidepressant-induced sweating involves their impact on neurotransmitters that regulate body temperature and sweating, particularly serotonin's effect on the hypothalamus.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Antidepressants with Low Risk of Causing Hyperhidrosis
- Mirtazapine: This antidepressant has a novel mechanism of action and is thought to have a lower risk of causing hyperhidrosis compared to other antidepressants 2.
- Venlafaxine: At low doses (up to 75 mg), venlafaxine may have a lower risk of causing hyperhidrosis due to its serotonergic effect, which can counteract sweating 3.
- Desvenlafaxine: As the primary metabolite of venlafaxine, desvenlafaxine may also have a lower risk of causing hyperhidrosis, although its potential for dose-dependent blood pressure elevation should be considered 4.
Antidepressants with Reported Cases of Hyperhidrosis
- Paroxetine: There have been reported cases of excessive sweating associated with paroxetine, and discontinuation of the medication may be necessary to resolve symptoms 5.
- SSRIs: Selective serotonin reuptake inhibitors, including paroxetine, have been associated with excessive sweating in some patients, and alternative treatments or dose adjustments may be necessary 5, 6.
- Duloxetine: While duloxetine is a more potent 5-HT and NE reuptake inhibitor, its potential for causing hyperhidrosis is not well-established, but it may cause other side effects such as nausea, dry mouth, and hypertension 4.