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 been found to have a more favorable side effect profile compared to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which are more commonly associated with hyperhidrosis 1. Bupropion, for example, works differently than most antidepressants by primarily affecting dopamine and norepinephrine rather than serotonin, which may explain its lower association with sweating side effects. Mirtazapine, which has antihistamine properties, tends to cause dry mouth rather than excessive sweating.
Key Considerations
- The mechanism behind antidepressant-induced sweating involves their effects on serotonin receptors and the autonomic nervous system 1.
- If excessive sweating develops while taking an antidepressant, patients should consult their healthcare provider about switching medications or adding treatments specifically for hyperhidrosis, such as anticholinergic medications, rather than discontinuing treatment abruptly.
- The American College of Physicians recommends selecting second-generation antidepressants based on adverse effect profiles, cost, and patient preferences 1.
- Regular assessment of patient status, therapeutic response, and adverse effects of antidepressant therapy is crucial, beginning within 1 to 2 weeks of initiation of therapy 1.
Comparison of Antidepressants
- SSRIs like sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac) are more commonly associated with hyperhidrosis.
- SNRIs like venlafaxine (Effexor) and duloxetine (Cymbalta) are also more commonly associated with hyperhidrosis.
- Bupropion, mirtazapine, and certain atypical antidepressants like vortioxetine (Trintellix) have a lower risk of causing hyperhidrosis.
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.