From the Guidelines
Bupropion (Wellbutrin) and certain selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa) and escitalopram (Lexapro) are less likely to cause hyperhidrosis compared to other antidepressants. These medications have been found to have a lower association with sweating, with bupropion affecting dopamine and norepinephrine rather than serotonin, which may explain its lower sweating risk 1. Mirtazapine (Remeron) is another option that has antihistamine properties, which can actually reduce sweating in some patients. Among SSRIs, citalopram (typically 20-40mg daily) and escitalopram (10-20mg daily) tend to cause less hyperhidrosis than other options like paroxetine (Paxil) or sertraline (Zoloft) 1.
Some key points to consider when choosing an antidepressant with lower sweating risk include:
- Bupropion's unique mechanism of action, which affects dopamine and norepinephrine rather than serotonin
- Mirtazapine's antihistamine properties, which can reduce sweating
- The differences in side effect profiles among SSRIs, with citalopram and escitalopram tend to cause less hyperhidrosis than other options
- The importance of consulting a healthcare provider before switching medications, as abruptly stopping an antidepressant can have negative consequences
It's also important to note that the mechanism behind antidepressant-induced sweating relates to how these medications affect the body's thermoregulatory system through serotonergic and noradrenergic pathways, with some medications having more pronounced effects than others 1.
From the FDA Drug Label
Adverse ExperienceBuspirone hydrochloride (n = 477)Placebo (n = 464) - Incidence less than 1%. * Events reported by at least 1% of buspirone hydrochloride patients are included ... Sweating/Clamminess1- Infrequent were edema, pruritus, flushing, easy bruising, hair loss, dry skin, facial edema, and blisters; rare were acne and thinning of nails.
Buspirone is an antidepressant that may be less likely to cause hyperhidrosis (excessive sweating), as it is reported in only 1% of patients taking the medication 2. However, it is essential to note that sweating/clamminess is still a possible side effect.
- Key points:
- Buspirone has a relatively low incidence of sweating/clamminess.
- The medication may still cause other side effects, such as dizziness, nausea, and headache.
- Patients should consult their doctor to discuss the potential benefits and risks of buspirone.
From the Research
Antidepressants with Lower Risk of Excessive Sweating
The following antidepressants may have a lower risk of causing excessive sweating:
- Bupropion: This medication has a unique mechanism of action that targets dopamine and norepinephrine, rather than serotonin, which may reduce the risk of excessive sweating 3, 4.
- Mirtazapine: This tetracyclic antidepressant has a novel mechanism of action that enhances noradrenergic and serotonergic neurotransmission, but may have a lower risk of causing excessive sweating compared to other antidepressants 3, 5.
- Trazodone: This medication has a unique mechanism of action that blocks 5-HT2A and 5-HT2C receptors, and may have a lower risk of causing excessive sweating 3.
- Vortioxetine: This novel antidepressant has a mechanism of action that targets serotonin receptors, but may have a lower risk of causing excessive sweating compared to other antidepressants 3.
- Vilazodone: This selective serotonin reuptake inhibitor has a mechanism of action that enhances serotonergic activity, but may have a lower risk of causing excessive sweating compared to other antidepressants 3.
Comparison to Other Antidepressants
Other antidepressants, such as venlafaxine, duloxetine, and milnacipran, may have a higher risk of causing excessive sweating due to their mechanism of action, which targets both serotonin and norepinephrine reuptake inhibitors 6.
Management of Antidepressant-Induced Sweating
If excessive sweating occurs, management strategies may include:
- Dose reduction or discontinuation of the antidepressant
- Switching to a different antidepressant
- Adding an agent to control sweating, such as benztropine or cyproheptadine 7