Can sertraline (selective serotonin reuptake inhibitor) cause night sweats?

Sertraline and Night Sweats

Yes, sertraline commonly causes sweating including night sweats, and this is a well-documented adverse effect listed in FDA prescribing information and clinical guidelines. 1

Evidence from FDA Drug Labeling

The FDA-approved prescribing information explicitly lists "increased sweating" as one of the most common treatment-emergent adverse events with sertraline across multiple indications 1:

• Incidence rates for increased sweating ranged from 4-11% with sertraline compared to 0-3% with placebo across different psychiatric conditions 1
• In major depressive disorder trials: 8% of sertraline patients vs 3% placebo 1
• In panic disorder: 6% sertraline vs 1% placebo 1
• In PTSD: 4% sertraline vs 2% placebo 1

The FDA medication guide warns patients that "increased sweating" is among the common possible side effects they should expect 1.

Clinical Guidelines Perspective

Clinical guidelines from the American Family Physician confirm that sweating is a commonly reported adverse effect with second-generation antidepressants including sertraline 2. This sweating can occur during the day or at night, and when it occurs nocturnally, patients experience it as night sweats 2.

Guidelines on SSRI use note that side effects including sweating are "commonly mild and short lived," though they cause 10-20% of patients to discontinue treatment 3.

Clinical Context and Mechanism

The sweating is dose-related - higher doses of sertraline are associated with increased frequency of this side effect 3. The mechanism appears related to serotonergic effects on thermoregulation and autonomic function 4, 5.

Research confirms that sweating is among the most frequently reported adverse events in elderly patients receiving sertraline 50-150 mg/day 4, 5.

Important Safety Consideration

Distinguish between common SSRI-induced sweating and serotonin syndrome, which is a medical emergency 2, 1. Serotonin syndrome presents with sweating PLUS:

• Mental status changes 1
• Neuromuscular hyperactivity (muscle twitching, rigidity) 1
• Autonomic instability (racing heartbeat, blood pressure changes, fever) 1

If sweating is isolated without these other features, it is likely the common benign side effect rather than serotonin syndrome 2.

Management Approach

If night sweats are bothersome but sertraline is otherwise effective 2:

1. First-line: Implement practical measures including lighter bedding, cooler bedroom temperatures, and moisture-wicking sleepwear 2

2. Second-line: Consider dose reduction if clinically appropriate, as sweating is dose-related 3

3. Third-line: Add an agent to control sweating if symptoms persist and are significantly impacting quality of life 6:

   • Oxybutynin 5 mg/day has demonstrated efficacy in reducing sertraline-induced sweating in a double-blind placebo-controlled trial 7
   • Benztropine or cyproheptadine are alternative options 6

4. Last resort: Switch to an alternative antidepressant if sweating remains intolerable despite the above measures 6

Clinical Pitfall to Avoid

Do not abruptly discontinue sertraline due to sweating without discussing with the prescribing provider, as sudden discontinuation can cause withdrawal symptoms including headache, dizziness, nausea, and electric shock-like sensations 1. Sertraline should be tapered gradually if discontinuation is necessary 3.