How to manage excessive sweating associated with Selective Serotonin Reuptake Inhibitors (SSRIs)?

From the Guidelines

To manage sweating from SSRIs, consider taking your medication at night and using antiperspirants containing aluminum chloride, as these approaches have been shown to be effective in reducing sweating 1. When managing sweating from SSRIs, several practical approaches can be tried.

Possible Solutions

• Consider timing your medication differently—taking it at night may help reduce daytime sweating.
• Stay hydrated and wear breathable, moisture-wicking clothing.
• Antiperspirants containing aluminum chloride (like Certain Dri or Drysol) can be applied to problem areas before bed.

Medication Adjustments

For more severe cases, talk to your doctor about adding medications like propranolol (20-40mg once or twice daily), clonidine (0.1mg twice daily), or anticholinergics like oxybutynin (2.5-5mg twice daily) 1. These work by blocking different aspects of the sweating response. If sweating remains intolerable despite these measures, discuss with your doctor about possibly switching to a different antidepressant, as some SSRIs like paroxetine tend to cause more sweating than others like citalopram 1. The sweating occurs because SSRIs increase serotonin, which affects your body's temperature regulation centers and sweat gland activity. Most people develop some tolerance to this side effect over several weeks, so if the medication is otherwise helpful, it may be worth trying these management strategies before switching medications 1. Some key points to consider when managing sweating from SSRIs include:

• The type and rate of occurrence of side effects appear to be acceptable to most patients and typically include nausea, dry mouth, drowsiness and reduced libido 1.
• Isolated cases of more serious complications, such as mania and withdrawal symptoms, and potential drug interactions also have been associated with the use of SRIs 1.
• Pharmacodynamic drug interactions resulting in a “serotonergic syndrome” characterized in mild cases by headache, nausea, sweating, and dizziness and in severe cases by hyperthermia, rigidity, delirium, and coma have been reported rarely with concomitant use of monoamine oxidase inhibitors, lithium, sumatriptan and tryptophan 1.

From the FDA Drug Label

Autonomic Nervous System Disorders Sweating Increased 8% 3% 6% 15% 1% 2% 6% 7% 2% 6%

Managing sweating from SSRI:

• The FDA drug label reports that sweating increased is a common adverse event associated with the use of sertraline, with an incidence of 8% in major depressive disorder, 3% in OCD, 6% in panic disorder, 15% in PTSD, 1% in PMDD daily dosing, 2% in PMDD luteal phase dosing, 6% in social anxiety disorder, and 7% in the combined population.
• However, the label does not provide specific guidance on managing sweating from SSRI.
• Based on the available information, it can be inferred that sweating is a potential side effect of sertraline, but the label does not offer any recommendations for managing this symptom 2.

From the Research

Managing Sweating from SSRI

• Sweating is a common side effect associated with selective serotonin reuptake inhibitors (SSRIs) 3, 4, 5.
• A study published in The Annals of Pharmacotherapy reported a case of excessive sweating probably caused by paroxetine, and reviewed the literature on antidepressant-induced sweating 3.
• The study suggested that agents such as benztropine and cyproheptadine may be effective in controlling sweating symptoms 3.
• Another study published in Drugs - Real World Outcomes found an association between SSRI use and night sweats in a primary care population 5.
• A narrative review published in Neurology International discussed the adverse effects of SSRIs, including sweating, and emphasized the importance of a risk-benefit analysis when prescribing SSRIs 6.

Treatment Options

• Dose reduction or a trial off antidepressant medication may be considered for managing antidepressant-induced sweating 3.
• Substitution of another antidepressant may be considered if dose reduction is not effective 3.
• Benztropine or cyproheptadine may be used to control sweating symptoms in the absence of contraindications 3.

SSRI-Associated Sweating

• Paroxetine has been associated with a higher incidence of sweating compared to other SSRIs 4.
• Fluvoxamine has also been linked to a higher incidence of sweating, as well as other adverse effects such as gastrointestinal symptoms and sedation 4.
• The use of SSRIs, including paroxetine and fluvoxamine, may increase the risk of sweating, particularly in older patients 5.