Meta-analysis: Risk of hyperhidrosis with second-generation antidepressants

Beyer, Chad E.; Cappetta, Kiley; Johnson, Jessica; Bloch, Michael H.

doi:10.1002/da.22680

Cited by 13 publications

(7 citation statements)

References 97 publications

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“…Increased sweating has been evaluated meta‐analytically in adults ( N = 28,544) treated with “second generation antidepressants,” and both SNRIs and SSRIs have similar risk ratios compared with placebo (SNRI risk ratio: 3.17, 95% confidence interval (CI): 2.63–3.82; SSRI risk ratio: 2.93, 95% CI: 2.46–3.47) 46 . However, in this meta‐analysis, all antidepressants, except fluvoxamine, bupropion, and vortioxetine, were significantly associated with hyperhidrosis, and the risk was related to the affinity for the dopamine transporter.…”

Section: Persistent or Late‐emerging Adverse Effectsmentioning

confidence: 99%

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Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents

et al. 2023

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Introduction Selective serotonin reuptake inhibitors (SSRIs) and, to a lesser extent, serotonin‐norepinephrine reuptake inhibitors (SNRIs) are the cornerstone of pharmacotherapy for children and adolescents with anxiety and depressive disorders. These medications alleviate symptoms and restore function for many youths; however, they are associated with a distinct adverse effect profile, and their tolerability may complicate treatment or lead to discontinuation. Yet, SSRI/SNRI tolerability has received limited attention in the pediatric literature. Methods This review examines the early‐ (e.g., activation, gastrointestinal symptoms, sedation) and late‐emerging (e.g., weight gain) adverse effects of SSRIs and some SNRIs in pediatric patients. Results We provide a framework for discussing SSRI/SNRI tolerability with patients and their families and describe the pharmacologic basis, course, and predictors of adverse events in youth. Strategies to address specific tolerability concerns are presented. For selected adverse events, using posterior simulation of mean differences over time, we describe their course based on Physical Symptom Checklist measures in a prospective, randomized trial of anxious youth aged 7–17 years who were treated with sertraline (n = 139) or placebo (n = 76) for 12 weeks in the Child/Adolescent Anxiety Multimodal Study (CAMS). Main Results In CAMS, the relative severity/burden of total physical symptoms (p < 0.001), insomnia (p = 0.001), restlessness (p < 0.001), nausea (p = 0.002), abdominal pain (p < 0.001), and dry mouth (p = 0.024) decreased from baseline over 12 weeks of sertraline treatment, raising the possibility that these symptoms are transient. No significant changes were observed for sweating (p = 0.103), constipation (p = 0.241), or diarrhea (p = 0.489). Finally, we review the antidepressant withdrawal syndrome in children and adolescents and provide guidance for SSRI discontinuation, using pediatric pharmacokinetic models of escitalopram and sertraline—two of the most used SSRIs in youth. Conclusion SSRI/SNRIs are associated with both early‐emerging (often transient) and late‐emerging adverse effects in youth. Pharmacokinetically‐informed appraoches may address some adverse effects and inform SSRI/SNRI discontinuation strategies.

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Section: Persistent or Late‐emerging Adverse Effectsmentioning

confidence: 99%

“…Management of SSRI‐related hyperhidrosis in children and adolescents is primarily based on an adaptation of strategies that have been successful in adults 46 . In general, strategies have included using low‐dose glycopyrrolate to attenuate cholinergic effects.…”

Section: Persistent or Late‐emerging Adverse Effectsmentioning

confidence: 99%

Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents

et al. 2023

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“…For instance, not all studies excluded patients with a current major depressive episode, which is problematic given that these patients show distinct thermosensory and thermoregulatory abnormalities, including reduced temperature sensitivity, sweating, and increased core body temperature ( Raison et al, 2015 ). Similarly, not all studies excluded medication that affects the thermal system (e.g., antidepressants; Beyer et al, 2017 ), and not all statistical analyses were adjusted for important confounders such as age, sex, or BMI. Further case-control research may thus benefit from consulting the methodological standards outlined in this review.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Thermosensation and Thermoregulation in Anxiety Disorders

2021

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“…The cholinergic system is part of the autonomic nervous system comprised of muscarinic and nicotinic receptors, with acetylcholine (ACh) as a key neurotransmitter. In terms of hydration, ACh may have antidiuretic effects (Fitzsimons, 1972;Pickford, 1939); a role in the sweat response (Beyer et al, 2017); and an effect on arterial blood pressure regulation (Mangiapane & Simpson, 1983). More specifically, the muscarinic ACh receptor (mAChR) subtype M3 is located in the salivary (among other) glands (though other cholinergic receptors are also implicated in saliva flow).…”

Section: Contextual-thirstmentioning

confidence: 99%

Redefining thirst: A conceptual four-compartment model characterising types of thirst, and their underlying mechanisms and interactions

Carroll¹

2020

Preprint

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Currently, the conceptualisation of thirst is based nearly entirely on osmoregulation, with some acknowledgement of anticipatory-thirst, though with no testable mechanism. Such a model of thirst is unable to explain many thirst-related phenomena, such as why drinking can occur with hypotonicity, or how quantity of intake at a drinking occasion is regulated. Herein, I aim to unify various lines of thinking from different disciplines surrounding thirst and body water regulation by presenting a four-compartment model comprising of both primary and secondary thirsts: true-thirst (osmo-regulated); contextual-thirst (e.g. mouth-breathing); pharmacological-thirst (induced from drugs); and impulsive-thirst (everyday spontaneous drinking). Within this framework, a differentiation of thirst and dry mouth is presented, with further differentiation between dry mouth (‘true-xerostomia’, hyposalivation) and the sensation of dry mouth (‘sensational-xerostomia’, a typically non-overwhelming desire to drink). Based off pharmacological-thirst mechanisms, the cholinergic system is proposed to initiate impulsive-thirst by triggering a (sensation of) dry mouth in everyday life (i.e. without hypertonicity). Following this, psychological food-appetite constructs that are centrally regulated (sensory-specific satiety, palatability, and pleasantness) are applied to thirst to explain quantities of fluid consumed, termination of drinking, and drinking patterns in everyday life, as well as offer further insights into how drinking habits are formed. The historical context is also provided, demonstrating that most of these are not new ideas in isolation, but combining them to create a unified model of thirst has not previously been attempted. Finally, ageing-, exercise-, alcohol-hangover-, and 3,4-methylenedioxymethamphetamine-induced thirst are explained by the model presented, given as examples of dysregulated hydration physiology causing thirst or drinking behaviours currently unexplainable by true osmoregulatory or anticipatory-thirst. Whilst some anomalies still remain, all these examples have some form of dysregulated cholinergic activity as a commonality. It is likely this model is incomplete and ideas for further exploration are presented with the hope that the conceptual model can be investigated, validated, refined, and developed further as appropriate. Overall, this thesis outlines a four-compartment model of thirst regulation (at least partially) explaining several outstanding questions relating to drinking behaviours.

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Meta-analysis: Risk of hyperhidrosis with second-generation antidepressants

Abstract: Risk of hyperhidrosis was significantly increased with most antidepressant medications but was associated with dopamine transporter affinity.

Cited by 13 publications

References 97 publications

Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents

Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents

A Systematic Review of Thermosensation and Thermoregulation in Anxiety Disorders

Redefining thirst: A conceptual four-compartment model characterising types of thirst, and their underlying mechanisms and interactions

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