Antidepressant-induced excessive sweating: clinical features and treatment with terazosin.
Level 4 - case-series / case-control
Open-label single-arm trial without a control group (prospective case series)
What was done
Researchers characterized antidepressant-induced excessive sweating (ADIES) using a semi-structured assessment and tested flexible-dose terazosin (1 to 6 mg/day) in an open-label trial. Following a 2-week baseline phase, 23 patients with moderate or greater ADIES received 6 weeks of terazosin. Outcomes were assessed using the Clinical Global Impressions (CGI) scale, patient ratings of daytime and nighttime severity, and percentage of time sweating.
What was found
ADIES was reported as persistent (median duration 63 months), episodic or occurring with episodic bursts (82%), and primarily affected the face (95%), scalp (62%), chest (57%), and neck (48%). On terazosin, 22 of 23 patients responded (CGI-Improvement score of 1 or 2), with median CGI-Severity dropping from 5 to 2 (P < .0001). Daytime and nighttime severity and proportion of time sweating also significantly improved. Common adverse events included dizziness or lightheadedness (n = 9) and dry mouth (n = 4), with no dropouts due to adverse effects. Median sitting and standing systolic blood pressure decreased by 3 mm Hg (P = .044) and 5 mm Hg (P = .063), respectively.
Why it matters
ADIES is a frequent, distressing adverse effect that impairs quality of life and treatment adherence. This study provides preliminary evidence that alpha-1 adrenergic blockade with terazosin may alleviate antidepressant-induced hyperhidrosis.
Limits
The study is limited by a very small sample size (n = 23), an open-label design lacking a placebo or active control group, and a short 6-week treatment duration. Specific antidepressant classes were not analyzed separately.
Cited by
- supports Hyperhidrosis (excessive sweating) is one of the most common side effects of SSRI antidepressants.