As temperatures hit record highs in the US, doctors warn that millions of Americans taking antidepressants are at risk of fatal heatstroke.
This is because certain antidepressants affect the body’s ability to regulate temperature.
Tricyclic antidepressants are an older class of medications that are less commonly prescribed due to more intense side effects, including insomnia, bedwetting, and chronic pain conditions such as fibromyalgia.
They prevent the body from cooling down normally, for example by sweating and to make you drink more water to compensate. And this heat intolerance affects multiple classes of these drugs.
However, the more common selective serotonin reuptake inhibitors (SSRIs) may actually make you sweat more. This still leads to heat stroke, because if you swear too much, you can get dehydrated.
Sertraline is a commonly used antidepressant and belongs to a group of drugs known as SSRIs or selective serotonin reuptake inhibitors
Some examples of tricyclics approved by the Food and Drug Administration (FDA) include amitriptyline (Elavil), nortriptyline (Pamelor), and protriptyline (Vivactil).
“Tricyclic antidepressants can make you sweat less,” said Dr Nial Wheate of the University of Sydney, Australia. Insider“because they act as anticholinergics, meaning they basically prevent your sweat glands from producing sweat.”
“We sweat to cool down, so if you don’t sweat, you can’t regulate your body temperature properly and you’re likely to overheat.”
Some of the most common FDA-approved SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
According to the Centers for Disease Control and Prevention, more than one in 10 Americans takes antidepressants. They are more common in women, 18 percent of whom have taken them in the past 30 days, compared to 8 percent of men.
In addition to heat intolerance, common side effects of antidepressants include nausea, increased appetite, fatigue, insomnia, dry mouth, constipation, dizziness, restlessness and erectile dysfunction, according to the Mayo Clinic.
Heat stroke is where the body is no longer able to cool itself and a person’s body temperature becomes dangerously high due to prolonged exposure to direct sunlight.
Common symptoms include confusion, altered mental status, slurred speech, failure to sweat, loss of consciousness, incoherence, profuse sweating, dry skin, seizures, nausea or vomiting, dizziness, headache, and rapid pulse.
When heat stroke occurs, body temperature can rise to 106°F (41°C) or higher within 10 to 15 minutes. Heat stroke can cause permanent disability or death if the person does not receive emergency treatment.
For those taking tricyclic antidepressants, Dr. Wheate suggested having a fan blow on you so that the limited sweat you produce can be easily dissipated.
Those taking antidepressants should focus on drinking plenty of water and electrolyte drinks to replace fluids lost through excessive sweating.
However, it is not recommended to stop taking antidepressants if you are concerned about overheating.
“Managing your depression is more important,” said Dr. Wheate.