This warning about medication is popular online, but is it true? Pharmacists and a psychiatrist share what you need to know.
I don’t know about you, but I keep seeing social media posts about antidepressants increasing the risk of heat stroke. In medication commercials, you hear a long list of side effects, but so many seem rare. Is this something we need to be worried about?
As a proud user of Prozac, I figured this was worth checking out, so I spoke with experts about whether antidepressants really cause issues with heat during the summer months.
The short answer? Yes.
How can antidepressants increase your risk of heat stroke?
Basically, antidepressants can affect your body’s ability to regulate your temperature and can contribute to dehydration, which can lead to a heat stroke.
“Antidepressants can impair the temperature regulation area of the brain, i.e., hypothalamus,” said Dr. Markus Ploesser, a psychiatrist and chief innovation officer at Open Mind Health. “They can also increase sweating, thus contributing to dehydration.”
Your body may also lose water as your sodium levels decrease because of the medication. “Certain antidepressants — most notably mood-stabilizing antidepressants used to treat bipolar depression — can cause lower sodium levels, making the body lose more water and increase dehydration,” Ploesser added.
In the summer months, you’re probably already feeling hot and dehydrated, which doesn’t combine well with those side effects. And if you become dehydrated and can’t sweat enough or drink enough water, your temperature rises, which can lead to a heat stroke.
Signs of a heat stroke include having a temperature above 103 degrees Fahrenheit, dry skin, not sweating, a rapid pulse, a headache, nausea, dizziness, confusion and unconsciousness, according to the Centers for Disease Control and Prevention.
Which antidepressants carry the most risk?
Some professionals lean more toward one kind of antidepressant than another — so it’s probably safe to say most or all of them carry some risks.
Selective serotonin reuptake inhibitors, or SSRIs, “can increase sweat output, therefore putting patients at higher risk of heat stroke,” said Shaili Gandhi, the vice president of pharmacy at SingleCare. Some common SSRIs include brand names Prozac, Zoloft, Celexa, Lexapro and Paxil.
Reema Hammoud, a clinical pharmacist at Sedgwick, believes there’s a riskier type, though. “Selective serotonin reuptake inhibitors, such as sertraline and paroxetine, can cause hyperhidrosis and stroke, but the risk is a lot lower compared to older agents such as tricyclic antidepressants (TCAs),” Hammoud said. She explained “hyperhidrosis” is the fancy word for “excessive sweating.” Some examples of TCAs include Pamelor, Elavil and Anafranil.
Ploesser agreed, adding other medication types that cause concern, too. “Medications which increase norepinephrine brain levels are also at an increased risk, e.g., Effexor, Wellbutrin. Lithium and some antipsychotic medications used to treat depression also have an elevated risk,” he said.
How likely is the chance you’ll experience a heat stroke?
As with most or all health conditions and side effects, some people are more susceptible than others. So, let’s be real: Is a heat stroke likely? Who needs to be most aware of this potential side effect?
To start, older folks. “While everyone needs to be careful to avoid dehydration and heat stroke, the risks are relatively higher among older adults as they often metabolize and excrete medications at slower rates,” Ploesser said. “Older adults, in general, are also more likely to be on a greater number of medications for their physical and mental health concerns, and polypharmacy is also a significant risk factor.”
Gandhi said blood pressure medications are one type that can cause particularly high risks. She added being outside in the sun and heat doesn’t help, either. “Depending on your treatment, it may be best to avoid being outside in high heat altogether, and it’s worth consulting your doctor,” she said.
Additionally, consider other side effects you’re experiencing. “There is research that suggests about 20% of those taking antidepressants experience excessive sweating as a side effect,” Gandhi said. “So for those people, the risk of heat stroke is even higher, and therefore, they should take extra precautions when considering being outside in high temperatures.”
Hammoud shared a 2020 study that found 22% of participants taking antidepressants experienced a sudden heat stroke related to hormone dysregulation. However, it’s not quite that simple or something to be overly concerned about, per se.
“Although several observational studies suggest that SSRIs are associated with new onset stroke, many randomized trials indicate that SSRIs are beneficial for patients who have suffered a stroke,” Hammoud said. “Most evidence suggests that SSRIs do not increase the risk of death in patients with strokes.”
How can you avoid a heat stroke?
The best ways to protect yourself from a heat stroke are pretty straightforward. Ploesser recommended drinking more water (check out these helpful hacks for doing so!), limiting drinks that worsen dehydration (such as caffeine and alcohol), avoiding the heat and sticking to the shade when possible.
Gandhi said even if you don’t feel thirsty, drinking water is crucial. She suggested talking to your doctor about the best course of action, whether or not that includes some adjustments.
“For psychiatric medications, including antidepressants, the dosage is very important and it can take some trial and error between patient and doctor to find the right dose,” she said. “So, it’s important to talk to your doctor when you know you’re going on vacation or plan to be in the sun for prolonged periods of time. Your doctor might advise limiting or avoiding sun exposure rather than adjusting the dosages of your medication.”
You can also make simple changes like eating cold foods with high fluid content (such as certain fruits and vegetables, or a salad) and wearing loose, lightweight clothes, Hammoud advised. And if you like to exercise outside, consider “exercise snacking,” aka shorter and more frequent workouts, so you don’t get too hot at once.
While the fact that antidepressants can have serious side effects, such as heat strokes, can be a huge bummer at best, doing what you need to do for your mental health is important, too. Set yourself up by drinking water, staying in the shade and checking in with your doctor.
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