QA With an ER Doctor

The current heatwave in Virginia is tough for everyone. But some of us face a greater risk for having medical problems due to the intense heat. One that surprised me – taking antidepressants. These medications up your heat intolerance – or feeling overheated when the temperature rises. A lot of people take antidepressants. Which means that a lot of people are at risk of overheating, getting heat exhaustion, or, most dangerously, suffering from heat stroke. 

Your risk for heat stroke is even greater if you take antidepressants along with a common heart medication.

Antidepressants Make It Harder to Stay Cool

Several types of antidepressants can interfere with the body’s ability to cool itself down. These include:

• Selective serotonin reuptake inhibitors (SSRIs) like Prozac & Zoloft (sertraline)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta
• Tricyclic antidepressants (TCAs) like Norpramin

Why Antidepressants Makes Us Experience Heat Intolerance

Antidepressant drugs mess with our hypothalamus – the gland in our brain that controls things like our internal temperature and sweat. During a heat wave, this gland can get confused. You might start burning too much energy, as if it’s cold outside. You might stop sweating as much as you need to. Both of these things can end up leaving you dehydrated.

As if that weren’t enough, the overheated hypothalamus might cause your salt levels to drop and depress your thirst. 

Andrew Muck, MD Answers Questions About Heat Intolerance

Andrew Muck, MD, head of the UVA Health’s emergency department, has been on the frontlines of this summer’s burn fest. He answers key questions about heat intolerance and the danger of overheating on antidepressants.

Does how much you take – your dose of antidepressant – play a role? Like, if you take more a day, you’re more at risk for heat-related problems?

Some of the medications, like tricyclic antidepressants, can be dose-dependent. Some of the other types seem to have an effect less related to dose.  

Does taking more than 1 type of antidepressant up your risk?

It can. Taking more than one kind of antidepressant can further influence your body’s ability to adjust to increased temperatures.

Does age have anything to do with your risk for heat issues?

In the ER, we see all ages affected by heat exhaustion and heat stroke.  However, your body loses the ability to compensate as well as you get older. 

How does someone know if they’re having difficulty with the heat? Or if it’s just normal?

Common signs of having difficulty with the heat include feeling fatigued, excessive sweating, not sweating at all despite it being hot, a headache, feeling short of breath, palpitations, and feeling overwhelming generalized weakness.  

As you could imagine, some of these symptoms are easy to ignore. You must remain mindful.

Do some medications, if taken in combination with antidepressants, increase your risk?

Other medicine can interfere with heat intolerance. Usually, they’re heart-related medications.  If you are on, for instance, beta-blocker medications, this can slow your body’s ability to increase your heart rate in response to the stress of heat.

Do antidepressants impact your heat sensitivity to the sun in general ways?

A. Tricyclic antidepressants are thought to possibly have some effects on UV protection. SSRIs can also influence your ability of your body to respond to sun exposure.

What’s the Best Way to Avoid Overheating on Antidepressants?

You can do a number of things to stay cool and lower your heat intolerance, Muck says:

• Avoid the outdoors – even moderate activity 
• Drink water, even if you’re not thirsty
• Take cool baths
• Apply cold rags to your neck, wrists, and face
• Ask your doctor about reducing your medications temporarily
• Wear sunscreen

Watch Dr. Muck discuss antidepressants and overheating on the news.