How to deal with hot weather if you’re taking an SSRI

As someone who’s lived in Phoenix for a few years, I’m pretty familiar with pavement-scorching, triple-digit temps. And while I can get as heat-fatigued as the next person, for the most part, I just deal.

This year, however, I just felt … different. My head started to pound after running just a few errands. My leisurely morning walks seemed strangely strenuous. My sweat seemed to quadruple in volume.

I had recently started taking the generic version of Zoloft, called sertraline, and wondered if my medication might be contributing to my sudden intolerance to high temps.

Selective serotonin reuptake inhibitors, or SSRIs, are often one of the first things doctors prescribe to treat depression and anxiety. They include medications like citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac), and millions of people take them every year in the U.S. While having extra serotonin floating around in your system — and thereby boosting your mood — is the primary effect of taking an SSRI, one potential side effect is that some of them might impact the system that the body uses to regulate temperature.

“SSRIs are known to make people — not everybody — sweat excessively,” said Gerard Sanacora, professor of psychiatry at the Yale School of Medicine. “And in those people, there’s always the risk of dehydration, especially on very hot days.” One 2005 study suggested that up to 20 percent of SSRI users might experience excessive sweating.

Here’s how SSRIs affect the body, especially when it’s hot outside.

The ways SSRIs impact your body in the heat

SSRIs can impact the function of the hypothalamus, a part of the brain responsible for temperature regulation, said Christine M. Crawford, a psychiatrist with Boston Medical Center.

“When people are sensitive to any changes in levels of serotonin, their hypothalamus responds differently,” she noted, adding that these mechanisms are also responsible for helping to cool a person’s body through sweat and vasodilation, a.k.a. the widening of blood vessels to boost blood flow. “So when that is altered, they just feel hotter,” Crawford explains. Night sweats also tend to be a common complaint among SSRI users.

An SSRI might cause someone to become excessively sweaty or even perspire less, which can be dangerous if the body can’t cool itself down with sweat and overheats. “It really depends on the individual,” Sanacora notes.

John Krystal, a professor of psychiatry at the Yale School of Medicine, said in an email that some tricyclic antidepressants — another type of medication used to treat depression — can block certain brain receptors that help with sweating.

And it’s not just antidepressants, Crawford said. Beta blockers, antihistamines, and even pain meds like acetaminophen, aspirin, and NSAIDs, can cause heat intolerance.

How to stay safe in hot temps, on antidepressants or not

No matter what the weather forecast looks like, don’t stop taking an SSRI without the help of a health care provider, experts said.

“You don’t want to stop treatment and then have more severe symptoms that could potentially lead to a mental health crisis,” Sanacora explained, adding that abruptly stopping an SSRI can make you feel even hotter than you might’ve felt while taking the medication.

Here are a few tips to keep safe in hot temperatures:

1. Talk to your health care provider. If you think your medication is making you excessively sweaty or uncomfortable in the heat, call your doctor, Sanacora said. They can potentially put you on a different medication or help you find another solution.
2. Limit your exposure on particularly sweltering days. “Try to stay out of the excessively hot weather if possible, and especially high humidity,” Sanacora said. “That combination of high temperature, high humidity makes it very hard to cool the body temperature.” If you have to be out when temps soar, try to take breaks in indoor malls, libraries, or any public air-conditioned facility. Here’s how to find a local cooling center near you.
3. Stay hydrated. Sanacora recommends keeping up on your fluid intake throughout the day — so your urine stays a pale yellow — and add in electrolytes if you’re going to be in excessive heat for long periods of time.
4. Dress appropriately. “Wear clothes that can wick,” Sanacora said, adding that our body cools itself when sweat evaporates properly, so if perspiration is stuck to your skin (especially if you’re sweating more on an SSRI), you could feel a lot more uncomfortable. Opt for natural vs. synthetic fibers.
5. Let go of looking cool in favor of actually being cool. Crawford recommends a mini fan around your neck on hot days. You could even opt for a sun-shielding umbrella. (I’m a huge fan of cooling towels, which helped me survive a recent rim-to-rim Grand Canyon hike.)
6. Know the signs of heat exhaustion. This includes dizziness, headache, nausea, reduced urine output, and an elevated body temperature. “If these signs are present, it is important to take steps to cool off before more serious complications of overheating emerge, such as heatstroke, which is characterized by confusion, excessive sweating or hot skin, but can progress to loss of consciousness, and seizures,” Krystal said. If your core body temp rises to 104 degrees (which can happen with heatstroke), it can damage the kidneys, brain, heart, and muscles.
7. Keep your room cool at night. If you’re prone to night sweats, it’s extra important to stay hydrated throughout the day. Try to keep your bedroom as cool as possible — somewhere between 60 and 68 degrees — and crank a nearby fan on high. Avoid memory foam mattresses, as those can trap heat. As for sheets, skip satin and wool materials, and invest in linen over cotton. While linen can be expensive, it might be worth it if you are perspiring through your bedding. FYI: Night sweats can also be indicative of underlying hormonal shifts, like menopause and perimenopause, so talk with your doctor regardless.

While you may be at a slightly higher risk for heat-related illnesses, that shouldn’t deter you from getting on, or continuing, an antidepressant if you need one, Sanacora said.

“You have to be really careful in excessively hot weather, regardless of whether you’re on an SSRI or not,” Sanacora said. “But you may want to even be a little bit extra careful if you are taking an SSRI.”

No Byline Policy

Editorial Guidelines

Corrections Policy

Source