Psychiatric drugs increase heat vulnerability by disrupting hypothalamus thermoregulation
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Medications for depression, anxiety and bipolar disorder increase heat vulnerability by interfering with the hypothalamus, the brain's temperature-control centre. Patients in Brussels and Los Angeles reported unusual fatigue, sweating and irritability during heatwaves after starting these drugs. Psychiatrists say the heat-related side effects often go unrecognised.
Key Facts
- Psychiatrist Robert Feder says the hypothalamus normally reduces activity, increases sweating and lowers metabolism to help the body adapt to heat.
- Tricyclic antidepressants can trigger sweating or suppress it, reducing heat elimination and raising body temperature through their anticholinergic effect on acetylcholine.
- Ileana Okumus, 28, slept about 18 hours on a day when her top-floor Brussels apartment reached 34C during Europe's June heatwave.
- Caroline Fraissinet, a 36-year-old Los Angeles career coach, reported losing focus and feeling more irritable while taking three psychiatric medications during a humid July heatwave.
- Caroline Fraissinet said she was well informed about her mental health conditions and medication side effects but did not know about the heat-related risk.
Drug Effects on Thermoregulation
Mental health drugs for depression, anxiety and bipolar disorder increase heat vulnerability by altering how the hypothalamus, the brain's thermoregulation centre, works, a risk highlighted by patients including Caroline Fraissinet, 36, in Los Angeles. Robert Feder, a retired psychiatrist in New Hampshire, says the hypothalamus normally reduces activity, increases sweating and lowers metabolism as beneficial adaptations to heat. Feder says that becomes a compounded problem when a person is already dehydrated because of high temperatures. Tricyclic antidepressants, an older type of antidepressant, can trigger sweating or suppress it, reducing heat elimination and raising body temperature. The anticholinergic effect of these drugs blocks acetylcholine, a neurotransmitter involved in sweat production.
Reported Symptoms During Heatwaves
Ileana Okumus, 28, struggled during Europe's June heatwave in a top-floor Brussels apartment without air conditioning. She said her face began sweating as soon as she left home, and she sometimes needed up to an hour to cool down. On a day when indoor temperature reached 34C, she slept about 18 hours and worried her blood pressure had dropped. Okumus had lived through 40C summers elsewhere, but this was the first time heat hit her this hard. She connected the heat symptoms to the depression and anxiety medicines she started taking two years earlier after seeing social media posts from people with similar symptoms.
Patient Awareness Gap
Some experts want patients to be made more aware of the highest-risk side effects, including heat-related illness. Caroline Fraissinet said that, despite being well informed about her mental health conditions and medication side effects, she did not know about this one. In Los Angeles during a humid July heatwave, Fraissinet lost focus, felt more irritable and sweated more than usual while taking three psychiatric medications. At first she attributed the symptoms to poor diet and not drinking enough water.
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Psychiatric drugs increase heat vulnerability by disrupting hypothalamus thermoregulation
