Cyproheptadine for Drug-Induced Sweating

Mr. A was a 51-year-old Caucasian man with major depression, dysthymia, and obsessive-compulsive disorder (OCD) who was taking fluoxetine, 40 mg b.i.d. He had been stable for 4 years but had developed sweating, which did not improve over time. A reduction of his fluoxetine dose led to symptom relapse. When fluoxetine was increased to its previous therapeutic dose, Mr. A was given cyproheptadine, 4 mg in the morning and at bedtime, which has eliminated his excessive sweating, with no side effects, for over 1 year.

Ms. B was a 65-year-old Caucasian woman with dysthymia and OCD who had not responded to, or had been intolerant of, 20 mg/day of fluoxetine, 400 mg/day of nefazodone, 100 mg/day of sertraline, and 75 mg clomipramine at bedtime. However, she had maintained remission while taking citalopram, 60 mg at bedtime, for over 2 years. Excessive sweating forced her to place a napkin on her forehead when she went out to dinner with friends. After trying trihexyphenidyl, fexofenadine, chlorpheniramine, terfenadine, and diphenhydramine without success, she responded to cyproheptadine, 4 mg at bedtime, which she called “a miracle.” Mild early-morning sedation was the only side effect. She has maintained her response for 1 year.

Mr. C was a 58-year-old Caucasian man with panic disorder with agoraphobia and major depression who was taking paroxetine, 30 mg at bedtime. His dose was slowly reduced and discontinued after a 9-month period of stability; his symptoms returned 3 months after he had stopped taking the drug. Paroxetine, 30 mg at bedtime, was reinstituted; he attained subsequent remission, which was maintained for 3 years. Sweating developed and has been controlled for 9 months with cyproheptadine, 4 mg in the morning and at bedtime, with no side effects.

Mr. D was a 56-year-old Caucasian man who was treated for major depression with extended-release venlafaxine, 375 mg/day. Excessive sweating necessitated discontinuation of the medication. Giving Mr. D sertraline, 200 mg/day, reduced his sweating, but he reported a return of depression. Extended-release venlafaxine was reinstituted, with the addition of cyproheptadine, 4 mg at bedtime. His excessive sweating has been controlled for 5 months without adverse events.

Ms. E was a 32-year-old Caucasian woman with dysthymia who was taking fluoxetine, 40 mg/day, and extended-release venlafaxine, 300 mg/day, and experiencing excessive sweating. A decrease in her doses worsened her depression, and the excessive sweating continued. Giving her cyproheptadine, 4 mg at bedtime, reduced her sweating markedly. Time spent not taking cyproheptadine led to a return of excessive sweating within 2 days. She has remained in improved health for over 7 months while taking cyproheptadine.