• Sydni Rubio-Weiss

Get a whiff of this: antidepressants and ADHD meds might make you sweat... A LOT

I'm going to assume that you're here for one of two reasons:

  1. You are currently taking ADHD medication and/or antidepressants

  2. You are about to start one or both of these medications (or you're about to start the process of getting a diagnosis and treatment)


But I'm sure the MAIN reason you're here is because you heard that these medications can cause excessive sweating and (not-so-pleasant) body odor. Keep reading if you want to know why our bodies react this way.


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Why do we sweat?

Let's start with the basics: why we even sweat in the first place. Sweating mainly serves the purpose of thermoregulation. (In other words, it helps us cool down if we get too hot.) It's also been speculated that sweat may serve as a garbage disposal, if you will, to get rid of the waste floating around in your body. However, this idea of sweat being an excretory mechanism hasn't been confirmed by scientists yet.


Sweat is produced by sweat glands, and there are three types of these glands all over your body:

  1. Eccrine Glands

  2. Apocrine Glands

  3. Apoeccrine Glands


Eccrine Glands

These are the most common glands in the human body - we literally have millions of them everywhere on our skin. The sweat produced from eccrine glands is made up of water and sodium (NaCl), so these are not the glands that lead to body odor. The eccrine glands in the palms of your hands and the soles of your feet ("glabrous glands") respond to both temperature and emotions, such as stress and anxiety. (This is why your hands get sweaty when you have to give a speech.) The eccrine glands everywhere else ("non-glabrous glands"; those associated with hair) mainly just respond to temperature/heat.


Since the eccrine glands are literally everywhere, it's safe to assume that larger people have more eccrine glands. However, it's important to note that more sweat glands do NOT mean more sweat. How much a person sweats is dependent on sweat secretion rate per gland, not on how many glands they actually have.


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Apocrine Glands

These glands are limited to only a few places on your body:

  1. Armpits

  2. Chest/Breasts

  3. Face/Scalp

  4. Groin

Apocrine glands are larger than the eccrine glands and are inactive until you hit puberty. (This explains why "Santa" started leaving deodorant in my stocking once I got to Middle School.) Apocrine glands also release sweat to a different "location" than the eccrine glands. While the eccrine glands deposit the sweat directly onto the surface of your skin, the apocrine glands are releasing the sweat into your hair follicle. The thick sweat made from an apocrine gland is made of proteins, lipids (fats), ammonia, and sugars. You may have guessed that these glands are the ones associated with body odor. If you did, you would be correct.


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Apoeccrine Glands

Last, and honestly kinda least, are the apoeccrine glands. These were only just discovered in the 80's and not much is known about them. But here's what we do know about them:

  1. Intermediate in size (larger than eccrine; smaller than apocrine)

  2. Only found in the armpits

  3. Release sweat onto the skin's surface (like eccrine glands)

  4. Made of only water and sodium (like eccrine glands)

That last point just screams, "I DON'T MAKE YOU SMELL BAD!" So, if it's okay with all of you, I'm going to move right along to the good stuff. (Unless you want to learn more about these glands, then you can click here.)

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@ Apoeccrine Glands


Apocrine Glands: Why they make us smell bad

So, if you may recall, I mentioned that apocrine glands produce sweat that contains all KINDS of yummy stuff: proteins, lipids, ammonia, sugars. "Um did you just call ammonia YUMMY??"


Heck yeah, I did! But I'm not talking about humans; I'm talking about bacteria. Certain bacteria love ammonia (and all of the other stuff I listed.) For those of you that don't know, our bodies are covered in microorganisms. We have millions and millions of bacteria cells living in and on our body, no matter how often you shower and scrub. These bacteria eat things from your body, like that digested banana you had at breakfast or the dead skin on the side of your nose.


AND! Guess what else they eat?!


Proteins, lipids, ammonia, and sugars - oh my! But, what goes in must come out (or something like that.) Bacteria will eat these things, but then they also excrete byproducts. These byproducts are the real cause of body odor. So, bathing doesn't remove the bacteria on your skin, but it does remove the remnants of bacteria burps and farts, for lack of better (more sophisticated) words.


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Yeah, that's nice and all, but what does this have to do with my medication?

Now that we know about apocrine glands and bacteria farts, we can move on to the sciencey part. Remember how eccrine glands respond to heat and emotions? Apocrine glands respond to adrenergic and cholinergic stimuli. (More specifically, adrenergic stimuli increase sweat production in apocrine glands, and cholinergic stimuli act as the "slow down" or "off" switch.)


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Adrenergic stimuli: Epinephrine (AKA Adrenaline) and Norepinephrine. These act as neurotransmitters in your brain that are released by your adrenal glands in response to fear or stress. This pushes you into "Fight or Flight" mode, which has a few effects on your body:

  1. Alertness

  2. Increased heart rate

  3. Increased blood pressure

  4. Decreased appetite

Sound familiar? ADHD stimulant medication does this too, and I'll talk about the connection in a minute.


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Me when I connected all of these dots before writing this



Cholinergic stimuli: Acetylcholine (or Butyrylcholine, which is the synthetic version of Acetylcholine). Remember everything that Epinephrine and Norepinephrine do to your body? Acetylcholine does the exact opposite. When released into the bloodstream, Acetylcholine puts you into the "Rest and Digest" mode, which has these effects on your body:

  1. Contraction of smooth muscle (the organs in your gut are made of smooth muscle; contraction of these muscles resumes digestion and can lead to an increased appetite and excretion of fluids and waste.)

  2. Slows the heart rate

  3. Relaxation

(Acetylcholine also plays a role in other important things, such as memory and concentration, but that's a whole other thing that I can get to some other time.)


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Antidepressants and Sweaty Pits

(That kinda sounds like a country song.)


So, if you have depression and/or anxiety (which are both very common comorbid conditions to ADHD), it's possible that you take antidepressants. A 2014 study on Antidepressants and Acetylcholine found that people with Depression and/or Anxiety naturally have higher activity in their Cholinergic System than those without these conditions. This suppresses the Adrenergic System. (In other words, people with Depression/Anxiety feel the way they do because their Cholinergic System is hogging all of the play time while the Adrenergic System sits on the sidelines.)


How did scientists combat this? Antidepressants that target Acetylcholine receptors and block them from accepting any more of those Resty Digesty molecules. In turn, this allows the Adrenergic System to finally get in the game and function at a higher level. Of course, there are other mechanisms and molecules at play when it comes to antidepressants (such as serotonin), but for now, we're focusing on Acetylcholine, Epinephrine, and sweaty pits.


NOW! Do you remember what I said about apocrine glands being activated by adrenergic stimuli? TA-DA! Here's the connection between sweating and antidepressants!


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When acetylcholine production slows down in a person that normally has higher amounts of it (ie depressed and anxious people), their body experiences a bit of a shocking shift of neurotransmitters.


Antidepressants that block Acetylcholine receptors (most SSRIs or Selective Serotonin Reuptake Inhibitors) increase the activity in the Adrenergic System. (Not by a LOT, mind you. You're not going to experience Fight or Flight because of your antidepressants. They just give the two systems a better balance.) This increase in activity can cause some serious sweating, which gives all of your pit and groin bacteria lots of yummy food, which... as you probably guessed... leads to lots of bacteria flatulence and not-so-flattering body odor.


I do want to note, though, that drugs can prompt different responses in different people. Some people may sweat PROFUSELY on Lexapro and smell like roses on Zoloft. However, I'm the exact opposite.


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Me every night, ever since I switched from Lexapro to Zoloft


Okay, so what about ADHD Medication?

ADHD stimulant medications (Adderall, Vyvanse, Ritalin, Concerta) work by stimulating your Central Nervous System. Some of you may already know that your Central Nervous System (CNS) is basically the hub for the adrenergic and cholinergic systems. In other words, your CNS is responsible for secreting higher levels of epinephrine and norepinephrine when prompted and it's responsible for eliciting a response to those higher levels. The effects I listed earlier when your body is in Fight or Flight mode are all responses from your Central Nervous System.


So, when we take a simulant medication, our CNS responds by producing epinephrine and norepinephrine (and dopamine, but again... a whole other thing), which helps you feel more alert. It also decreases your appetite and increases your heart rate as I mentioned earlier, both of which are commonly reported as side effects of stimulant medication.


BUT DO I SENSE AN ISSUE?


Why, yes. Yes, I do.


I sound like a broken record at this point, but: increased levels of epinephrine and norepinephrine = increased adrenergic stimuli = apocrine glands flood your pits and private bits = all-you-can-eat buffet for your bacteria = ALL OF THE FLATULENCE = *sniff sniff* "oof, is that me?"


Any questions?


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Again, ADHD medication effects will vary from person to person. For example, Vyvanse made me SMELL SO BAD, but Adderall does not. Everyone's body is different and we don't share identical chemistry. I feel like this is also a good time to remind everyone that I'm not a doctor - just a biology grad student procrastinating on writing her thesis by writing blogs about sweaty pits and private bits. You're welcome.


Stay weird -


Sydni


 

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773238/#CIT0018

https://pubmed.ncbi.nlm.nih.gov/5446389/

https://pubmed.ncbi.nlm.nih.gov/2654204/

https://www.frontiersin.org/articles/10.3389/fmicb.2018.00116/full

https://www.sciencenewsforstudents.org/article/explainer-bacteria-behind-your-bo






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