Mirtazapine and HH?

Hi there,

Now since HH is not running in my family, yet I have it quite badly myself, I was looking into underlying causes, like pheocromocytoma and hyperthyroidism, both of which I can't check myself so I won't know till I ask the medical people to look into it, but also social anxiety disorder, and I came accross someting:

Mr. A, a 60-year-old man, was seen for the first time in our outpatient clinic with a diagnosis of major depressive disorder according to DSM-IV criteria. He reported having been affected for over 45 years by essential hyperhidrosis affecting several bodily areas. His diagnosis of hyperhidrosis was confirmed by his many medical records. His condition was not affected by any drugs. He was taking lorazepam, 2.5 mg/day, but was showing no improvement. At baseline, his score on the Hamilton Depression Rating Scale was 20, and his score on the Hamilton Anxiety Rating Scale was 14. We prescribed mirtazapine, 30 mg/day. After only 3 weeks of treatment, Mr. A's hyperhidrosis disappeared completely. Mirtazapine was well tolerated, apart from morning sedation. After 6 weeks of treatment, his hyperhidrosis was still better, his score on the Hamilton depression scale was 7, his score on the Hamilton anxiety scale was 5. Lorazepam was discontinued.

Follow-up visits were made at 6 and 16 months: at 6 months, Mr. A was in excellent clinical condition with no hyperhidrosis. He continued taking mirtazapine at a lower dose of 15 mg/day. At 16 months, Mr. A was still free of hyperhidrosis.

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Although this guy is 60, it sounds interesting nonetheless I think, anyone has some experience with this drug? As much as I dislike the idea of taking drugs in general and antidepressants in particular if it cures my HH I'll take a view trays... :wink:

I tried this medication recently, because my HH is generalized, and I am constantly hot. My doctor hypothesized that it might help with both of these problems. I only took it for a short while, but found the tiredness too much to handle. To be fair, I only took it for about a month and half, and I have read that this particular side effect goes away after a while. However, at this point in my life, I could not really afford to feel like a zombie during the day (grad school and work)....

As to its effect on my HH, I didn't notice much of a difference, though it certainly lessened my anxiety about it. Perhaps, one day again, I will re-try this med.

That's interesting, I am thinking of trying it also because I have generalized hyperhidrosis that I have been on oxybutynin for. What was your dose of the remeron? I hear with higher doses the tiredness isn't as bad. I am kind of to the point that I have decided I really need something for anxiety anyway, not sure which came first the hyperhidrosis or the anxiety but I know I have them both now.

I am thinking if it doesn't help with the hyperhidrosis enough maybe I'll continue on some of the oxybutynin and see if that will help. Are you thinking about trying another antidepressant, or just giving up on them for now?

I am always on the lookout for new systemic drugs, my HH is fairly bad, and it truly interrupts my day....it is difficult to sit still and concentrate when I am burning up, my clothes are wet with sweat, and my skin is cold and clammy. I recently sent my doctor a fax with information on the following medications:

Indomethacin
Fludrocortisone
Mexiletine
Terazosin

I am most interested in trying Terazosin, because there is actually a clinical trial being done on its use for SSRI induced HH, as well as idipoathic HH.

I was on 30 mg of Remeron.

Thanks for the info guys.


I think that the mirtazapine might help in cases where the HH is completely due to an underlying social anxiety disorder.

I don't know about the time frame; in the case report it says that the effects were almost immediately noticable, so with that in mind you'd think 1,5 months should be enough.
Then again, these kinds of medications are known to have different effects on different people, and furthermore I understand it usually takes some weeks for the body to find a new equilibrium (dopamine, serotonine etc). As they say it gets worse before it gets better.

Anyway, I'm in the same situation as you I guess. I should be working on my final thesis right now to wrap up my study. That's the reason I kept from taking medication till now (that and I wanted to at least try botox first, but it's a tough situation to get it regularly and reliably while the years are ticking away). At the same time that means I'll have to go working soon and the sweating isn't very helpful for that.

I'm thinking it might be worth a try, but did you endure any side effects after you quit the treatment? With these kind of meds sometimes that's a problem I think.

The Terazosin clinical trial sounds promising. However, I still start to feel weak when I see side-effects of a drug that is initially intended for something else, eventhough I know most of it is exaggerated, that makes it even harder to assess the real risks. One would think they can design a drug that is intended to attack HH in the first place...*sigh*

Still, if it works and side-effects are minimal than let's order a seacarrier of the stuff.

Anyway, I would be happy to hear what your doc has to say about the meds you proposed to him.

One med that I was once prescribed by a neurologist that is quite unusual is Artane. It's used for people with parkinson's disease. Anyway, that was about two years ago and ultimately I decided not to take it because it seemed a quite heavy drug that is not usually prescribed to people my age (I was 20 at the time and it is advised not to take it for people below 18 ).

I googled Artane and it says that it is an Anticholinergic, so that make sense that it might help with sweating.

I don't think they will find a silver bullet for HH anytime in the near future...especially for generalized HH. I think it is much too complicated physiologicaly. For now, I think we are largely stuck with drugs that reduce sweat unselectively and, unfortunately, have too many side effects.

I've tried tons of oral meds for hyperhidrosis, it's awesome to finally find someone else who is looking too. Maybe between the two of us we can find something that will work. I have tried indomethacin and I can give u a heads up now that it is not the answer. What else have I tried ummm off the top of my head....all the usual ones like oxybutynin robinul propranolol clonidine then also a few random ones like levsin, umm something that started with a D. Probably more but those are all the ones off the top of my head. The other ones u mentioned I haven't heard of but heres what I'm hoping for right now:

Phenoxybenzamine
Topiramate

maybe atarax

I looked at the fludrocortisone and mexiletine. How did you come up with those two? One was for addison's disease, if I remember correctly that does cause sweating (I think I was tested for it) but the mechanism that causes it is different I think than idiopathic hyperhidrosis. I lo0ked at Terazosin also and it is an alpha blocker. I have tried beta blockers, and I think I might have tried an alpha blocker but I'm not 100% sure. Clonidine is an alpha agonist I believe. Have you tried the typical robinul and oxybutynin?

Well it took a couple months but I finally got prescribed mirtazapine. I am on my second day of taking 15mg's. So yeah we'll see how it goes over the next couple of weeks or so.

Here is a link to an article about Mexiletine:

http://jnnp.bmj.com/cgi/content/extract/72/1/122

My doctor has an open mind about trying different things, so I can let you know what I try next. I am going this Thursday to see if he is willing to prescribe a new medication.

By the way, what happened with Indomethacin? I know there is one article online with a case report of it working on one women (hardly a sample size). Did it just not do anything at all?

Good stuff you guys have going on there.

My bets are on topical glycopyrronium cream for now...next monday I'll go to the dermatologist and ask for it.

I'm still anxious to find out if the Mirtazapine will do anything though.

yeah indomethacin really didn't do anything except give me a few side effects. It's a NSAID, I guess you could basically just take a large dose of aspirin or something instead. I'm now on my 4th day of mirtazapine and right away it did seem to lessen my palmar hyperhidrosis. I am still sweating quite a bit and I don't think the actual antidepressant effects have kicked in yet, but I am prepared to take topical glycopyrrolate if necessary.

The more I think about it the more I realize that I really do have social anxiety in addition to my general hyperhidrosis so I'm thinking I am going to need to treat the social anxiety in some way. I have read that paxil is the best way to do so but am nervous about the sweating associated with SSRI's. Have you tried an SSRI?

Also did you drink alcohol at all while on mirtazapine? A lot of the posts here say avoid it completely but that is pretty much impossible for me and my social life.

has anyone here stayed on the remeron and had any success in sweat relief?? im thinking of trying it soon!

don't bother, didn't help my hands/feet and truly was a dreadful drug. avoid like the plague