For a first, a very educated patient came in noting that the day he started Wellbutrin and Xiidra on the same day, his stubborn dry eye symptoms of burning, redness, and reflex tearing improved noticeably.
Most often this class of drugs makes dry eye symptoms worse.
But it has been reported that Bupropion (Wellbutrin) to cause excessive sweating. Why does Bupropion do this? Is it due to a change in the brain's internal temperature regulation or a local effect on the sweat glands as noted in below link? Could it help meibomian glands.
Thus far there are no published reports that Bupropion helps dry eye that I could find on a quick literature search. If your eyes have been helped by Bupropion, let us know. jramirez@voeyedr.com
SLC
https://clinicaltrials.gov/ct2/show/NCT01588717
https://www.goodrx.com/blog/medications-cause-excessive-sweating-side-effect/
1) Antidepressants
All classes of antidepressants may cause excessive sweating. Bupropion (Wellbutrin) causes excess sweating in approximately 1 in 5 people
taking it, slightly more often than the typical selective serotonin reuptake inhibitor (SSRI) antidepressants like escitalopram (Lexapro), paroxetine (Paxil), fluvoxamine (Luvox), and sertraline (Zoloft).
Tricyclic antidepressants like amitriptyline (Amitril, Elavil) and nortriptyline (Pamelor) and serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta) and venlafaxine (Effexor) also cause excess sweating.
Why? SSRIs increase serotonin levels in the brain. Serotonin affects both the hypothalamus, which sets our core temperature at which sweating occurs, and the spinal cord, which may lead to excessive sweating. Tricyclic and SNRI antidepressants cause more norepinephrine to float around the brain, which stimulates receptors (peripheral adrenergic receptors) that lead to sweating.
It is important to keep in mind that sometimes sweating from antidepressants, particularly those involving serotonin, can be a sign of a potentially lethal condition called serotonin syndrome. There is a higher risk if you are taking more than one medication that affects serotonin, or if another medication you take interacts with your antidepressant. Contact your healthcare provider right away if you start experiencing sweating, confusion, muscle spasms, fever, and/or fast heartbeat.
Dry Eye Related to Commonly Used New Antidepressants
- PMID: 26075491
- DOI: 10.1097/JCP.0000000000000356
Abstract
Antidepressants may have an impact on the course of eye dryness. The aim of this study was to investigate the effects of commonly used new antidepressants on eye wetting. Fifty-four patients using new antidepressants and 57 controls were recruited. The Beck Depression Scale and Beck Anxiety Scale questionnaires were completed by the patients, and drug use time and dosages were recorded. The Schirmer test was performed without prior instillation of topical anesthesia to the ocular surface, and the wetting result was recorded for each eye. Escitalopram, duloxetine, and venlafaxine were used by 27, 13, and 14 patients, respectively. The Schirmer test results in the patients were significantly lower than in the controls (P < 0.001). The patients using selective serotonin reuptake inhibitors (SSRIs) displayed lower wetting measurements (≤5 mm) compared with those using serotonin-norepinephrine reuptake inhibitors, which was independent of the duration of antidepressant usage (P < 0.05). Although SSRIs do not have anticholinergic adverse effects except paroxetine, we found that both SSRIs and serotonin-norepinephrine reuptake inhibitors increased the risk for eye dryness. The lower Schirmer test results of the SSRIs may be associated with a mechanism other than the anticholinergic system. An awareness of the drugs that contribute to dry eye will allow ophthalmologists, optometrists, and other physicians to better manage patients who have this problem.
https://www.khanacademy.org/test-prep/mcat/organ-systems/integumentary-system/v/whats-in-sweat-holocrine-apocrine-and-merocrine-glands
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