Reflex vasodilation and sweating in response to passive whole body heating are blunted in women with major depressive disorder.

Major depressive disorder (MDD) is associated with alterations in the mechanistic regulation of body temperature, including altered circadian temperature profiles, reduced sweating, and blunted cutaneous vasodilation. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) may affect vascular function and sweating; however, heat stress thermoregulation in MDD and during SSRI or SNRI therapy has not been measured. The purpose of this study was to measure reflex cutaneous vasodilation and sweating responses during passive heating in women with MDD who were non- or chronically treated with either SSRI or SNRI monotherapy. Sixteen women (aged 18-36 yr) with unmedicated MDD, 16 women with SSRI-treated MDD, 16 women with SNRI-treated MDD, and 16 nondepressed women were passively heated using a water-perfused suit to increase core temperature (Tc) by 1.0°C. Forearm blood flow (FBF; venous occlusion plethysmography) was measured at every 0.1°C increase in Tc, normalized to mean arterial pressure (MAP), and expressed as forearm vascular conductance (FVC). Skin blood flow (SkBF; laser-Doppler flowmetry) and local sweat rate (LSR; ventilated sweat capsule) were continuously measured. FVC was lower in unmedicated MDD compared with nondepressed (P = 0.03) and SSRI-treated (P = 0.01). FVC in SNRI-treated was not different from nondepressed (P = 0.09) or MDD (P = 1.0) but lower than SSRI-treated women (P = 0.03). Greater increases in mean body temperature from baseline were required for the onset of LSR and SkBF in unmedicated MDD compared with all other groups (all P < 0.05). Together, these findings suggest alterations in reflex thermoregulation in unmedicated women with MDD; these effects may be ameliorated by antidepressant pharmacotherapies.NEW & NOTEWORTHY Reflex skin vasodilation is blunted in women with MDD who are not using antidepressant medications compared with women with MDD currently taking SSRIs and nondepressed women. In addition, unmedicated women with MDD have a delayed onset of thermoregulatory effector function. This suggests that there are alterations in the central control of thermoregulation in women with MDD not using pharmacotherapies; however, these detrimental effects may be partially ameliorated by common antidepressant medications, specifically SSRIs.