Dr Martin Scurr, a GP who writes an advice column, has told a reader that her 22-year-old daughter's night sweats are most likely a side effect of fluoxetine, an antidepressant the young woman has taken for a long time.
The reader, whose name and address were supplied to the column, said her daughter's sweats were disrupting her sleep and that blood tests had shown low iron levels, though other results were otherwise normal.
Dr Scurr said night sweats are a common side effect of fluoxetine and other SSRIs, or selective serotonin-reuptake inhibitors, a group of medicines used to treat depression and anxiety. He said these drugs can affect the way the brain regulates temperature.
He added that the drug may not be entirely to blame, since sweats can be made worse by anxiety, alcohol or hormonal changes during the menstrual cycle. He said there is also the possibility of an undiagnosed health problem, particularly if the sweats started recently and come with symptoms such as unexpected weight loss or fever, pointing to an overactive thyroid, a viral infection or tuberculosis as possible causes.
Dr Scurr said he would expect the blood tests already carried out to have included checks on thyroid function, along with C-reactive protein and the erythrocyte sedimentation rate, both markers that rise when there is inflammation in the body from infection or injury. He said it sounded from the letter as though those results were normal.
He said he did not think the low iron levels were a factor in the night sweats, but recommended the daughter have a physical examination by her GP to rule out any underlying illness. If nothing is found, he said fluoxetine remains the most likely explanation, and reducing the dose might help ease the symptoms.
Natural ways to prevent insect bites
A second reader, Irene Day, wrote in to say she struggles with allergies and insect bites, especially in summer. She said she uses insect repellent outdoors, particularly in the garden, and always wears long sleeves and trousers, but still gets bitten and itchy, and takes the antihistamine fexofenadine as a result. She asked Dr Scurr for a natural preventative.
Dr Scurr said the only genuinely natural product he could recommend is oil of lemon eucalyptus, which he said should not be confused with ordinary lemon eucalyptus essential oil, a different substance. He said that although both come from the same tree, the lemon eucalyptus, native to Australia, they differ in the way they are processed.
Oil of lemon eucalyptus contains a compound called PMD, short for para-menthane-3,8-diol, which Dr Scurr said multiple studies have shown gives good protection against biting flies, making it his preferred natural option.
For readers open to a product derived from a natural source rather than being fully natural itself, Dr Scurr suggested picaridin, a synthetic repellent modelled on piperine, a compound found naturally in black pepper plants. He said it is highly effective against mosquitoes, ticks, biting flies, chiggers and gnats.
Whichever repellent is chosen, Dr Scurr said the key is to apply it carefully and consistently, including indoors, since insects often find their way through open windows in hot weather. He said fexofenadine will help with bites that do occur, and suggested 1 per cent hydrocortisone cream, which needs no prescription, or Anthisan cream as anti-itch alternatives.
Concerns raised over long-term PPI use
In a separate opinion piece, Dr Scurr warned readers to be wary of proton pump inhibitors, or PPIs, such as omeprazole, which are taken by millions of people to ease heartburn and acid reflux.
He said research now suggests PPIs may be linked to flare-ups of conditions such as chronic bronchitis and emphysema, making patients more vulnerable to potentially dangerous infections, adding it to a mounting list of concerns about the long-term use of the drugs.
Dr Scurr explained that PPIs suppress the production of stomach acid and were hailed as a breakthrough when introduced in the late 1980s, as they were far more effective than the H2-receptor antagonists that came before them.
He said that for years PPIs were considered safe, but that this overlooked the key role stomach acid plays in digesting protein, aiding the absorption of iron, calcium and vitamins, and boosting the body's defences against bacteria and viruses. He said the latest study showed PPIs effectively allowed disease-causing bacteria to travel up through the stomach and ultimately into the lungs.
Dr Scurr said it is important to use PPIs only at the lowest effective dose and for the shortest time possible, adding that they are certainly not the panacea they were once thought to be.
