Hyperhidrosis and Anxiety: Causes and Treatment Options

Excessive Sweating (Hyperhidrosis) and Anxiety: What is the Connection?

Anxiety is the body’s natural reaction to stressful situations. When faced with potential stressors or fear triggers (e.g., a job interview, a biology exam, heights, spiders) the amygdala of the brain sends a signal via the sympathetic nervous system to the adrenal glands (situated atop the kidneys), telling them to pump out adrenaline. This hormone goes right to the heart and tells it to pump faster in anticipation of either fighting or fleeing potential danger. Core body temperature rises and the eccrine glands push sweat out to the surface of the skin for evaporative cooling.

Unfortunately, the amygdala can’t tell the difference between anxiety from an actual physical threat and perceived threat. It’s going to excrete adrenaline either way, which is going to make you excrete sweat. In non-threatening situations this can increase your anxiety, which of course makes you sweat even more.

Mental disorders do not cause hyperhidrosis. Hyperhidrosis is a physical condition caused by overstimulation of the eccrine sweat glands and is not a psychiatric condition, as was previously believed by physicians. [1] Anxiety is not the only reason hyperhidrosis occurs; it is merely a symptom of the condition. Furthermore, hyperhidrosis is not dangerous, but the anxiety and stress that can result from it are detrimental if they are not treated.

Some of the Ways in Which Hyperhidrosis Causes Anxiety

Hyperhidrosis manifests in many ways. The symptoms may worsen due to particular situations such as interviewing, performing company presentations, and/or public speaking.  There are many other areas that hyperhidrosis affects one’s quality life, such as:

  • Personal hygiene – a patient may feel the need to change clothes or freshen up throughout the day. This can interfere with time schedules and affect job performance.
  • Self-worth – is often lowered due to this condition, which in turn affects all aspects of daily living.
  • Relationships – whether romantic or platonic the patient may feel unworthy, unattractive, and unclean.
  • Professional success – could be compromised due to appearing nervous or unprepared.
  • Social stigmas – something as routine as a handshake and having sweaty palms or palmer hyperhidrosis.

These are just some of the ways that hyperhidrosis can cause anxiety and lower the quality of life for those suffering. [2] Luckily, there are different ways to manage hyperhidrosis, and certain treatments are shown to reduce the anxiety produced by hyperhidrosis.

How to Deal with Anxiety Caused by Excessive Sweating

Some therapeutic approaches that can help relieve anxiety are deep breathing exercises, yoga, and meditation. Although these relaxation methods may greatly help, they generally do not eliminate all of the symptoms. In many cases, the most effective way to treat the symptoms or decrease anxiety caused by hyperhidrosis is to treat the actual condition. This often means seeking a doctor to implement a treatment plan. However, there are also some topical treatments a patient can try prior to visiting a doctor, such as antiperspirant lotions or sprays.

Medical Treatment Options for Hyperhidrosis to Decrease Anxiety

Patients with primary focal hyperhidrosis are prone to high levels of anxiety. [2] This is usually noticed during adolescence and often occurs in certain areas of the body, including the palms and the soles of the feet. [3] The most effective and well-studied medical treatments that have been shown to reduce sweating and anxiety are minimally-invasive surgical treatments for primary focal hyperhidrosis. These procedures include botox treatments for palmar, plantar, and axillary hyperhidrosis (hands, feet, and underarms). There is also a surgical procedure called endoscopic thoracic sympathectomy (ETS), in which the sympathetic nerves responsible for inducing sweating are either clamped off or cauterized. Both treatments reduce sweating to a specific area of the body and thus greatly reduce the amount of anxiety for those suffering from hyperhidrosis.

Patients should be wary of a surgical procedure called endoscopic lumbar sympathectomy. It has been shown to have potentially serious and detrimental side effects, not to mention the side effect of compensatory sweating that can be difficult to handle. Most doctors maintain the that thoracic sympathectomy is still a safe treatment, despite some of the risks. [1][2]

Hyperhidrosis sufferers also have the option of being treated with oral medications, such as anticholinergic drugs like glycopyrrolate or oxybutynin, which can reduce sweating and therefore anxiety. This treatment option has been shown to be promising, although surgical treatments are more often associated with major improvements. [2] While these treatments show promise they are costly and insurance may not cover them.

Research on Hyperhidrosis and Anxiety, and Its Findings

There have been several studies examining the relationship of stress, anxiety, and hyperhidrosis, with some mixed reviews. However, there is a definite link between anxiety and hyperhidrosis. Several studies have used psychological testing and stress hormone testing to see if there is a connection between stress levels and hyperhidrosis. While the cortisol levels stayed similar within the control group, the hyperhidrosis group exhibited higher levels of stress and depression. [4]

There are many other assessments used to determine the quality of life for those suffering from hyperhidrosis including the Dermatology Quality of Life Index, Hyperhidrosis Impact Questionnaire, Skindex, and more. [2] Researchers or doctors may use these tools to identify how or to what extent patients are suffering psychologically from hyperhidrosis.

Some people suffer from stress sweating, or sweating that is greatly worsened when a person is in an acutely stressful situation. It makes sense that hyperhidrosis, stress, and anxiety are so closely related as the symptoms of hyperhidrosis cause both physical, social and emotional discomfort. [2] Fortunately, as stated above, there are many available solutions and ways to manage the condition so that patients feel better and have an improved quality of life.


  1. Ruchinskas, R. (2007). Hyperhidrosis and Anxiety: Chicken or Egg? Dermatology, 195-196. Doi: 10. 1159/000099581
  2. Pariser, D. M. (2014). Hyperhidrosis (4th, vol. 32). Philadelphia, PA: Elsevier.
  3. Ghorpade, V. (2009). Idiopathic unilateral focal hyperhidrosis with social anxiety disorder. Indian Journal of Psychiatry, 51 (3), 214-215. Doi: 10.4103/0019-5545.55094
  4. Gross, K.M., Andrea, B., Schneider, K.K., & Meyer, J. (2014). Elevated Social Stress Levels and Depressive Symptoms in Primary Hyperhidrosis. PLoS One, 9(3). Doi: 10.1371/journal.pone.0092412

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