What is the link between excessive sweating, stress, anxiety, and depression?

What is the link between excessive sweating, stress, anxiety, and depression?

Hyperhidrosis, Stress, and Anxiety

In this episode of Dermadry Segments, we spoke to Registered Nurse Courtney Reichenbach about the link between excessive sweating and mental health. We delve into how hyperhidrosis can affect stress levels and lead to anxiety disorders.

Watch the full segment to learn more about the various ways that excessive sweating can impact everyone from school-aged children to adults. As an experienced school nurse and hyperhidrosis sufferer herself, she shares her top tips and tricks on dealing with the condition, how to recognize it in children, and the importance of education and awareness, as well as the importance of speaking out and seeking help.

About Courtney Reichenbach, RN BSN

Courtney Reichenbach, RN works with the International Hyperhidrosis Society to make sure that information on SweatHelp.org is current, practical and actionable for hyperhidrosis sufferers. Access to patient-focused care is very important to Courtney and, as a registered nurse, she wants sufferers of all ages to know that they are NOT alone and to encourage them NOT to lose hope. Courtney is especially eager to help children and teens with hyperhidrosis find support sooner. “They shouldn't have to spend years suffering unnecessarily,” she says.

Courtney received her Bachelor of Science in Nursing from the University of North Carolina-Wilmington, NC. After graduating from nursing school, Courtney worked in the operating room setting for many years. Later, she turned to case management and focused on pairing uninsured and underinsured patients with primary care providers and improving access to specialized care. In a similar vein she wants uninsured hyperhidrosis patients to know there are options for them, too. Courtney currently works in public schools and was inspired to reach out to IHhS when she saw a poster for our "Know Sweat in School" campaign in a middle school clinic. “It’s important for pediatricians and school nurses to be well-educated about hyperhidrosis and potential treatment options for their young patients," she says, "and this is something IHhS can play a big role in. I'm excited to be a part of it.”

Courtney currently resides in Virginia with her husband, daughter, and two rescue dogs. In her spare time, she plays an active role in the animal welfare community. She is also a Certified Group Exercise Instructor and has a passion for health and fitness.

Interview with Courtney Reichenbach, RN BSN

Amanda: So good morning, everyone. Thank you very much for coming on. Today's episode of Dermadry Segments. Today, we have Courtney Reichenbach on the line today with us. We're going to be speaking about hyperhidrosis and anxiety, what is the link between them and what tips and tricks she may have to help us. So, thank you very much, Courtney for coming on the line today.

Courtney: Glad to be here.

Amanda: So just to go into some of the questions that we collected through our community of hyperhidrosis sufferers or those who are interested in hyperhidrosis. There were many questions that came through. For the first one, we would like to know in your experience, what kind of mental and emotional toll can hyperhidrosis have on someone?

Courtney: I think hyperhidrosis can be exhausting for people, mentally and physically. We live in a society where if you have something that makes you different somehow, you have to justify that. Sweating outside of physical activity is still considered gross. And when you sweat five to seven times more than the average person, it can definitely make you feel like an outcast.

Amanda: Yeah, a hundred percent. And that's something that a lot of avid kids and a lot of those who do suffer from hyperhidrosis, kind of come write that into the community blogs. And, we're really happy that you're on board to kind of share that experience. Going into the next question.

Research indicates that those with hyperhidrosis have a lot of anxiety, depression, and attention deficit disorder. It is general in the population. However, there's a lot of research that it's important in hyperhidrosis. In your research and experience, is this something that you've noticed as well?

Courtney: Absolutely. It's something that I have noticed, and have experienced, hyperhidrosis. It's not a disease that just goes away. It's a chronic condition and research shows the diagnosis of many chronic diseases goes hand in hand with feeling anxious and being depressed about it. Hyperhidrosis affects so many aspects of people's lives. There's not just social implications, but it affects jobs, it affects hobbies. If you want to be a police officer and you can't hold a gun because your hand is dripping sweat, you know, that's going to affect that. Or if you want to play the piano and your fingers were slipping off the keys, you know, there's like I said, it's not just a social thing, but it can affect your livelihood as well.

Amanda: Right. And having a lot of conversations with those who do suffer from hyperhidrosis, that was some feedback that we were getting with them. Sometimes when, even when it came to writing down notes or if they were going into media reporting, just for them, it was difficult. They had to kind of have some type of technology, a pen and paper wasn’t always the best solution for them. Going towards the next question. What are the mental health impacts and implications of living with this lifelong condition?

Courtney: Sure. I think it's critical to figure out ways to deal with the chronic diagnosis. There's, you know, use of anti-anxiety or anti-depressant medications that can be used in conjunction with other treatment modalities. However, I'm personally not a big fan of those medications being used over a long period of time. So honestly I think the best tool we have is education and support. Finding one other person in the world that has the same diagnosis that you share that you can share your experiences with and your feelings with. I think that's the most important thing.

Amanda: And we had a lot of questions that were coming in on what is the link between hyper and anxiety. They would like to know, is it anxiety that triggers hyperhidrosis or is it hyperhidrosis that leads to developing this type of anxiety disorder? Or could it be both?

Courtney: This is a good question. It's a real, it's kind of a, which came first, the chicken or the egg type question. I think it’s very hard to pin down. Are you anxious because you're sweating profusely or are you sweating profusely because you're anxious. And I think the answer lies somewhere in the middle. I think these two things, I think they'll always go hand in hand. I think it's actually less important to figure out which one is perpetuating the other and focus on means of controlling both. I also find it interesting to note that hyperhidrosis goes away while we sleep. So I think it's interesting that when our little, you know, active brains during the day finally get to shut down for a while, the sweating also goes away.

Amanda: And that's always that kind of different rotation cycle that comes into play.

Courtney: Absolutely.

Amanda: There is another question in regards to excessive sweating again. They want to know if excessive sweating leads to feelings of stress and the development of an anxiety disorder and specifically do certain situations like, for example, school or social interactions can come into play in this?

Courtney: Definitely. From my own personal experience, knowing if I was going to be in a social situation, would be very anxiety-provoking, especially if it was a situation where I knew I may be introduced to someone where I was going to have to shake someone's hand, hold someone's hand, etc. I think it's very stressful and I think we especially need to be super sensitive to this in the school age population where every day of your life is a social situation.

Amanda: And I know you've worked with different age groups, especially as a registered nurse previously. When it came to different age groups, was there a specific group that had more anxiety in relation to excessive sweating?

Courtney: Well, primary hyperhidrosis is often reported starting in the elementary school age years. I think it certainly can cause anxiety in all age groups, but I think that school aged children are especially susceptible because you become very conscious that you have something that other kids don't have, and especially as a young child, and moreover, as a teenager, you just want to fit in. You don't want something that's gonna make you different.

Amanda: There was someone that I was speaking to actually, a pediatric dermatologist, and it's super prevalent in children. We were so shocked when we heard that. Cause there are certain age groups that are a bit more prevalent, but when it came to children in elementary schools and to hear the stories that they were going through, we were kind of shocked to hear those as well and how the parents were trying to figure out ways to help their children.

And I'm speaking with this dermatologist, they actually gave her tips and tricks as well, so that was super interesting. Linking to the next question, as a registered nurse who worked in schools, is hyperhidrosis something you commonly see in school aged children and adults.

Courtney: This is an interesting question because it's definitely there in this population, but you aren’t going to see it unless you're really tuned in to look for it.

Even adults that suffer from hyperhidrosis find all sorts of tricks to hide it. Dark clothing, wearing a jacket when it seems to someone else unseasonably warm, sitting on your hands, keeping your hands in your pockets, never wearing socks, or shoes without socks. You figure you come up with all ways to not draw attention to yourself. So unless you're really looking for the signs, they're not going to be quite so obvious.

Amanda: And as you're going into the tips and tricks, how can we as parents, instructors, school nurses, etc., how can we help the children and these teens that are actually suffering from hyperhidrosis.

Courtney: For the majority of kids, their excessive sweating is a major source of embarrassment. One of the most powerful things I think we can do in schools, whether it's in nurses, office, school, nurse offices, or even, you know, school bathrooms is to display posters with links, contact information, for example, about the International Hyperhidrosis Society. These should also be encouraged to be displayed in primary care offices, pediatrician, offices.

Kids need to know that the burden that they carry actually has a name, and then, you know, being able, you know, kids are so technologically advanced these days, you know, if you give them a link to a website, they're going to be reading all about it. Then being for these kids to hopefully go to their parents and locate a physician in their area that can offer treatment solutions is the next line of defense.

Amanda: And now I'm going into the next question. Do you have any tips for parents and instructors regarding how they deal with their children who do suffer from hyperhidrosis? Is there anything that they should look for?

Courtney: I would encourage parents to be on the lookout for behaviors that might just seem kind of off to them. Their child not wanting to be in social situations where they may have to touch hands with another person, only wearing dark colored shirts, frequently changing their shirts. You can be on the lookout for, especially in light colored clothing, you know, look for sweat stains at the axilla

You know, I can remember as a child in a church situation dreading the time in church where you'd have to greet the people around you and shake their hand. So I'd come up with the need to, at that time, have to suddenly go to the bathroom. So things like that, like I said, you get used to figuring out ways to get around it. And I think as a parent, you just need to keep an eye on behaviors that seem just a little suspect.

Amanda: So actually regarding that as well, earlier today we were speaking with someone that was trying to get the iontophoresis treatment for her husband. However, her husband is not sure that he has hyperhidrosis, he's kind of timid and shy to speak about it. So what would be tips and tricks for you when concerting a spouse that would want to support their spouse actually on, treating hyperhidrosis and kind of getting that to talk about it.

Courtney: Sure. That's kind of more of a sticky situation because, like many things in life, someone has to be ready to do something on their own and take those steps. It's hard to convince or make somebody do something because you think they should. I think you can ease them into that by providing some literature, giving them a website and just saying, “Hey, you know, I came across this website, um, whether it's the international hyperhidrosis society, which is sweathelp.org, which has an amazing amount of information, and just encourage them to look that over and be like, this seems like it's, you know, you have to approach it gingerly. This seems like something. I've noticed that you might, that might bother you, that you may have bought, you know, suffered from. And I just came across this and thought you might like to read about it and just kind of present them with the information. And then when they're ready to do something about it, they will.

Amanda: Okay. Amazing. Thank you very much for sharing that insight. Moving forward, we do know when it comes to hyperhidrosis, it can affect different areas of the body. Are there certain types of hyperhidrosis, for example, like palmar that are more prone to leading, developing an anxiety disorder.

Courtney: Absolutely. Hyperhidrosis in any area can certainly cause anxiety, but I think there's more increased opportunity to develop anxiety when it's especially palmar or facial as these are areas are more difficult to hide from. At least prior to COVID we lived in a world of handshakes and high fives, which is the super stressor to those with palmar hyperhidrosis.

You know, when you sweat from your, your head or your forehead, the face is the first thing people see, your first hello to the world. So axillary and plantar are definitely, they're aggravating in their own right, but they're a little easier to hide. Although your choice of clothing can be limited with the axillary hyperhidrosis.

Amanda: And there are a lot of questions coming in asking. When it comes to hyperhidrosis, some of them may have body odor. Some of them may not have that extra body odor. However, there, the question to you would be that many people who do suffer from hyperhidrosis also can have body odor, which makes them feel even more anxious. Do you have any tips and tricks when it comes to controlling their body?

Courtney: Definitely. If you're using a topical antiperspirant, it's going to be effective if you, after washing at night, you apply your antiperspirant actually before bedtime, which is kind of counterintuitive because we've been taught you wake up, you're getting ready and you put on your deodorant in the morning, but you actually want to do that right before bedtime.

Then if you need more odor control during the day, you can use, you know, keep a deodorant product handy. Keep baby wipes in your car or purse, as you need to freshen up as needed, even in a pinch, you know, if you're at work, you can go into the restroom, just, you know, grab a paper, towel, little soap and just, anything that to help you feel a little more, more fresh, but baby wipes are fantastic for that too.

Amanda: Those are actually great tips. I never thought of the baby wipe side. Going into the next question. The effects of hyperhidrosis have on mental health and emotional wellbeing, how can they be managed?

Courtney: Honestly, I think the most important thing you've got to talk to somebody that has it. Whether you can definitely find solace in talking to someone who has experienced some of the same things that you have, there's forums online, there's videos on YouTube. You may feel like you're the only person in the world with this condition, because you've gotten very used to figuring out how to hide it. You are not, reach out to a therapist, whatever works for you, but you will find more comfort sharing your story with someone who has walked in your shoes.

Amanda: And I think these are really important points to go into. And that's why we're also trying to create a Dermadry community, a community that's a safe space for people to share their thoughts and feelings if they feel like it. That's what we're trying to build and go for. So we think even having information packages, even with yourself, eventually, I think it would be really great to see how we could spread that awareness and create that safe space.

Courtney: Absolutely.

Amanda: And moving now to the next question. Does treating hyperhidrosis often lead to other forms of anxiety symptoms as well as improving overall mental health and wellbeing?

Courtney: Treating hyperhidrosis can absolutely help alleviate the anxiety about it.

I remember having cautious optimism, especially when I first tried Botox, which again, you don't cure hyperhidrosis, but the Botox can keep it at bay for many months. At first, when I noticed it take effect, you kind of have that moment where you feel like “This is too good to be true”. And, you know, you're kind of looking down at your palms, waiting for the sweat to break through, and it doesn't, and the same thing with the iontophoresis. You go through the period where the sweating, you know, gets under control. And then, like I said, you, you go through that mental game with yourself, like, this has gotta be way too good to be true. I remember the first time I was able to wear a light colored shirt without a sweater over it, you just, you feel like a new person, so it literally can be life-changing.

Amanda: And for someone that is interested in nursing, that's your field of interest, and also someone that does suffer from hyperhidrosis, you kind of have this great background.

We would love to also know what would be your overall thoughts on iontophoresis treatment.

Courtney: It's a fantastic option. I wish more people knew about it and I think getting the word out is great. We've come a long way too in the machines that are out there, especially you guys with Dermadry, that's literally your only focus. So I think you're focusing on making an effective product, whereas there's other companies that may have a good product as well, but they’re companies who are also doing other medical devices and that sort of thing. But you know, it's not going to hurt to give it a try. And if there's potential for helping the condition, go for it.

Amanda: And I'm so excited to hear that. And I think that's something that we're also trying to build when it comes to spreading that awareness as well, for different treatments when it comes to hyperhidrosis.

Linking back now to the other questions, we do know excessive sweating can lead to feelings of stress, embarrassment, and anxiousness. Can you share some other tips and insight on managing these overwhelming emotions?

Courtney: Sure. Many people will turn to anti-anxiety medication and antidepressants and that's certainly fine. But again, personally, I'm a believer that those medications are best used for short-term management of situations and with hyperhidrosis, you really need to find something feasible for the long term. The best advice I can give is to find someone you can share your feelings and frustrations with, tell them your frustrations and listen to theirs.

You've got to find healthy ways to deal with your stress, whether it's in social situations, you feel that heart rate getting up, deep breathing, get that heart rate back down. Yoga, walking outside, jogging, you know, even just watching a 30 minute funny sitcom, there's gotta be some point in your day where you just let yourself, just be yourself and be gentle with yourself and relax a little bit. Just remember, almost everybody out there is going through something, even if you don't know about it, and at the end of the day, we're all just doing the best we can.

Amanda: Yeah, thank you very much for sharing that. I think that's a really important key message that needs to be shared with everyone. And now we know we're going to be switching over again in the treatment side, but what treatment options for someone that does suffer from anxiety, but also has hyperhidrosis, what would you recommend for them to use?

Courtney: Sure. If you can manage the hyperhidrosis, the anxiety is going to lessen. I've always been a fan of starting with your least invasive treatment options.

Whether, you know, there's a host of topical products out there. For someone with mild hyperhidrosis, those might be completely effective. If those don't work, I think your next step is to try iontophoresis. There's also oral medications you can try, those would be something to discuss with your dermatologist or your primary care physician.

And then, you know, you can kind of go from there. You can get quite invasive with it. You know, there are surgeries out there too that people have had, but surgery to me is kind of the last option because it's not without risks. So I'm always a fan of starting small and working your way up.

Amanda: And are there any hyperhidrosis treatments you would recommend for those living with social anxiety? So for example, those that are wanting to have more social interactions, but they're kind of scared and they're avoiding it. What would you suggest for them to use?

Courtney: Sure. I think you've got to treat the mental component as well as the physical. Counselling, talk therapy are great options for that. As well as the, you know, the prior mentioned physical treatment options to go after the sweating.

Amanda: And what are the benefits of treating hyperhidrosis at home? Such as an at-home iontophoresis. Do you think it is suited for those that are living with anxiety disorders?

Courtney: Absolutely. at-home options, like iontophoresis units are a fantastic option. Most of these treatments are done in a dermatologist’s office, but what if you live in a rural area and you live, you know, over an hour away from your physician's office. Iontophoresis is something you need to do every day or nearly every day for weeks and sometimes up to months and then you have to maintain it after that. So it's just not realistic for many people. Especially if you work outside of the house, you know, you don't have two and a half hours to take out of your day to go to the doctor's office. So the iontophoresis, especially it gives you the flexibility to do it at your own time, you know, put something on Netflix, sit back and do what you need to do, you know.

Amanda: That's true. I was speaking to someone actually the other day, and they were saying you were, went through a whole series of Netflix, then she goes, I started the treatment then put it away and then I just still kept watching the Netflix series.

Courtney: Yeah you can burn through some good shows for sure.

Amanda: So we know there is lots of research that has been done about hyperhidrosis, but what is the importance of hyperhidrosis research and awareness?

Courtney: Oh, goodness. Only good things can come from increased awareness and education. If you think about recently, you know, even with the COVID vaccine, all the research that was done in a relatively, relatively short amount of time and the change and the effect that that will have on the world. So if we continue to find ways to treat this condition, you know, the day may come where millions of people don't have to suffer from it.

Amanda: I think that would be a dream. And moving now, especially in a world now COVID there’s a lot of telemedicine that's happening. Do you think telemedicine may help those living with hyperhidrosis and anxiety to kind of get the treatment that they may need and at what point should someone consult a medical profession?

Courtney: Telemedicine is certainly a good option and it still may be the only option for some people in light of the times we're still living in. If you're suffering from hyperhidrosis, I would contact your primary care provider or your dermatologist immediately. There's no reason to put that off. I think dermatologists may be a little more in tune with the diagnosis than some primary care physicians. Hopefully that gets better. If you don't have anyone you feel comfortable talking to about it, by all means there's never a bad time to reach out to a mental health professional as well.

Amanda: I think those are great actually great points, and now great tips and tricks. We'd like to know if there's anything that you feel like you missed or you really want to pinpoint when it comes to general tips or advice for those that are living with hyperhidrosis.

Courtney: Sure. The number one thing I would tell people is just realize you're not alone with this. You may not see us because like you, we've gotten good at hiding it, but we're out there too. Number two, educate yourself. Like I said, the International Hyperhidrosis Society, which is sweathelp.org has a wonderful amount of information, physician finders, you know, you can put in your zip code and find, you know, the closest provider to you. And hopefully as providers are educated about the condition and the treatment options, then we'll just see those numbers increase.

Amanda: Actually speaking about the Hyperhidrosis Society. What was the role that you were taking charge of when, when you worked with them and did a collaboration with them?

Courtney: Sure. I've only had a small role with the international hyperhidrosis society, doing some things, working with some things that were on information on their website, but I've been honored to be associated with the organization. My dream job would be to work with hyperhidrosis patients every day. I feel very passionate about the subject and I would love to help as many people as possible.

Amanda: Oh my God. Thank you so much for sharing all that information. And I think that's something that we should work towards and we really appreciate you coming on board today and sharing your story.

We hope that we can continue spreading the awareness and working together and seeing how we could kind of build that advocacy for hyperhidrosis. If anyone has any questions, when it comes to hyperhidrosis, please feel free to contact her if you have any questions and we're looking forward to seeing you next episode. Thank you very much.

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