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mise à jour du
12 avril 2009
Prog Neuro Psychopharmacol
Biol Psychiatry
2009;33(4):747
Venlafaxine-induced excessive yawning:
a thermoregulatory connection
 
Gallup AC, Gallup Jr GG

Chat-logomini

Andrew C. Gallup. Yawning and the thermoregulatory hypothesis
 
Recently, Chen and Lu (2009) describe how the use of venlafaxine as treatment for major depressive disorder produced a disturbing and disabling instance of excessive yawning. They found that this side effect was dose-dependent and was relieved by decreasing the dose, yet they fail to identify a mechanism that may mediate this response. The purpose of this letter is to call attention to a strong connection between yawning and thermoregulation.
 
We believe this view of yawning may provide critical insight into the understanding and treatment of this and similar cases in the future. There is growing evidence that yawning is a thermoregulatory mechanism and that the physiological actions following a yawn function to promote cerebral cooling (Gallup and Gallup, 2007, 2008). Well documented brain cooling mechanisms (i.e., nasal breathing and forehead cooling) diminish the incidence of yawning in human subjects (Gallup and Gallup, 2007), and rising ambient temperature has been shown to increase yawning (Gallup et al., 2009).
 
In addition, a growing body of medical and physiological evidence shows that yawning occurs before, after, and during instances of abnormal thermoregulation, heat stress, and hyperthermia (Gallup and Gallup, 2008). For instance, conditions such as central nervous system damage, epilepsy, migraine headaches, multiple sclerosis, sleep deprivation, and stress and anxiety have all been linked to thermoregulatory dysfunction and am often associated with an increased yawn frequency.
 
Similarly, drugs that increase brain temperature have been shown to produce excessive yawning, while drugs which produce hypothermia inhibit yawning (Gallup and Gallup, 2008; Prasad, 2008a). Serotonin is a vasoactive compound that regulates skin blood flow, and therefore is intrinsically involved in thermoregulation (Maurer Spurej, 2005). Increases in serotonin are linked to increases in brain and core temperatures (Myers, 1981; Schwartz et al., 1995), and night s sweats have also been reported by women taking selective serotonin reuptake inhibitors for treatment of depression (Shahine and Lathi, 2006).
 
Chen and Lu (2009) have shown that another common and well documented side-effect of selective serotonin reuptake inhibitors used for antidepressant therapy is excessive yawning. Overdose of o venlafaxine by itself has been linked to thermoregulatory dysfunction; producing seizures in two independent cases (Durback and Scharman, 1997; Leaf, 1998), while inducing serotonil) syndrome in another (Kolecki, 1997).
 
Moreover, two separate case reports describe the use of benztropine to counter the effects of venlafaxine-induced sweating (Garber and Gregory, 1997; Pierre and Guze, 2000). Therefore, it s would appear that excessive yawning may be a consequence of increases in brain and core temperature produced by such drugs (Gallup and Gallup, 2008; Prasad, 2008a). Excessive yawning has been shown to reduce overall body temo perature.
 
In a report of two women suffering from abnormal thermoregulation accompanied by chronic and debilitating bouts of excessive yawning, one took her underarm temperature prior to and following a series of excessive yawning episodes over a period of days, and found that in 9 out of 10 instances her temperature went down by an average of .36 C on each occasion (Gallup and Gallup under review). This is consistent with the view that yawning contains a cooling component and that similar to other cooling mechanisms, yawning may be triggered by increases in brain and/or body temperature. We agree with Chen and Lii (2009) that excessive yawning should not be trivialized when indicated as a side effect to various conditions or drugs; however we argue these symptoms may be a diagnostic indicator of thermoregulatory dysfunction.
 
-Nayak R, Bhogale GS, Patil NM. Venlafaxine and excessive yawning: is there any link? J Neuropsychiatry Clin Neurosci. 2011 Spring;23(2):E56-7.
 
-Philibert C, Sauveplane K, Pinzani-Harter V et al. Le bâillement: de la physiologie à la iatrogénie. La lettre du pneumologue. 2011;14(5):168-172
 
References
 
Chen CH, Lu ML Venlafaxine-induced excessive yawning. Prog Neuropsychopharmacol I Biol Psychiatry 2009:33:156-7.
 
Durback LF, Scharman EJ. Seizure resulting from venlafaxine overdose. Ann Pharmacother 1997:31:790-1.
 
Gallup AC, Gallup Jr GG. Yawning as a brain cooling mechanism: nasal breathing and forehead cooling diminish the incidence of contagious yawning. Evol Psychol 2007:5: 92-101.
 
Gallup Ac, Gallup Jr CG. Yawning and thermoregulation. Physiol Behav 2008:95:10-6.
Gallup GG, Gallup AC. Excessive yawning and thermoregulation: two case histories of chronic, debilitating bouts of yawning. Sleep Breath. 2010;14:157-159
 
Gallup AC, Miller ML Clark AB. Yawning and thermoregulation in budgerigars (Melopsittacus undulatus). Animal Behav 2009;77:109-13.
 
Garber A, Gregory RJ. Benztropine in the treatment of venlafaxine-induced sweating. J Clin Psychiatry 1997:58:176-7.
 
Kolecki P. Isolated venlafaxine-induced serotonin syndrome. J Emerg Med 1997:15: 491-3.
 
Leaf Ev. Venlafaxine overdose and seizure. Ann Psychother 1998;32:135-6.
 
Maurer-Spurej E. Circulating serotonin in vertebrates. Cell Mol Life Sci 2005:62:1881-9. Myers RD. Serotonin and thermoregulation: old and new views. J Physiol 1981:77: 505-13.
 
Pierre IM, Guze BH. Benztropine for venlafaxine-induced night sweats. J Clin Psychopharmacol 2000:20:269.
 
Prasad H. Drug-induced yawning: a vital protective reflex. Med Hypotheses 2008a;71: 457.
 
Prasad H. Amelioration of pathological yawning after tracheostomy in a patient with locked-in syndrome: a thermoregulatory approach. EurJ Neurol 2008b:15:e114.
 
Schwartz PJ, Wehr TA, Rosenthal NE, Bartko JJ, Oren DA, Luetke C, et al. Serotonin and thermoregulation. Physiologic and pharmacologic aspects of control revealed by intravenous m-CPP in normal human subjects. Neuropsychopharmacol 1995:13: 105-15.
 
Shahine LX, Lathi RB. Night sweats and elevated follicle-stimulating hormone levels while taking selective serotonin reuptake inhibitors. Obstet Cynecol 2006:108: 741-2.
Andrew C. Gallup. Yawning and the thermoregulatory hypothesis
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-Nayak R, Bhogale GS, Patil NM. Venlafaxine and excessive yawning: is there any link? J Neuropsychiatry Clin Neurosci. 2011 Spring;23(2):E56-7.