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


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.
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Andrew C. Gallup. Yawning and the thermoregulatory hypothesis
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