SSRIs: Emotional Detachment: Personality Changes & Reduction in Positive…

Paragraph two reads:  “A recent study published in the
British Journal of Psychiatry found that the majority of
patients taking SSRIs experienced emotional detachment, feelings of
indifference, personality changes,
and a reduction in

positive and negative emotions.[1]”

http://www.medscape.com/viewarticle/716929

Physicians Are Talking About: Selective Serotonin Reuptake Inhibitors and
the Choice to Numb Out

Nancy R. Terry

Authors and
Disclosures

Posted: 02/18/2010

Selective serotonin reuptake
inhibitors (SSRIs), mainstays of psychopharmacology, effectively eliminate
suicidal ideation — not to mention feelings of exhilaration, caring, and
desire.

A recent study published in the British Journal of
Psychiatry
found that the majority of patients taking SSRIs experienced

emotional detachment, feelings of indifference, personality changes, and a
reduction in positive and negative emotions.[1]

Currently,
tens of millions of patients in the United States take SSRIs daily. However,
evidence pertaining to the long-term effects of these drugs is scant. “In a few
decades, as many as 15% of the world’s population might be on SSRIs,” comments a
psychiatrist. “Although the suicide rate might decrease, I wonder what the
long-term effect will be.”

The conjecture posited on Medscape’s Physician
Connect (MPC), an all-physician discussion board, launches a discussion about
the apparent choice in SSRI use — to be crippled by depression or functional
and emotionally numb.

MPC contributors commented that their anecdotal
experience aligns with that of the British study.

In several patients on
long-term SSRIs, I have noticed some subtle personality changes,” says a
psychiatrist. “Of course, there’s no way of ascertaining cause and effect
without a good, long-term study, but this is what I’ve observed: (1) SSRIs

decrease pain (irritability, depression) but also seem to increase the threshold
for what constitutes an exciting event (a person needs more novelty than
previously for the same effect); and (2) SSRIs increase apathy and have the
potential to decrease empathy.”

“It would be unrealistic,” adds another
psychiatrist, “to think that taking a medication which significantly impacts a
major neurotransmitter would not have, in some cases if not many, a significant
effect on a person’s personality, either short- or long-term.” The psychiatrist
comments that case studies documented in Peter Kramer’s book Listening to
Prozac
indicate that SSRIs strongly impact a patient’s feeling of “caring,”
which can affect the patient’s relationships with friends and family.

An
endocrinologist suggests that his colleagues view the film Numb, which
documents filmmaker Phil Lawrence’s struggle to stop taking the popular SSRI
Paxil. In the trailer for the film, Lawrence says, “I’m flatlined. This isn’t
me. This is me on Paxil®.”[2]

“These are the
wonder drugs of psychiatry,” argues a psychiatrist. “They continue to benefit
people over the long term, even at low doses. They help with anxiety, much more
robustly than with depression, but they help in depression too. If I had my way
Prozac®, Zoloft®, and Celexa® would be sold
over the counter.” The psychiatrist comments that the life-time prevalence of
depression is between 15% and 30%,[3] and most people remain
untreated for fear of persecution and judgment formation about their need to
take antidepressant drugs. Over-the-counter distribution, he reasons, would make

SSRIs more readily available to people who need them.

“I disagree about
the OTC [over-the-counter] issue,” replies Stephen Grcevich, MD, a child and
adolescent psychiatrist. “I think there are untoward effects of SSRIs that are
still poorly understood, such as the very small but statistically significant
risk of suicidal behavior in persons aged 25 and under. We also saw a subgroup
of kids who displayed significant disinhibition and indifference to academics in
a large, open-label, federally funded study looking at SSRI safety.” He comments
that he hopes to present the study data at the 2010 annual meeting of the
American Academy of Child and Adolescent Psychiatry (AACAP).

An internist
who frequently prescribes SSRIs, reports that she repeatedly experienced
suicidal thoughts while taking an SSRI for depression. “I have been placed by my
physician on Lexapro® 3 times. In each instance, my mood lifted and
crying decreased. I could sleep. In 3 days’ time, I started having thoughts that
came out of the blue, such as ‘I want to drive off this bridge.’ Stopping the
medication stopped the thoughts.” She says that she tells her patients about
this potential side effect, but no patient has related having a similar
response.

SSRIs and then SNRIs [serotonin noradrenaline reuptake
inhibitors] nearly killed me,” says an obstetrician/gynecologist. “They caused
narcolepsy, and I fell asleep and drove off the road.” He comments that his
level of apathy while taking the drugs was so extreme as to appear parkinsonian.
In my opinion as a patient, mild to moderate depression should be treated by
cognitive behavioral therapy, not meds.”

A surgeon comments that, in many
cases, SSRIs are given to patients who are only mildly depressed. “The drugs are
given as mood elevators,” he says. “We essentially are giving out the drug for
the same reason people self-medicate or abuse alcohol.”

“I do agree we
are pushed to start meds too early on mild cases sometimes,” says a family
medicine physician. “We must ask the tough questions of patients about suicidal
thoughts to determine the severity of their illness. Then start a multipronged
approach to treatment and not just write a script and send them out the
door.”

A neurosurgeon comments that clearly there are a number of
questions about SSRIs that need to be addressed:

  • Should we treat mild depression knowing the risks?
  • Are we educating patients about the possibility that they will experience
    apathy?
  • Are we increasing the risk for substance abuse in patients who attempt to
    counterbalance induced conditions of apathy and boredom?
  • Are the artificially high levels of serotonin caused by the use of SSRIs
    chronically changing the brain and making it impossible to withdraw from these
    drugs?


“I agree that higher doses and long-term use does blunt
emotions,” says a pediatrician. “I used Effexor® for about 7 years
and tried to wean off during that time, but at very low doses would redevelop
extreme sadness that resolved when I upped the dose.” He says that working with
his psychiatrist, he switched to Wellbutrin® and now experiences a
wider range of appropriate emotions. “However, if I did not have another option,
I would prefer Effexor® side effects over the chronic anxiety and
sadness I experienced for much of my life without it.”

The authors of the
British study reported a similar finding. Many participants in the study
considered whether they should stop taking their medication, but viewed the side
effects as preferable to the illness for which they were being
treated.

“And that is the problem, isn’t it?” comments an MPC
contributor. “We just don’t have meds that treat without some side
effects.”

The full discussion can be accessed at http://boards.medscape.com/forums/.29f65335

References

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ANTIDEPRESSANTS: Emotional Blunting: British Journal of Psychiatry

NOTE BY Ann Blake-Tracy (www.drugawareness.org): Studies like these make me crazy!!!! Why? Talk about OBVIOUS!!! Why do you need a study?! Here are their reasons for doing so and what they intended to learn. Continue reading and I will tell you where they are missing the mark with this one.

Paragraphs three & four read:

Background:
Some people who take selective serotonin reuptake inhibitor (SSRI) antidepressants report that their experience of emotions is ‘blunted’. This phenomenon is poorly understood.

Aims:
To understand patients’ experiences of this phenomenon.

NOTE FROM Ann Blake-Tracy CONTINUED:

1. Are emotions and consciousness blunted when you are under anesthesia?

2. The SSRI antidepressants are almost identical to the dissociative anesthetic, Serynl, first introduced in 1957 by Parke Davis Pharmaceutical. It was accompanied by studies showing it to have a “large margin of safety in humans.” Today we know the drug as PCP, Angel Dust, etc. Law enforcement, not physicians, got the drug pulled from the market due to the high number of extremely violent outbursts caused by the drug.

3. Patients coming off SSRI antidepressants commonly report that they feel as if they are coming out from under anesthesia.

4. Many patients taking the antidepressants report not being able to bond to their own babies due to this emotional blunting when given an antidepressant for Post Partum Depression after birth.

5. Patients have also reported stopping the use of the antidepressants because of the emotional blunting (for years these have been known among patients as the “I don’t give a damn” drugs). I recall one patient coming to me years ago and telling me she got off her antidepressant because she realized that she could drive off the road with her children in the car and care less. Nothing mattered.

So, my question is, if you are putting someone on antidepressants that will over time put you gradually into an anesthetised state, wouldn’t you expect “emotional blunting”?!

http://bjp.rcpsych.org/cgi/content/abstract/195/3/211

The British Journal of Psychiatry (2009) 195: 211-217. doi: 10.1192/bjp.bp.108.051110
© 2009 The Royal College of Psychiatrists

Emotional side-effects of selective serotonin reuptake inhibitors: qualitative study

Jonathan Price, DPhil, MRCPsych, Victoria Cole, MSc and Guy M. Goodwin, FMedSci DPhil

University of Oxford Department of Psychiatry, The Warneford Hospital, Oxford, UK

Correspondence: Jonathan Price, University of Oxford Department of Psychiatry, The Warneford Hospital, Oxford OX3 7JX, UK. Email: jonathan.price@psych.ox.ac.uk

Declaration of interest

J.P. has received grants and honoraria from Servier and is a former shareholder in a UK company marketing a computerised CBT package for depression. G.G. has received grants from Sanofi-Aventis and Servier in the past and recent honoraria from AstraZeneca, BMS, Eisai, Lundbeck and Servier. He is a current advisor for AstraZeneca, BMS, Lilly, Lundbeck, P1Vital and Sanofi-Aventis, and a past advisor for Servier and Wyeth.

Funding

Servier, the funders, were able to comment on initial study design, but had no role in the collection, analysis and interpretation of data, and no role in the writing of the manuscript. Servier have a research programme for the development of psychotropic compounds, including antidepressants. Although they were able to comment on the final manuscript, no changes were introduced as a result of their comments, and they had no influence on the decision to submit the paper for publication. The researchers were, therefore, independent of the funders.

Background

Some people who take selective serotonin reuptake inhibitor (SSRI) antidepressants report that their experience of emotions is ‘blunted’. This phenomenon is poorly understood.

Aims

To understand patients’ experiences of this phenomenon.

Method

Qualitative study, gathering data through individual interviews, a group interview and validation interviews; and searching patient websites for relevant posts.

Results

There was strong evidence that some people taking SSRIs experience significant emotional symptoms that they strongly attribute to their antidepressant. These emotional symptoms can be described within six key themes. A seventh theme represents the impact of these side-effects on everyday life, and an eighth represents participants’ reasons for attributing these symptoms to their antidepressant. Most participants felt able to distinguish between emotional side-effects of antidepressants and emotional symptoms of their depression or other illness.

Conclusions

Emotional side-effects of SSRIs are a robust phenomenon, prominent in some people’s thoughts about their medication, having a demonstrable impact on their functioning and playing a role in their decision-making about antidepressant adherence.

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1/11/2001 – More Self Harm Seen with SSRI Therapy Than With Tricyclics

Now, a report out of the UK debunks a popular marketing
strategem of SSRI manufacturers–that SSRI’s are inherently
safer because they are less toxic in overdose. This study
recently published in the British Journal of Psychiatry clearly
points to a great risk of self-harm with drugs like Prozac, Zoloft
and Paxil over the older tricyclic antidepressants. Mark
———

More Self Harm Seen with SSRI Therapy Than With Tricyclics

http://psychiatry.medscape.com/reuters/prof/2000/12/12.29/20001228clin013.html

WESTPORT, CT (Reuters Health) Dec 28 – Significantly more
instances of deliberate self-harm occur in patients prescribed a
selective serotonin reuptake inhibitor (SSRI) than in those
prescribed a tricyclic antidepressant (TCA). In their report in the
December issue of the British Journal of Psychiatry, UK
investigators caution that the choice of antidepressant for
patients at risk should not be based solely on overdose toxicity.

In this prospective study, 2776 deliberate self-harm events
occurred in 1954 individuals attending the Derbyshire Royal
Infirmary in 1995 and 1996. Dr. Stuart Donovan, of University
Hospital, in Nottingham, and associates observed that the most
frequent method of self-harm was medication overdose, and
paracetamol (acetaminophen) was the medication most
frequently involved

In the cases of antidepressant overdoses, SSRIs were used
more often than TCAs, in 16.0 and 11.8 cases per 10,000
prescriptions, respectively. The relative incidence of self-harm
events was significantly higher in those prescribed SSRIs than
in those prescribed TCAs. Exposure times were similar for the
two types of drugs.

Dr. Donovan’s group adds that SSRIs may have been prescribed
more often following unsuccessful use of a TCA, making it
possible that “a greater proportion of more ‘difficult to treat’
patients may have been prescribed SSRIs and this may
manifest as a greater risk of deliberate self-harm.” However, they
emphasize that the reduced overdose toxicity of SSRIs
compared with TCAs “does not extrapolate to a reduced risk of
deliberate self-harm.”

In fact, the reduced risk of morbidity following overdose is offset
by the higher risk of self-harm by other methods in patients
taking SSRIs.

Br J Psychiatry 2000;177:551-556.
Copyright © 2000 Reuters Ltd. All rights reserved.

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