A review of ssri-induced indifference
Download 203.85 Kb.
|
BackgroundA quick internet search of the layman’s mental health related forums shows that there is much public concern about the emotional blunting associated with SSRIs. The concerns are sometimes described by patients in dramatic terms such as “feeling like a zombie” or “losing your personality”1 – these concerns play on the element of the horror present in us of the effacement of the personality and the loss of the self.2 The ability to respond fully and appropriately to emotional stimuli is an essential human function, the loss of which can cause problems for patients in their relationships and general wellbeing.3 The adverse effect of emotional blunting poses challenges for the clinician in practice. Firstly, whether it is common or serious enough that we ought to advise our patients of the risk when offering to start an SSRI and whether the suggestion of the risk itself may influence its appearance. Secondly, whether the clinician can be confident the adverse effect is caused by the SSRI directly, and not related to a residual symptom of depression, or a pre-existing personality characteristic. Despite the public concerns anecdotally, and the ubiquity of the use of SSRI medications, this phenomenon has been little studied in the past. In an early review by Barnhart et. al., a series of case reports describes loss of motivation and indifference, or conversely disinhibition, and concludes that there is a phenomenon of the “treatment-emergent emotional blunting”.4 The conclusion that the phenomenon was real was derived from firstly, subjective reports by patients of the different quality of the loss of motivation upon commencing SSRI, secondly, the abatement of the symptoms with a decrease in dose of the SSRI and thirdly, objective evidence of cerebral blood flow demonstrated by computed tomography matching neuropsychological testing that supported the hypothesis that the effect in question was a “reversible frontal lobe syndrome”. This theme of emotional blunting being part of a larger syndrome of symptoms is articulated more fully by Sansone and Sansone5 in their review in 2010. They describe apathy and loss of motivation, as the behavioral counterpart to the emotional perspective of the syndrome termed emotional blunting that refers to the diminished emotional sensitivity and responsiveness in interpersonal relationships and other parts of daily living. The authors therefore recommend the term “SSRI-induced indifference” as a name that recognizes this cluster of symptoms. However, the literature subsequently has continued to refer to the cluster of symptoms as emotional blunting and that is the term I shall use in this review. The terms emotional diminution/reduction of emotional responsiveness, a sense of emotional blunting or numbing, or detachment or indifference have all been used in the various studies.5 These earlier reviews accept that there are no large-scale epidemiological studies and that the epidemiology and etiology are largely unknown. Boyce in his review3 suggests that while their treatment effect lies in reducing emotional response to negative events, serotonergic drugs reduce emotional responsiveness generally. These reviews suggest that SSRI-induced emotional blunting is likely to be under-recognized (due to low-insight in those afflicted), have an insidious and delayed onset, and can be completely resolved with dose reduction or discontinuation of the SSRI. Given that none of the reviews offer a comprehensive search methodology and that there have been several studies since the 2010 review, it is worthwhile to systematically review the literature to explore the epidemiology of the phenomenon. Download 203.85 Kb. Share with your friends:
|