Apathy associated with antidepressant drugs: a systematic review

Author:

Masdrakis Vasilios G.,Markianos Manolis,Baldwin David S.ORCID

Abstract

AbstractObjectives:Administration of antidepressant drugs – principally selective serotonin reuptake inhibitors (SSRIs) – may induce clinically significant ‘apathy’ which can affect treatment outcomes adversely. We aimed to review all relevant previous reports.Methods:We performed a PUBMED search of English-language studies, combining terms concerning psychopathology (e.g. apathy) and classes of antidepressants (e.g. SSRI).Results:According to certain inclusion (e.g. use of DSM/ICD diagnostic criteria) and exclusion (e.g. presence of a clinical condition that may induce apathy) criteria, 50 articles were eligible for review. Together, they suggest that administration of antidepressants – usually SSRIs – can induce an apathy syndrome or emotional blunting, i.e. a decrease in emotional responsiveness, to circumstances which would have triggered intense mood reactions prior to pharmacotherapy. The reported prevalence of antidepressant-induced apathy ranges between 5.8 and 50%, and for SSRIs ranges between 20 and 92%. Antidepressant-induced apathy emerges independently of diagnosis, age, and treatment outcome and appears dose-dependent and reversible. The main treatment strategy is dose reduction, though some data suggest the usefulness of treatment with olanzapine, bupropion, agomelatine or amisulpride, or the methylphenidate–modafinil–olanzapine combination.Conclusion:Antidepressant-induced apathy needs careful clinical attention. Further systematic research is needed to investigate the prevalence, course, aetiology, and treatment of this important clinical condition.

Publisher

Cambridge University Press (CUP)

Subject

Biological Psychiatry,Psychiatry and Mental health

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