How antidepressants affect your ability to enjoy activities you once loved

Friday, June 7, 2024.

Antidepressants can be a double-edged sword.

While they help alleviate the psychological pain of depression, they can also dull the pleasure from activities that once brought joy.

This phenomenon, known as "emotional blunting," affects about half of all patients on these medications. Let's dive into why this happens and how it impacts everyday life.

The Emotional Blunting Effect

Emotional blunting manifests as a lack of motivation, apathy, or emotional numbness. Imagine trying to enjoy your favorite hobby, but instead of feeling the usual excitement, you feel... well, nothing. This is a common experience for those on antidepressants.

The Science Behind the Numbness

A study on 66 humans found that antidepressants, specifically the SSRI escitalopram (known as Lexapro or Cipralex), reduce sensitivity to rewards. Participants who took escitalopram for three weeks showed decreased "reinforcement sensitivity," which is crucial for learning from our environment.

Reinforcement learning helps us repeat behaviors that lead to positive outcomes and avoid those that lead to negative ones. For example, if you enjoy a walk in the park today, you're more likely to do it again tomorrow. But if an out-of-control dog scares you, you're less likely to go for another walk soon.

Why Rewards Don't Feel Rewarding

Taking SSRIs like escitalopram makes people less responsive to this pleasure/pain principle. Without the sensation of pleasure, those on these medications may stop engaging in activities that usually bring joy — the very things that make life worth living.

As Professor Barbara Sahakian, study co-author, explains:

"Emotional blunting is a common side effect of SSRI antidepressants. In a way, this may be in part how they work—they take away some of the emotional pain that people who experience depression feel, but, unfortunately, it seems that they also take away some of the enjoyment.

From our study, we can now see that this is because they become less sensitive to rewards, which provide important feedback."

The Next Steps in Research

The researchers are now examining how escitalopram affects the brain during reward learning. Dr. Christelle Langley, the study’s first author, says:

"Our findings provide important evidence for the role of serotonin in reinforcement learning. We are following this work up with a study examining neuroimaging data to understand how escitalopram affects the brain during reward learning."

Common Antidepressant Side Effects

Antidepressants come with a variety of side effects, including:

• Nausea

• Headache

• Dry mouth

• Drowsiness

• Insomnia

• Agitation

• Sexual dysfunction

• Weight gain

The duration of these side effects varies. While some, like nausea or headache, may subside within days or weeks, others, such as weight gain or sexual dysfunction, might persist throughout the treatment.

Final thoughts

Understanding the side effects of antidepressants, especially emotional blunting, is crucial.

Talking to a healthcare provider is essential if you or someone you know is experiencing these symptoms. Balancing the benefits and side effects of antidepressants can help ensure a better quality of life.

Remember, while antidepressants can dull some feelings, they are also vital in managing depression. It's all about finding the right balance.

Be Well, Stay Kind, and Godspeed.

REFERENCES:

Langley, C., Armand, S., Luo, Q., Savulich, G., Segerberg, T., Søndergaard, A., Pedersen, E. B., Svart, N., Johansen, A., Borgsted, C., Cardinal, R. N., Robbins, T. W., Stenbæk, D. S., Knudsen, G. M., & Sahakian, B. J. (2023). Chronic escitalopram in healthy volunteers has specific effects on reinforcement sensitivity: A double-blind, placebo-controlled semi-randomised study. Neuropsychopharmacology, 48(4), 664-670. https://doi.org/10.1038/s41386-022-01523-x