Depression has a marked effect on compromising psychological functioning, and therefore, impairing one’s ability to attain and sustain effective social interactions. Intuitively, many in the field of mental health have assumed that it is the condition of depression itself that can also negatively impact empathy. However, recent findings by Rütgen et al. (2019) suggest that treatment with antidepressants, rather than the inherent condition of depression itself, is implicated in reduced empathy in individuals with depression.
In this longitudinal study at the University of Vienna, a cohort of patients with diagnosed Major Depressive Disorder (MDD) took part in sessions of functional magnetic resonance imaging (fMRIs) prior to, as well as three months after taking antidepressant medications, in particular, selective serotonin-norepinephrine reuptake inhibitors (SSRIs).
What the authors did, both before and after antidepressant therapy, was to assess the participants for their empathetic responses to the pain of others. This stimulus of the “pain of others” was presented to the participants as videos of people who underwent changes in facial expressions from neutral to painful subsequent to being exposed to a painful sound.
The participants were told that the people in the videos suffered from severe tinnitus, and that the administration of this painful sound was part of a necessary, but nonetheless unpleasant, auditory stimulation therapy for them.
The participants, at periodic intervals, were also to rate both the unpleasantness that they perceived was felt by the people in the video (target unpleasantness), as well as to the unpleasantness that they themselves felt while watching the videos (self-experienced unpleasantness).
These rating was done to gauge empathy for the pain of others. This (experiment) was done concurrently with neuroimaging.
Changes in Empathy Not Connected to Depression
The authors found that, at the beginning of the study, prior to SSRI treatment, the MDD patients exhibited no difference either on neuroimaging or on empathy ratings when compared to healthy controls. This result suggested that any changes in empathy were not because of the depression itself.
However, three months after SSRI treatment, the MDD cohort exhibited notable decreases in fMRI neural responses and connectivity in the bilateral anterior midcingulate cortex (aMCC) and the bilateral anterior insular (AI) cortex. These same segments of the brain have been found to be generally activated in the condition of empathic pain (Lamm, Decety, & Singer, 2011).
Additionally, the MDD patients reported a notable decrease in self-experienced unpleasantness in response to the stimulus of others in pain.
Research in prior literature has often cited the notion that SSRIs can induce apathy and general indifference (Barnhart, Makela, & Latocha, 2004). However, in this study, it must be noted that cognitive empathy and general affect did not change after antidepressant therapy.
Furthermore, there was no overall blunting in general negative emotions. What the authors suggest is that the antidepressants may elicit a reduction in aversive responses that would normally be induced upon exposure to the pain and suffering of others.
Depression Improves But Empathy Diminishes
Taking this into account, the authors established a correlation between improvement in depression and reduced pain empathy. Their logic is such that this pharmacological treatment of depression enables individuals to feel less of an emotional impact of negative effects around them that affect others. This can possibly enable the patient to be less prone to carrying on additional emotional baggage, and allow them to recover more effectively and easily.
Of course, more research will be needed to delve further into this potential effect of the drug (and the mechanistic features therein). However, it is something that should definitely be taken in account, and is potentially significant in the context of patients’ interactions with their loved ones, which may change to the point that the depressed patient may seem like a new person.
Just as much as we stress the somatic effects of drugs, we should also reiterate that there are psychological changes, intentional or otherwise, that may manifest with drugs such as antidepressants. Being able to learn more about the nature of such drugs in greater mechanistic detail can allow us to tailor our treatments, both our psychotherapy and our pharmacotherapy, in a way that is most beneficial and least detrimental to our patients.
Barnhart, W. J., Makela, E. H., & Latocha, M. J. (2004). SSRI-Induced Apathy Syndrome: A Clinical Review. Journal of Psychiatric Practice, 10(3), 196-199. doi:10.1097/00131746-200405000-00010
Lamm, C., Decety, J. & Singer, T (2011). Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain. Neuroimage 54, 2492–2502.
Rütgen, M., Pletti, C., Tik, M., Kraus, C., Pfabigan, D. M., Sladky, R., . . . Lamm, C. (2019). Antidepressant treatment, not depression, leads to reductions in behavioral and neural responses to pain empathy. Translational Psychiatry, 9(1). doi:10.1038/s41398-019-0496-4