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Aydemir, 2018 SSRI Induced Apathy Syndrome

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Psychiatry and Behavioral Sciences 2018;8(2):63-70 http://dx.doi.org/10.5455/PBS.20180115111230

SSRI Induced Apathy Syndrome

Elcin Ozsin Aydemir1 , Eda Aslan2 , Mustafa Kemal Yazici2

 

Full text at www.pbsciences.org/pdf/EN-JMOOD-74045399.pdf

 

ABSTRACT
Objective: Apathy is defined as diminished motivation and reduced goal-directed behavior accompanied by decreased emotional responsiveness. Besides being a symptom of some neurological conditions and psychiatric disorders, apathy is also a known to be an adverse effect of antidepressants. Although attention to antidepressant-induced apathy has been increasing in recent years, studies about apathy are still very limited and generally presented as case reports. Despite being an important cognitive side effect of antidepressants it is not well recognized and may be misinterpreted as a residual symptom of the psychiatric disorder by clinicians. In this study, we aimed to analyze apathy levels of patients with anxiety disorders (AD) and major depressive disorder (MDD) before and after antidepressant treatment, with a prospective design.


Methods: Our study included 20 MDD and 20 AD patients admitted to Mersin University Research and Training Hospital, Outpatient Clinic of Psychiatry, who have not taken any antidepressant medication for at least last one month. Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Apathy Evaluation Scale (AES) were administered before antidepressant treatment and on the 6th week of the treatment. Correlations and relationships between scale scores were analyzed.


Results: Thirty-five (87,5%) of the 40 patients were taking Selective Serotonin Reuptake inhibitors (SSRIs), while 5 (12,5%) were taking Serotonin-Noradrenalin Reuptake Inhibitors (SNRIs). In the whole group of patients, AES scores increased from a mean of 20,5 at baseline to 25 after antidepressant treatment (p<0,05). The increase in AES scores were significant only in patients taking SSRIs (p<0.001). Symptoms of depression and anxiety were improved in both patient groups. The mean HAM-D scores before and after treatment were 17,8 and 8,2 in MDD patients, respectively (p<0,05). The mean HAM-A score was 18,6 in AD patients before treatment, which decreased to a mean of 9,9 points after treatment (p<0,05).


Conclusion: Despite the reduction in depression and anxiety scores, six weeks of treatmet with SSRIs was associated with the development of apathy in our study group, consisting of patients with MDD or AD. Clinicians should bear in mind that apathy is likely to occur within weeks of SSRI treatment and screen for it during the course of treatment.


Keywords: Anxiety disorder, apathy, major depressive disorder, SSRI, SNRI, side effect


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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ShiningLight

This is so validating! I've spent 20 years being this way and thinking it was me. :( I can even see a difference in myself 10 years ago vs now.


Now: Gabapentin 31 mg 4x/day =124 mg, 150 mg Zoloft am since 2004, 50 mg Trazodone bedtime.  Daily drug burden decreased from 2050 mg to 324 mg 🐢🐢

2020, Gabapentin each dose 4x/day: Aug 20 31 mg, Aug 18, 33 mg, July 29, 35 mg, July 23 38 mg, July 22 40 mg Jun 24 42 mg, Jun 15 44 mg, Jun 9 48 mg, May 22 50 mg, May 14 54 mg, May 7 56 mg, Apr 16 58 mg, Mar 28 60 mg, Mar 18 62 mg. Feb 26 64 mg. Feb 19, 66 mg. Jan 23, 70 mg.

2019 Dec 19, 72 mg. Nov 14 ,76 mg. Aug 8, 80 mg. Aug 6, 85 mg. Jul 26, 90 mg. Jul 11, 95 mg.

Jul 16 trazodone from 100 to 50 mg.

Jun 17-July 10 Slowly changed gab fr pill to liquid at same dose 100 mg 4x/d.

Apr 24 Stopped klon!!! 🌞 Apr 4  Decreased gaba to 400 mg (100 mg 4x/day)-Apr 4, 2019   0.25 klon

March 11  Klonopin .5 mg twice daily, varied dose til Apr 15. Started Klon fast taper 25%, short use

Mar 16, 450 mg gaba 3x/day cut 600 mg--not exact!--updose after learning w/d

Feb 20, 1800 mg gabapentin; MD taper; off 3 days=mvt disorder & autonomic instability. July 2018 temazepam 15 mg 1-2; prn several x/wk til Jan/Feb 2019 when cold turkey, flu illness for months

July 2018 started gabapentin 100 3x/day; titrated up to 1800 mg (600 3x/day)

Buspar, I forget how much, 2 pills a day Jan 2017-July 2018 cold turkey

*I speak from my experience. Nothing I say is medical advice. I'm not a doctor.

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FleeingFluoxetine

This could be why I don’t care to do much lately. 


As of May 28th, 2020:

15 mg liquid Prozac

12.5 mg Imovane

50 mg Seroquel

20 mg Propranolol 3x a day

0.5 mg Clonazepam 3x a day

Supplements including Omega 3 fish oil, vitamin B complexes, magnesium, vitamins A, C, and E

 

 

 

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drugged

I think I'm suffering from this and I believe that this apathy is causing me the most harm.  I've lost significant muscle mass, strength, and endurance due to my becoming completely sedentary these last 5 years or so.  Prior to that I was a very active and athletic person.  I have tried to get back into some type of exercise routine and, the few times I've been successful for even a few days, I've felt so much better for doing so.  I can't seem to summon the motivation to follow through though.  It seems like too much effort to get dressed and go out for a walk or go to the gym or even do a bit of yoga at home.  

 

Every time I see a doctor I'm screened for depression and I'm constantly told that I'm depressed but I'm NOT depressed!  I try to explain the difference between apathy and depression but no one is listening.  I was prescribed an antidepressant years ago therefore any and all issues I might struggle with MUST be depression.  

 

Note: I wasn't diagnosed with depression.  I was diagnosed with PTSD.


1994  Venlafaxine XR 300mg, 2003 tapered, 2004 off briefly back to 37.5 then 75mg, held, June 2019 up to  150mg, Aug.12 tapered down to 112.5mgs, Oct. 21, 2019 96mg;  Dec. 8, 2019  90mg, Jan. 8 2020 81mg, Feb. 4, 75mg;

2003/2004? Diazepam 10mg/bedtime

2013 Lyrica 300mg to 25mg; April 6, 2020 17mg; April 28, <5mg; May 7, 2020 Lyrica 0 mg!

2013 Tramadol 50mg tablets, 200mg/day divided

2005? Trazodone 50mg bedtime, Feb. 12, 2020 40mg, March 7, 25mg

2009? Zolpidem 5mg at bedtime. Nov. 9, 2019 Zolpidem 0 mg! 

1990? Omeprazole 20mg in morning.

2010? Levothyroxine 75mcg morning

2011? Liothyronine 5mcg morning

1999? Buspirone 30mg twice a day  August 2019 15mg once a day,  Oct.21, 2019 2.5mg evening  Oct. 25, 2019 Buspirone 0 mg!

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FleeingFluoxetine
6 hours ago, drugged said:

- For me it's always been all about the drugs. I was never depressed until I tried coming off my crazy high dose of Prozac. I got to almost zero on it, but I was crying at everything and definitely depressed, so my doctor put me on Cipralex. It got rid of the tears, but it made me completely apathetic to life. I would wake up every morning thinking how bleak I felt, how I didn't care to do anything. I was on it for a few months and got up to 20 mg. Then my doctor and I started lowering it by 5 mg amounts, and every time we did I felt better and more enthusiastic about life.

Once I got off the Cipralex, it meant that the Seroquel which I had been taking for sleep was able to effect my brain without any interference, and I fell into this crazy apathy where I just didn't care about anything. I would lie on the sofa and do nothing, and doing anything felt like pushing through Saran Wrap. About a month ago we started weaning me off the Seroquel, and within three days I was getting off the sofa, getting back into my hobbies, getting back into my life. I still have 68 mg to go (and the withdrawal feelings are awful) but every time we reduce the dose I feel better and more energized. The first day after I reduce it I'm usually bouncing off the walls, but then I settle down.

I also read a post by a woman on drugs.com about Seroquel. She was put on it for sleep by her doctor, and "about the same time" (that's the phrase to look out for) she developed this terrible depression that put her on the sofa and made her useless for two years. Then one weekend she goes on a trip and forgets to take her meds with her. She wakes up the next day and her depression is gone.

I know it's not the same for everyone, but the 100 mg of Seroquel felt like someone had put a weight on me, and especially on my eyes. Every time I lower the dose, it weighs a little less. I'm hoping to reduce the drug again in about a week or so. I'm paying close attention to the 10% rule, even if I know I'm going to have to break it because the pills don't cut so easily.

I hope this helps.

Fleeing

 

 

6 hours ago, drugged said:

 

 

I think I'm suffering from this and I believe that this apathy is causing me the most harm.  I've lost significant muscle mass, strength, and endurance due to my becoming completely sedentary these last 5 years or so.  Prior to that I was a very active and athletic person.  I have tried to get back into some type of exercise routine and, the few times I've been successful for even a few days, I've felt so much better for doing so.  I can't seem to summon the motivation to follow through though.  It seems like too much effort to get dressed and go out for a walk or go to the gym or even do a bit of yoga at home.  

 

Every time I see a doctor I'm screened for depression and I'm constantly told that I'm depressed but I'm NOT depressed!  I try to explain the difference between apathy and depression but no one is listening.  I was prescribed an antidepressant years ago therefore any and all issues I might struggle with MUST be depression.  

 

Note: I wasn't diagnosed with depression.  I was diagnosed with PTSD.

 


As of May 28th, 2020:

15 mg liquid Prozac

12.5 mg Imovane

50 mg Seroquel

20 mg Propranolol 3x a day

0.5 mg Clonazepam 3x a day

Supplements including Omega 3 fish oil, vitamin B complexes, magnesium, vitamins A, C, and E

 

 

 

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Rhiannon
On 9/10/2019 at 4:14 AM, drugged said:

I think I'm suffering from this and I believe that this apathy is causing me the most harm.  I've lost significant muscle mass, strength, and endurance due to my becoming completely sedentary these last 5 years or so.  Prior to that I was a very active and athletic person.  I have tried to get back into some type of exercise routine and, the few times I've been successful for even a few days, I've felt so much better for doing so.  I can't seem to summon the motivation to follow through though.  It seems like too much effort to get dressed and go out for a walk or go to the gym or even do a bit of yoga at home.  

 

Every time I see a doctor I'm screened for depression and I'm constantly told that I'm depressed but I'm NOT depressed!  I try to explain the difference between apathy and depression but no one is listening.  I was prescribed an antidepressant years ago therefore any and all issues I might struggle with MUST be depression.  

 

Note: I wasn't diagnosed with depression.  I was diagnosed with PTSD.

 

I was started on Prozac for PTSD too. With absolutely NO evidence base of any kind. Just a doctor who said "try this." GRRRRRRRRRRRRR

 

Anyway, the thing about apathy is interesting. I've always thought of apathy as sort of a passive emotional state, and when I was on the meds my emotional state was definitely not passive, I was suffering a lot and in tons of internal turmoil all the time. But it's true that I did lose interest in the things that I had enjoyed in the past. I'm not sure I've ever gotten my old passion for life back even now, but I definitely remember a point in my AD taper where I noticed that I was actually wanting to go out and do things again. (I don't do as much as I want to, because it's just still too overwhelming; I need a lot of down time.)


Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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drugged
14 hours ago, Rhiannon said:

 

I was started on Prozac for PTSD too. With absolutely NO evidence base of any kind. Just a doctor who said "try this." GRRRRRRRRRRRRR

 

Anyway, the thing about apathy is interesting. I've always thought of apathy as sort of a passive emotional state, and when I was on the meds my emotional state was definitely not passive, I was suffering a lot and in tons of internal turmoil all the time. But it's true that I did lose interest in the things that I had enjoyed in the past. I'm not sure I've ever gotten my old passion for life back even now, but I definitely remember a point in my AD taper where I noticed that I was actually wanting to go out and do things again. (I don't do as much as I want to, because it's just still too overwhelming; I need a lot of down time.)

Exactly!  There's all this turmoil around me and in me but I have no interest in the things I used to like to do just a few years ago.  Even 5 years ago I still had things I enjoyed doing but not now.  Each time I make a tiny cut I'm saying to myself, "Maybe this time I'll feel just a bit more motivated to do something." 


1994  Venlafaxine XR 300mg, 2003 tapered, 2004 off briefly back to 37.5 then 75mg, held, June 2019 up to  150mg, Aug.12 tapered down to 112.5mgs, Oct. 21, 2019 96mg;  Dec. 8, 2019  90mg, Jan. 8 2020 81mg, Feb. 4, 75mg;

2003/2004? Diazepam 10mg/bedtime

2013 Lyrica 300mg to 25mg; April 6, 2020 17mg; April 28, <5mg; May 7, 2020 Lyrica 0 mg!

2013 Tramadol 50mg tablets, 200mg/day divided

2005? Trazodone 50mg bedtime, Feb. 12, 2020 40mg, March 7, 25mg

2009? Zolpidem 5mg at bedtime. Nov. 9, 2019 Zolpidem 0 mg! 

1990? Omeprazole 20mg in morning.

2010? Levothyroxine 75mcg morning

2011? Liothyronine 5mcg morning

1999? Buspirone 30mg twice a day  August 2019 15mg once a day,  Oct.21, 2019 2.5mg evening  Oct. 25, 2019 Buspirone 0 mg!

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