APATHY ASSOCIATED WITH ANTIDEPRESSANT DRUGS-A SYSTEMATIC REVIEW

Objectives: 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%-50%, and for SSRIs ranges between 20%-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, etiology, and treatment of this important clinical condition. © Scandinavian College of Neuropsychopharmacology 2023