Posted by JPHR on January 4, 2009, at 16:34:57
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by Neal on January 4, 2009, at 1:02:17
There are two reasons for suggesting a distinction between "apathy syndrome," which is thought to be a side effect of SSRI use (especially long-term SSRI use), and apathy as a symptom of depression. First, the emotional state of people suffering from apathy syndrome differs from that of people suffering from depressive apathy. To be specific, depressive apathy generally is associated with emotional distress, whereas SSRI-induced apathy generally is not. Second, a reduction in SSRI dosage often results in a decrease in the apathy of those suffering from apathy syndrome. This distinction between the two types of apathy was described in the review article by Barnhart, Makela, and Latocha (2004) mentioned in other posts in this thread. In the following, I will excerpt the relevant passage from that article (it can be found on page 196 of the article):
"Although apathy is conventionally defined as indifference, a clinical definition must be more specific, since there are many cases in which a manifest indifference would not be considered the result of apathy (e.g., intoxication, sedation). Marin [1991] suggested the following definition of apathy: a syndrome in which there is a primary absence of motivation that is not attributable to cognitive impairment, emotional distress, or diminished level of consciousness. Based on this definition, he suggests that the following conditions comprise the differential diagnosis of apathy: delirium, dementia, abulia [a lack of will or initiative resulting from a disease process], akinesia [an inability to initiate movement resulting from a disease process], despair, demoralization, and, perhaps most important for the purposes of this review, depression, since depressed patients are often characterized as being apathetic [Marin, 1990]. However, Marin noted that, although externally inactive, these patients may be in great emotional distress internally.
"There is subjective evidence that the inactivity or loss of interest experienced in depression is different from the apathy that may be experienced as a late-onset side effect in SSRI treatment. One patient noted that this experience was unlike the lack of motivation she had sometimes experienced during prior episodes of depression [Hoehn-Saric, Lipsey, & McLeod, 1990]. Another noted that her feelings of apathy bore no relationship to depression. Several adolescent patients who experienced such an effect reported being unconcerned or feeling 'fine' [Garland & Baerg, 2001]. Objectively, the data indicate that this effect diminishes with a decrease in SSRI dose, even when the dose has been titrated to a level that remains effective in treating the patients symptoms."
There is speculation, apparently supported by some evidence, that apathy syndrome is the result of decreased activity in the frontal lobes. Among many other things, frontal-lobe activity is important for goal-oriented behavior. People with damage to particular areas in the frontal lobes often show a great deal of apathy and avolition.
REEFERNCES
Barnhart, W.J., Makela, E.H., & Latocha, J. (2004). Selective serotonin reuptake inhibitor induced apathy syndrome: A clinical review. Journal of Psychiatric Practice, 10(3), 196-199.
Garland. E. J. & Baerg, E. A. (2001). Amotivational syndrome associated with selective serotonin reuptake inhibitors in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 11, 181186.
Hoehn-Saric, R., Lipsey, J. R., & McLeod, D.R. (1990). Apathy and indiffer-ence in patients on fluvoxamine and fluoxetine. Journal of Clinical Psychopharmacology, 10, 343512.
Marin, R. S. (1990). Differential diagnosis of apathy. American Journal of Psychiatry, 147, 2230.Marin R. S. (1991). Apathy: A neuropsychiatric syndrome. Journal of Neuropsychiatry and Clinical Neuroscience,3, 24354.
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