Apathy from SSRIs

Barnhart et al. (2004) reviewed the literature on apathy syndrome and found 12 relevant case reports and one open-label treatment trial. They pointed out the difficulty in distinguishing apathy from clinical depression but noted that patients can often tell the difference. In my experience, patients suffering from SSRI-induced apathy experience an indifference or lack of interest, even when their own rational assessment tells them that they do not feel sad or depressed, when in fact they would like to feel more involved in life. Whereas depressed patients typically lapse into feeling helpless and withdrawn, these individuals want to become more interested in their loved ones, friends, work, or hobbies but find themselves unaccountably stifled in their capacity to do so. They often feel frustrated rather than depressed. Or if spellbound, they may actually claim to feel fine, even while they display indifference to their surroundings. 

In their review of 12 reported cases, Barnhart et al. (2004) found three cases associated with fluvoxamine, seven with fluoxetine, and two with paroxetine. The apathy states improved or resolved with dose reduction or discontinuation. The authors believed that the syndrome frequently goes undetected despite its significant clinical impact. Opbroek et al. (2002) reported that 80% of patients with SSRI-induced sexual dysfunction reported suffering from treatment-emergent emotional blunting. This is consistent with my clinical observations that so-called sexual dysfunction in patients receiving antidepressants often involves a more generalized loss of interest in both sex and loved ones. 

---