SSRI-Induced Apathy Syndrome in Adults

Hoehn-Saric et al. (1990), who were among the first to report it, described apathy and indifference in patients on fluvoxamine and fluoxetine as well as loss of initiative and disinhibition with and without hypomania in five patients. Levine et al. (1987) reported that 7% of 59 nondepressed obese patients became depressed following a rapid increase in fluoxetine to a dose of 80 mg/day, but they did not identify apathy as an aspect of this drug-induced depression. 

Apathy was reported as an infrequent adverse reaction during the testing of Prozac for depression (Physicians Desk Reference, 2000). However, it has become sufficiently common to be described in The 

American Psychiatric Publishing Textbook of Clinical Psychiatry (Ma-rangell et al., 2003 see also Marangell et al., 1999)  

Apathy syndromes We and others have noted an apathy syndrome in some patients after months or years of successful treatment with SSRIs. Patients often confuse this syndrome with a recurrence of depression, but the two conditions are quite distinct. The syndrome is characterized by a loss of motivation, increased passivity, and often feelings of lethargy and flatness. ... Mistakenly interpreting the apathy and lethargy for a relapse of depression, and hence increasing the dose of medication, will worsen the symptoms. 

Note that the apathy syndrome is so spellbinding that patients often confuse this syndrome with a recurrence of depression. As the textbook indicates, doctors can make the same mistake of failing to identify the drug as causal. 

---