Antidepressants Blunt Emotions and Cause Sexual Dysfunction

“It is possible that participants taking escitalopram experience greater sexual dysfunction due to experiencing less pleasure,” the researchers write.

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The loss of happiness and sexual satisfaction might be the cost of using antidepressants, according to a new study. Researchers found that healthy people who took the SSRI escitalopram (Lexapro) for less than a month became less reactive to both positive and negative experiences and more likely to have sexual dysfunction.

“It is possible that the clinical effectiveness of SSRIs for MDD is due to this reduced negative affect,” the researchers write. “However, if indeed positive affect is also reduced, then this would lead to a more general blunting effect, as often reported by patients taking chronic SSRIs.”

They add, “This may also be further supported by our findings that the escitalopram group had significantly higher dysfunction on the dimensions/phases corresponding to orgasm/completion on the CSFQ-14. It is possible that participants taking escitalopram experience greater sexual dysfunction due to experiencing less pleasure.”

Researchers have known that antidepressants cause blunting or numbing of emotions for over 30 years (see this 1990 article on the subject, for example). Studies have also found that sexual dysfunction is a common effect of the drugs and may be linked to this same numbing of emotions.

One study found that SSRIs cause emotional blunting in up to 75% of patients, while other types of antidepressants (like Wellbutrin) may cause it in 33%. In one paper, it’s described like this: “When I want to cry, I can’t.”

Many of these studies demonstrated that numbing and sexual dysfunction occurred after taking antidepressants, even for people who did not have these symptoms before taking the drugs, and that these symptoms often (but not always) diminish after stopping the drugs.

Nonetheless, some have suggested that emotional blunting and sexual dysfunction are symptoms of the underlying depression that leads to the use of antidepressants—and not a result of the drugs themselves.

The new study helps disentangle this position by testing the effects of the drugs in people who do not have a diagnosis of depression.

The study, a double-blind, placebo-controlled trial, included 66 “healthy” adults who were semi-randomly assigned (the groups were balanced for age, sex, and IQ) to receive Lexapro (escitalopram) or a placebo for an average of 26 days. At the endpoint, they completed a bevy of neuropsychological tests.

The research was led by Christelle Langley and Sophia Armand at the University of Cambridge, UK, and published in Neuropsychopharmacology.

The first finding is that, when asked about sexual function, those who took the drug had a significant decrease in the ability to reach orgasm:

“The escitalopram group had significantly lower scores on the Changes in Sexual Functioning (CSFQ-14) Questionnaire, corresponding to higher dysfunction on dimension 5 (Orgasm/Ejaculation (t (42.25) = 2.68, p = 0.01, Cohen’s d = 0.68) and phase 3 (Orgasm/Completion t(42.25) = 2.68, p = 0.01, d = 0.68)).”

The other main finding was that the group who took the drug had difficulty with two reinforcement learning tasks. They were asked to repeatedly choose between two options, one of which was far more likely to lead to a reward. After choosing a few times, you learn the pattern and select the one that leads to the reward.

Those who took the SSRI were significantly slower to respond to this pattern by selecting the correct option. This demonstrates that their ability to respond to a positive outcome (reward) or negative outcome (failure) was diminished. This reflects emotional blunting, according to the researchers.

“The novel and important finding was that escitalopram had the specific effect of reducing reinforcement sensitivity in two independent tests,” the researchers write.

The researchers found that for most of the other measures, including emotion recognition and measures of cognition like attention and memory, escitalopram did not appear to have a negative effect. However, previous studies have found that antidepressants impair the ability to read social cues and also harm learning and cognition in healthy volunteers.

Of course, a 26-day trial of SSRIs doesn’t compare to the years or decades that many people spend taking them. That more prolonged period of use could cause even more harm.

The most important takeaway of the current study, according to the researchers, was that it provides strong evidence that SSRIs cause emotional blunting even in people without depressive symptoms:

“The results have important clinical implications as they may reflect the blunting effect often reported by patients with neuropsychiatric disorders receiving chronic SSRI treatment,” the researchers write.

This may be especially relevant since SSRIs are prescribed for many reasons, including anxiety, PMS, fibromyalgia, IBS, OCD, bulimia, and PTSD. People receiving the drugs for these other indications may not even consider that the cost will be the loss of positive emotions and sexual functioning. And for people with depression? The drugs might reinforce two of the worst symptoms.

 

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Langley, C., Armand, S., Luo, Q., Savulich, G., Segerberg, T., Søndergaard, A., . . . & Sahakian, B. J. (2023). Chronic escitalopram in healthy volunteers has specific effects on reinforcement sensitivity: a double-blind, placebo-controlled semi-randomized study. Neuropsychopharmacology. https://doi.org/10.1038/s41386-022-01523-x (Link)

5 COMMENTS

  1. Peter, fantastic job in condensing a complex scientific article into this highly readable summary, and linking it with previous research! This kind of journalism is so valuable and hard to find outside of MIA.

    I downloaded the study and was struck by this excerpt:

    “At the end of the study, participants were asked whether they thought they received escitalopram or placebo. In response, 53% of participants in the escitalopram group correctly guessed that they received escitalopram, whereas 15.6% of participants in the placebo group guessed they received escitalopram. Comparison of the two groups showed a significant difference in the ability to correctly detect group membership (χ2 (1, N=65) = 10.46, p=0.01 [two sided]). The ability to guess the correct allocation in the escitalopram group was at chance level.”

    In other words, the blind was broken. If this were a treatment efficacy trial, this result would potentially invalidate the results. One wonders how often this predictable phenomenon occurs in industry-sponsored psychiatric drug trials. It doesn’t surprise me that this critical result is almost never reported as it’s not in the sponsor’s interests.

    Returning to the findings supporting a blunting effect of the “antidepressant,” too little attention has been paid to the myriad possible consequences when people’s emotional responses are diminished. A person who cares less might love family and friends less, have less interest in sex or other potentially rewarding activities and relationships, be more likely to engage in risky behaviour that was previously avoided due to fear of consequences, commit increased acts of violence or self-harm, have less empathy for others, and so on. There is no free lunch. You can’t pharmacologically blunt peoples’ emotions without eliciting a wide range of practical effects, some of which are negative and potentially destructive. I hope articles like this encourage pressure on clinical trial authors to report the full range of effects of psychiatric drugs and not just scores on symptom checklists.

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  2. It has always been my belief from observation that the main action of “antidepressants” was a general blunting of emotion. That result is described by many who take the SSRIs in particular, and fits with both the “positive” and “negative” reported effects. If one is very anxious all the time, a blunting of emotions can be associated with reduces anxiety, which might seem positive. If one is being held back from doing impulsive things (including killing oneself or harming others) by fear of the consequences, blunting may result in manic episodes, increase in suicidality, or increase in impulsive violence, including those occasional murderous acts we all have heard about. Loss of sexual function is also consistent with blunting of physiological sensations and with impairment of the motivational system to rewards (rewards are less rewarding, hence not as much worth pursuing, or sometimes not even physiologically feasible). There isn’t much that the SSRIs do that isn’t explained by emotional blunting. I think that is their main mechanism of action. And I think it is well worth recognizing that these are not “antidepressants” but “antiemotion” pills, and to ask whether this is really something that society as a whole really wants to be promoting as a benefit.

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  3. I’m old enough to remember the 80s and 90s when different antidepressants became well known. Those decades also featured a lot of economic growth, not so healthy competition, a push to make it big or get rich or be on the right trend. Life was sold to us as no place for someone who was not tough and ambitious and willing to do whatever it took to be the best. So since those years, depression and the feelings and thoughts that go with it were vilified. People reached for something that would take away psychological pain and male them more bulletproof. The resultant numbing of body and mind was seen as a good thing– to not be held back or down. But the personal stories I read on this website have a common theme- the human being just wanted someone somewhere to validate their situations and feelings, not just have them dismissed or covered up by a pill. Even today, people are still so fearful of normal human feelings and still afraid to share their actual experiences that we have a whole cadre of younger people automatically labeled “on the spectrum” when they have been encouraged not to be too loud or joyful, not to cry or complain when legitimately hurt, and not to disturb others. Teaching our kids to be human and emotional and needing and help starts with us– but we need to see the societal brainwashing done to us first, since those 80s and 90s years of boldness, moneymaking, conquering the world, and looking down on others.

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