Motivation and emotion/Book/2020/Long-term side effects of antidepressants on motivation and emotion

Overview
This chapter delves into the long-term side effects of antidepressant treatment on motivation and emotion. Antidepressants are a common form of medication for individuals experiencing mood disorders, specifically depressive disorders, and they are most effective when partnered up with psychological therapeutic treatments. However, while they are a common treatment for mood disorders, they also come with negative side effects which can affect individuals motivation and emotions.

The chapter covers what antidepressants are, as well as covering the different types of antidepressants. Then it will discuss how these antidepressants affect motivation, understanding the affects it may have upon sexual drive, place preference and the phenomenon of apathy. Then the effects on emotion will be discussed, particularly the effect of emotional blunting and what it encompasses.

While antidepressants are a common way of treating depressive disorders, it is important to learn and understand that they do come with potential long-term side effects. Focus questions:
 * What are Antidepressants?
 * What are the long term side effects of Antidepressants on motivation?
 * What are the long term effects of Antidepressants on emotion?

Depression
Depression is a psychological mood disorder where individuals experience persisting feelings of sadness, hopelessness, worthlessness, guilt as well as experiencing loss in some motivation in daily activities (DSM 5). It is the most common psychological disorder where the use of antidepressant medication is used. Depression is a psychological disorder which is becoming more prevalent within modern day society, with around 4% of the world’s population experiencing and living with it (Jowit 2018). According to the World Health Organization (WHO), for people born after 1945, they are ten times more likely to suffer from depression (World Health Organisation 2015). Depressions is becoming more and more common, making it important to understand what antidepressants are and also the potential long term side effects that they bring with them.

What are Antidepressants?
Antidepressants are medications used to treat mental health problems, such as depressive disorders (most common), some anxiety disorders such as social anxiety disorder, some chronic pain conditions and are even sometimes used to help manage some addiction problems (Jick et al. 1995). The aim of antidepressants are to correct imbalances of neurotransmitters in the brain that are believed to be responsible for causing changes in an individual’s mood and behaviour (Hauser et al. 2013). In 2019 it was found that one in every eight of the Australian population were using antidepressants, with this number including around 100,000 children (Fordham 2019). There are five main types of antidepressants commonly prescribed to individuals seeking help with mental health.

SNRIs
Serotonin and noradrenaline reuptake inhibitors (SNRIs) are commonly used to treat major depressive disorder, mood disorders, less commonly but sometimes used for ADHD, OCD and anxiety disorders, and sometimes for chronic neuropathic pain (a burning pain often caused by nerve damage or a malfunctioning nervous system). Serotonin and noradrenaline are chemicals in the brain that are responsible and involved with the regulation of pain, mood and sleep (Hauser et al. 2013). The role of SNRIs are to increase the concentration of serotonin and noradrenaline in the brain, as a common cause of mood disorders such as depressive disorders and anxiety disorders are low concentrations of these neurotransmitters (Hauser et al. 2013).

SSRIs


Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed types of antidepressants and are commonly used for treating depressive disorders (Geddes et al. 1999). Serotonin influences mood, emotion and sleep. After serotonin carries a message to the brain, the serotonin is then absorbed by the nerve cells (Hetrick et al. 2007). SSRIs work by blocking this reuptake causing more serotonin to be readily available in the brain to pass further messages between nerve cells, which then improves symptoms in individuals suffering from depressive disorders.

==== [https://www.healthline.com/health/depression/tricyclic-antidepressants-tcas#:~:text=Tricyclic%20antidepressants%20treat%20depression%2C%20but,chemical%20found%20throughout%20your%20body. Tricyclic Antidepressants] ==== Tricyclic antidepressants were one of the first antidepressants introduced, and are commonly used to treat and relieve depressive disorders (Furukawa et al. 2002). Nowadays these antidepressants are only commonly prescribed after other drugs such as SSRIs have failed to relieve symptoms of depressive disorders (Furukawa et al. 2002). They work similarly to other antidepressants and help to keep more serotonin and norepinephrine available to an individuals brain which helps to elevate mood.

'''[https://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992#:~:text=Antidepressants%20such%20as%20MAOIs%20ease,that%20are%20operational%20in%20depression. Monoamine Oxidase Inhibitors (MAOIs)]'''

More commonly prescribed before the introduction of SSRIs and SNRIs, the role of these antidepressants is to inhibit the action of monoamine oxidise, which is a brain enzyme which has been found to help the breakdown of neurotransmitters such as serotonin (Fiedorowicz, Swartz et al. 2007). With less serotonin breaking down, more serotonin should be available in the brain. MAOIs treat mental health problems similar to SSRIs and SNRIs.

Noradrenaline and specific serotoninergic antidepressants (NASSAs)

- not a proper sentence like the rest of the above descriptions Used to treat anxiety disorders such as personality disorders, and also to treat depressive disorders. NASSAs are an antagonist for noradrenaline auto receptors which results in enhanced releases of NA from noradrenergic terminals and also for receptors on serotonin neurons, which increases serotonin releases from serotonergic terminals (Kishi, Iwata 2014). This creates more of the neurotransmitters in the brain for the brain to readily use, which hopes to relieve symptoms from the disorder that the individual is suffering from.

Antidepressants conclusion - awkward title and placement, delete and just have concluding paragraph
Antidepressants are a common form of treatment for individuals suffering from a range of mental health related problems. However while they have benefits to relieving symptoms of mental health related problems, they also have some long term side effects which can negatively impact upon individuals emotions and motivation

Antidepressants and Motivation
This section covers:


 * What is motivation?
 * Sexual drive and antidepressants
 * Apathy and antidepressants
 * Place preference and antidepressants

What is motivation?


Motivation within the field of psychology is defined as the biological, emotional, social and cognitive forces which activate behaviour. It is a process that initiates, guides and maintains goal orientated behaviour (McInerney, 2019). These can be actions such as getting a drink to reduce thirst, participating in sexual actions to gain a feeling of intimacy, or partaking in exercise to stay healthy.

Motivation is often described as being extrinsic or intrinsic motivations (McInerny, 2019). Extrinsic motivation are motivations that arise from outside of the individual, such as actions that result in rewards such as money or social recognition. While intrinsic motivations are those that arise from within, which could involve engaging sexually with a partner as an individual wants to feel intimacy and connection, or participating in a sport because an individual wants to stay fit and healthy.

The long-term effects of antidepressants and how it impacts upon motivation is a topic which has started to receive attention within the field of mental health. Two areas of motivation which has been found to be impacted by the long term use of antidepressants was on place preference and sexual drive.

Sexual drive and Antidepressants
Sexual drive, also called libido, is ones desire/motivation for sexual activity. Our libido is influenced by biological, psychological and social based factors. Humans are sexual beings, who strive for sexual relationships (Gregorian et al. 2002).

One of the side effects which has been found through extensive research, to be caused by the use of antidepressants is the loss, or severe reduction in sexual drive/libido. The causation of this has been said to be quite complicated, but could involve nitric oxide (Ferguson 2001). Research has found that the effect can be attributed to simulation of postsynaptic 5-HT2 receptors, and the effect can manifest into decreased libido (Ferguson 2001). While this is a common side effect of depressive disorders, multiple clinical studies have assessed the effects of sexual drive reduction in individuals receiving SSRIs. Research has found that for women suffering form depression, their sexual desire is drastically reduced, while in contrast for men, sexual desire was significantly reduced whilst undergoing antidepressant treatment (Ferguson 2001; Gregorian et al. 2002).

Apathy and Antidepressants
Apathy is the loss of motivation or interest in activities (Sansone, Sansone 2010). While apathy has been defined as an effect brought on by depression, research has looked into SSRI-induced apathy syndrome which is also known as SSRI induced difference (Barnhart et al. 2004). SSRI induced apathy syndrome is a late-onset side effect of SSRI treatment. Case studies of individuals undertaking SSRI treatment for depression, described this feeling of apathy from SSRI treatment as very different from the apathy caused by suffering from depressive disorders, often having more of a negative impact on their life than the apathy caused from the depressive disorder alone (Barnhart et al. 2004).



Place Preference and Antidepressants
Place preference is a type of Pavlovian conditioning in which an individual may be more or less motivated to avoid or spend more time in a certain area (Subhan et al. 2000). Research has looked into whether the long-term use of certain antidepressants motivates individuals to spend more time in certain areas, or to avoid places entirely. The research found that SSRIs in particular when used to treat depressive disorders produced place preference. Serotonin plays a role in reward pathways and the differences in serotonin, noradrenaline and dopamine reuptake-inhibiting properties caused by SSRIs may explain why place preference occurs after the long-term use of SSRIs as an antidepressant (Subhan et al. 2000). The study also found that for tricyclic antidepressants, participants developed a sense of place aversion, and became motivated to avoid areas (Subhan et al. 2000). While the research on this side effect has not received a large amount of theoretical attention, it demonstrates that individuals can become more or less motivated to attend certain places based off of antidepressant treatment.

See more: Subhan et al. 2000

Side effects of Antidepressants on Motivation
 * 1) Sexual Drive
 * 2) Apathy
 * 3) Place Preference

Antidepressants and Emotions
This section covers


 * What is Emotion
 * What is Emotional blunting and how it is a side effect of Antidepressants

Emotion
According to the cognitive appraisal theory – emotions are the judgements we have about the extents to which current situations meet our set goals. Happiness is then defined as the evaluation that goals are being satisfied, meaning that sadness is then the evaluation that goals are not being satisfied, and anger is caused when something is blocking the accomplishment of goals (So 2013). Other definitions of emotion include that emotion is a subjective state of being that we describe as feelings, a subjective, affective state that is relatively intense and occurs due to experiences (Lewis et al. 2010) or strong feelings that are derived from ones circumstances, mood or relationships with others (Fredrickson 2011). Multiple definitions of emotion exist and it is not set in one definition. Causes of emotion stem from phenomenon in an individual’s environment and internal processes, this occurs through life events, neural activity, cognitive processes, biological processes and social expression and ones social surroundings (Lewis et al. 2010).

Emotions are affected within antidepressant treatment with long-term benefits side effects which play a key role in the way individuals feel and sense emotions.

Emotional Blunting as a side effect of Antidepressants
One of the main side effects of antidepressants on emotions is emotional blunting and limited emotional responses. Emotional blunting is when feelings and emotions are dulled, causing an individual to feel neither up or down, but instead just feeling ‘flat’ (Goodwin et al. 2013). Common experiences for individuals feeling emotionally blunt after receiving antidepressant treatment are; being less able to laugh or cry even when appropriate, feeling less empathy for others, loss of motivation and drive, and not being able to respond with the same level of enjoyment that they normally would (Read et al. 2014). Studies have found that this is a common long-term effect across multiple different types of antidepressants (SSRIs, SNRIs and tricyclic). A study by Goodwin et al. (2013) found that blunting occurs in nearly 50% of individuals undergoing antidepressant treatment. Further studies discovered that this emotional blunting occurs more in men (54%) than women (44%) (Read et al. 2014). For groups undergoing SSRI treatment, participants reported significant reductions in aspects, including ability to cry, irritation, less care about others feelings, sadness, sometimes anger and the feeling of not being able to express their feelings (Price et al. 2009).

The idea and concept of SSRI induced difference has found that the long term use of SSRI treatment reduces individuals intensity and/or experiences of all emotions, as well as diminishing emotionality within professional and interpersonal relationships (Sansone, Sansone 2010) which can impact upon relationships. While some of these effects can be beneficial, for example reduction of anger in an angry patient, it can have negative effects on family, friends and other relationships in an individuals life.

Emotional blunting is the main long term side effect of antidepressant treatment and is a rather common occurrence in patients and requires more research into the reduction of this side effect, as the only way to deal with this problem currently is to reduce dose sizes with antidepressant treatment.

Conclusion
The side effects that antidepressants have on motivation and emotion has been well covered across psychological literature. The main side effects of antidepressants on motivation, is the decrease of an individuals sex drive and the increasing of apathy within an individual. Interesting findings into the side effect of place preference was also identified, with place aversion and preference being impacted by SSRI treatment. Antidepressant treatment also was found to have side effects on emotion, with the introduction of emotional blunting being a serious side effect. While antidepressants are a common form of treatment for depressive disorders, they also have been found to cause negative side effects. It is important that more research is conducted into this area to further understand the side effects and create a way to avoid them.