Looking forward to…nothing

When Prozac was launched in 1987, this new breed of antidepressant, called an SSRI (selective serotonin reuptake inhibitor), was heralded as the future of psychiatric medicine.

It would treat depression without all the ghastly side-effects of the tricyclic antidepressant medicines because, as the theory went, sadness and depression all had to do with faulty brain chemistry, a biochemical brain disorder—too little of the chemical messenger serotonin, which is key to our sense of wellbeing.

The new drug was reputedly able to slow the “reuptake” of serotonin so that more would be available to assist in messaging between neurons. Hence, we could stay out of emotional pain and generally be happier for longer.

This theory, which has never actually been decisively demonstrated anywhere, nevertheless proved so seductive that other drug companies quickly followed Eli Lilly’s suit with their own versions of Prozac.

Currently more than one in six people in America and one in seven in Britain take an SSRI antidepressant. In fact, this class of drugs is one of the most prescribed in the world.

Aside from the fact that SSRIs are being given to millions on the basis of a questionable premise, there is another, potentially bigger problem with this class of drugs. New evidence shows that taking SSRI drugs numbs a person’s emotions—so much so that it robs patients of the ability to respond to events in their lives, either positively or negatively.

An important meta-analysis of 112 trials discovered that both healthy volunteers and patients suffering from depression experienced what is referred to in the psychiatric trade as “emotional blunting” while taking SSRIs.1

In an Oxford University survey of nearly 700 patients, about half of patients on either the first or second generation of SSRI drugs (which slow the reuptake of norepinephrine, another chemical messenger, as well as serotonin) reported a restriction in the range of emotions they were able to feel, including the ability to experience enjoyment or even to cry.2

As our cover story points out, between 40 and 60 percent of SSRI users report this kind of emotional deadening.

One major South American study reviewed  “behavioral adverse effects” of a variety of drugs. It noted that “SSRI antidepressants produce changes in emotional processing, modifying the recognition of all basic emotions such as happiness, sadness, fear, disgust, and surprise.”3

This, along with the well-known effect on the ability to reach orgasm during sex while taking these drugs, would suggest that although SSRIs remove emotional pain, they also remove a good deal of the joy in life.

Research further concludes that the drugs have a big influence on our decision-making ability, and not to the good. In one study, when patients were given a choice—one of which would reap a reward—those on SSRIs did not appear able to detect a sense of success or rewards from doing tasks, or to learn from them.4

Without being able to feel or even to distinguish between positive and negative rewards, people who experience depression are likely to have difficulty imagining a happy future.

SSRIs are not the only drugs that cause emotional blunting. Anti-psychotic drugs used to treat disorders like schizophrenia also reduce a person’s ability to react to life with emotion, as do drugs for bipolar disorder.3

Even beta-blockers, ordinarily used to lower blood pressure and manage other forms of heart disease as well as anxiety, numb emotions. One study examining the effects of the popular beta-blocker propranolol on emotional memory in healthy volunteers concluded that the drug not only blunted emotional arousal but also blunted the memory of past emotional events.5

Even more worryingly, the drugs cause difficulties in participants’ decision-making processes. In one study, after only three weeks on the common SSRI drug fluoxetine, healthy volunteers experienced a removal of wariness around risk.6 This has been seen not only in experiments with gambling tasks but also with increases in crime, violence and self-harm among young adults given SSRIs.

Scientists have long understood that serotonin plays an important role in our ability to discern a positive outcome from a negative one, and to try to avoid situations that put us at risk. But in those who take SSRIs, the natural aversion to risk gets significantly diminished, leading them to consistently choose riskier options.

What all this research points to is that SSRI drugs seem to mess up neuronal pathways, causing the brain to function abnormally so that people can’t tell the difference between something joyful, fulfilling and rewarding and something that will cause them harm.

Those neuronal changes may end up being permanent with long-term use of SSRIs due to downregulation of the feel-good hormone dopamine—a situation associated with chronic apathy and a lack of the ability to feel.

Zombifying a large percentage of our population has enormous ramifications for our future.

The big question remains for the psychiatric community: is it better to feel nothing for the rest of your life than to feel pain?

We don’t think so, particularly as there is a raft of better and safer ways to heal an unhappy heart.