Over a quarter of a million Norwegians take antidepressants.

Antidepressants are used for both depression and anxiety.

But an annoying side effect is that many people feel emotionally dull or flat. About half state this.

According to The prescription register took 353,000 people off antidepressants in 2020 in Norway. Figures for 2021 and 2022 are not available, due to reorganization of the register.

Serotonin provides well-being

The most commonly used antidepressants affect the level of and the signaling substance serotonin in the brain. These are the common SSRI drugs.

They work by bringing more serotonin to the brain and making it last longer.

The signaling substance serotonin plays an important role in a number of cognitive functions such as mood, memory and sleep.

Serotonin is also called a well-being substance.

SSRIs are the first choice for drug treatment of mild to moderate depression when talk therapy alone is not enough.

Well, researchers have analyzed and of these medications, which are sold under the name Cipralex. Escitalopram is the active ingredient.

In the same group as it is called the «happy pill»

Escitalopram is the most widely used drug against depression and anxiety both in Norway and in large parts of the world.

– Therefore, it is natural that this study has focused on emotional discharge, which is a common side effect in users of escitalopram in particular, says Erik Sveberg Dietrichs to forskning.no.

He is senior physician at the Center for Psychopharmacology, Diakonhjemmet and associate professor at UiT, the Arctic University of Norway.

Escitalopram is in the same group of drugs as the so-called happy pill – namely fluoxetine, he says. It is known as Prozac in the US.

Both fluoxetine and the drug escitalopram belong to the group of drugs called selective serotonin reuptake inhibitors (SSRIs).

Feeling lethargic and bored

A common side effect of SSRI medications is lethargy. Patients report being emotionally bored. They find little or nothing gives them much pleasure anymore.

Probably between 40 and 60 percent of patients using SSRIs experience this side effect.

So far, most studies on SSRI preparations have only examined short-term use. Men in practice many depressed use these tools quickly over long periods of time.

Affects a learning mechanism

Well, researchers from Denmark and England have done more research into what the reason for the side effect might be.

Researchers at the University of Cambridge collaborate with collaborations at the University of Copenhagen. They have tested the preparation on voluntary fresh participants, to see how their brains are affected.

They found few differences between the antidepressant group and the control group.

But they found a difference. The antidepressant effects affect a specific characteristic.

The results are published in the journal Neuropsychopharmacology.

Does not impair memory

The researchers found no significant differences between the groups when it came to pure comprehension tasks. Like attention and memory.

There was also no difference in most testers who had cognitive functions such as involved emotions.

But they found a difference. The participants who had received anti-depressant medication had reduced sensitivity for a form of learning.

So-called reinforced learning was weakened. The characteristic means that we learn from the environment.

Less sensitive to reward

The participants who took Cipralex were less able to use positive and negative feedback as a guideline for learning.

It appears to affect their sensitivity to reward and their ability to respond accordingly.

The finding can also explain a difference between the group, which comes out in the questionnaire, where they had to self-report how they felt.

Hard to orgasm

Those who went for help also had more problems achieving orgasm when they had sex. This is also a known side effect that is often reported.

– Emotional flattening and sexual dysfunction – both in men and women, are common side effects of SSRI drugs such as escitalopram, explains Espen Sveberg Dietrichs.

These effects are therefore not happy pills, and are used as an important part of the treatment in patients suffering from severe depression or anxiety.

– The utility value of the means for milder pressure and anxiety disorders must always weigh the side effects they give, which are expressed against Dietrich’s.

Also takes away some of the joy

– Emotional solution is part of the way that works. They must remove some of the emotional pain depressed people feel. But unfortunately it seems that they also take away some of the joy, says Professor Barbara Sahakian at the Department of Psychiatry at the University of Cambridge in a press release.

Now the researchers have to take pictures of the brain to see how they can affect reward learning.

Reference:

C. Langley and others: Chronic escitalopram in healthy volunteers has specific effects on reinforcement sensitivity: A double-blind, placebo-controlled, semi-randomized study. Neuropsychopharmacology, 23 Jan. 2023.