In the JournalsPerspective

Antidepressants, not depression, reduce behavioral responses to empathy

Contrary to prior cross-sectional reports of empathy deficits in major depression, study findings published in Translational Psychiatry indicated that antidepressant treatment decreased aversive responses triggered by exposure to the suffering of others.

“[Although] the impact of major depressive disorder on mood and basic emotional processing has been investigated intensely, few attempts have been made to explore its influence on empathy, which is a crucial skill for everyday social interactions,” Markus Rütgen, PhD, postdoctoral researcher in the social, cognitive and affective neuroscience unit at University of Vienna in Austria, and colleagues wrote.

To separate the effects of MDD and antidepressant treatment, the researchers conducted a longitudinal neuroimaging study on empathy among 29 patients (median age, 29.6 years; women, n = 21) with depression.

Participants who underwent two functional MRI sessions before and after 3 months of antidepressant therapy completed an empathy-for-pain task, in which they watched videos of people undergoing painful medical procedures, as well as an additional electrical pain task to control for general effects on processing of negative affective states. The investigators compared their responses to those of 35 healthy controls (median age, 27.4 years; women, n = 23). Participants also gave self-report ratings targeting cognitive (perspective taking) and affective (unpleasant affect) aspects of empathy.

Rütgen and colleagues found no behavioral or neural differences between patients with depression and controls before antidepressant treatment. After 3 months of treatment, patients with MDD exhibited reduced neural responses in a priori brain areas specifically associated with empathy for pain (bilateral anterior insular and anterior midcingulate cortex) as well as reduced self-experienced unpleasant affect in response to others’ pain.

In addition, the results showed that reductions in affective empathy were linked to symptom improvement, and functional connectivity during the empathy task between brain regions tied to affective (anterior insula) and cognitive (precuneus) empathy dropped between sessions among those with MDD.

"The lowered emotional impact of negative events in a social context possibly allows patients to recover more easily,” Rütgen said in a press release. “Nevertheless, the actual impact of reduced empathy on patients' social behavior remains to be explored." – by Savannah Demko

Disclosure: Rütgen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Contrary to prior cross-sectional reports of empathy deficits in major depression, study findings published in Translational Psychiatry indicated that antidepressant treatment decreased aversive responses triggered by exposure to the suffering of others.

“[Although] the impact of major depressive disorder on mood and basic emotional processing has been investigated intensely, few attempts have been made to explore its influence on empathy, which is a crucial skill for everyday social interactions,” Markus Rütgen, PhD, postdoctoral researcher in the social, cognitive and affective neuroscience unit at University of Vienna in Austria, and colleagues wrote.

To separate the effects of MDD and antidepressant treatment, the researchers conducted a longitudinal neuroimaging study on empathy among 29 patients (median age, 29.6 years; women, n = 21) with depression.

Participants who underwent two functional MRI sessions before and after 3 months of antidepressant therapy completed an empathy-for-pain task, in which they watched videos of people undergoing painful medical procedures, as well as an additional electrical pain task to control for general effects on processing of negative affective states. The investigators compared their responses to those of 35 healthy controls (median age, 27.4 years; women, n = 23). Participants also gave self-report ratings targeting cognitive (perspective taking) and affective (unpleasant affect) aspects of empathy.

Rütgen and colleagues found no behavioral or neural differences between patients with depression and controls before antidepressant treatment. After 3 months of treatment, patients with MDD exhibited reduced neural responses in a priori brain areas specifically associated with empathy for pain (bilateral anterior insular and anterior midcingulate cortex) as well as reduced self-experienced unpleasant affect in response to others’ pain.

In addition, the results showed that reductions in affective empathy were linked to symptom improvement, and functional connectivity during the empathy task between brain regions tied to affective (anterior insula) and cognitive (precuneus) empathy dropped between sessions among those with MDD.

"The lowered emotional impact of negative events in a social context possibly allows patients to recover more easily,” Rütgen said in a press release. “Nevertheless, the actual impact of reduced empathy on patients' social behavior remains to be explored." – by Savannah Demko

Disclosure: Rütgen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Brendon Watson

    Brendon Watson

    A subset of patients report that after treatment with antidepressants they have deficits of various sorts. Some complain of feeling ‘empty,’ ‘robotic,’ ‘numb’ or ‘detached’ in comparison to their previous baseline. This study is interesting in that it seems to show that the more effective the antidepressant treatment (as measured by reduction in depression rating scores), the greater the reduction in empathy reports. Furthermore, antidepressant treatment may lower some measures of empathy below the baseline not just of these patients but of the undepressed subjects.

    Perhaps similarly, patients with anxiety often report that they feel insufficiently to take on high-level or long-lasting tasks. The common explanation for this phenomenon is that their anxiety was a major driving force and as the medication reduces the anxiety, they are less driven. 

    The phenomenon reported in this article with reduced empathy after depression treatment may be similar to the reports of reduced motivation with anxiety treatment. In both cases, the mind of the subject may be ‘tuned’ to operate based on a certain set of internal states and medications may change those internal states sufficiently to significantly alter how the mind is functioning under certain circumstances. It would be of interest to learn if these subjects later recalibrate towards their previous empathy states once they have time to acclimatize to the antidepressant treatment.

    Clinically, this seems to indicate that clinicians should take seriously deficits by patients and especially attend to how those deficits affect social, professional and other functionality.

    • Brendon Watson, MD, PhD
    • Assistant professor in psychiatry
      University of Michigan

    Disclosures: Watson reports no relevant financial disclosures.