Summary: Antidepressants for major depressive disorder reduce the aversive response triggered by exposure to the suffering of others. Findings suggest antidepressants may lead to impaired empathy of pain perception.
Source: University of Vienna
Depression is a disorder that often comes along with strong impairments of social functioning. Until recently, researchers assumed that acute episodes of depression also impair empathy, an essential skill for successful social interactions and understanding others. However, previous research had been mostly carried out in groups of patients who were on antidepressant medication. Novel insights of an interdisciplinary collaboration involving social neuroscientists, neuroimaging experts, and psychiatrists from the University of Vienna and the Medical University of Vienna show that antidepressant treatment can lead to impaired empathy regarding perception of pain, and not just the state of depression itself. The results of this study have been published in the scientific journal Translational Psychiatry.
An interdisciplinary research team jointly led by Prof. Claus Lamm (Department of Basic Psychological Research and Research Methods, University of Vienna), Prof. Rupert Lanzenberger (Department of Psychiatry and Psychotherapy, Medical University of Vienna) and Prof. Christian Windischberger (Center for Medical Physics and Bioengineering, Medical University of Vienna) set out to disentangle effects of acute depressive episodes and antidepressant treatment on empathy. The research has been performed within the research cluster “Multimodal Neuroimaging in Clinical Neurosciences”, an intramural research initiative aimed at translational collaborations between researchers at the University of Vienna and the Medical University of Vienna. The researchers recruited unmedicated patients with acute depression, and tested their empathic responses to the pain of others twice: first, during an acute depressive episode, i.e., before they had received any medication. Second, after three months of psychopharmacological treatment with antidepressants (mostly selective serotonin reuptake inhibitors).
In both sessions, patients underwent functional magnetic resonance imaging while watching videos of people undergoing painful medical procedures. Their brain activity and self-reported empathy were compared to those of a group of healthy controls. Before treatment, patients and controls responded in a comparable way. After three months of antidepressant treatment, the research revealed relevant differences: patients reported their level of empathy to be lower, and brain activation was reduced in areas previously associated with empathy.
First author Markus Rütgen underlines that reduced empathic responses were not caused by a general dampening of negative emotions: “The lowered emotional impact of negative events in a social context possibly allows patients to recover more easily. Nevertheless, the actual impact of reduced empathy on patients’ social behavior remains to be explored.”
University of Vienna
Markus Rütgen – University of Vienna
The image is in the public domain.
Original Research: Open access
“Antidepressant treatment, not depression, leads to reductions in behavioral and neural responses to pain empathy”. Markus Rütgen, Carolina Pletti, Martin Tik, Christoph Kraus, Daniela Melitta Pfabigan, Ronald Sladky, Manfred Klöbl, Michael Woletz, Thomas Vanicek, Christian Windischberger, Rupert Lanzenberger & Claus Lamm.
Translational Psychiatry. doi:10.1038/s41398-019-0496-4
Antidepressant treatment, not depression, leads to reductions in behavioral and neural responses to pain empathy
Major depressive disorder (MDD) has been hypothesized to lead to impairments in empathy. Previous cross-sectional studies did not disentangle effects of MDD itself and antidepressant treatment. In this first longitudinal neuroimaging study on empathy in depression, 29 patients with MDD participated in two functional magnetic resonance imaging (fMRI) sessions before and after 3 months of antidepressant therapy. We compared their responses to an empathy for pain task to a group of healthy controls (N = 35). All participants provided self-report ratings targeting cognitive (perspective taking) and affective (unpleasant affect) aspects of empathy. To control for general effects on processing of negative affective states, participants additionally underwent an electrical pain task. Before treatment, we found no differences in empathic responses between controls and patients with MDD. After treatment, patients showed significant decreases in both affective empathy and activity of three a priori selected brain regions associated with empathy for pain. Decreases in affective empathy were moreover correlated with symptom improvement. Moreover, functional connectivity during the empathy task between areas associated with affective (anterior insula) and cognitive (precuneus) empathy decreased between sessions in the MDD group. Neither cognitive empathy nor responses to painful electrical shocks were changed after treatment. These findings contradict previous cross-sectional reports of empathy deficits in acute MDD. Rather, they suggest that antidepressant treatment reduces the aversive responses triggered by exposure to the suffering of others. Importantly, this cannot be explained by a general blunting of negative affect, as treatment did not change self-experienced pain.