Antidepressants linked to major personality changes

[Guest guest]

I'm sure that I do not have to express the depth or scope of my disagreement

with this study. What a crock.

T.

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Antidepressants linked to major personality changes

By Healy

Updated: 2:24 PM 12/8/2009

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Antidepressant medications taken by roughly 7% of American adults cause profound

personality changes in many patients with depression, far beyond simply lifting

the veil of sadness, a study has found.

Researchers saw strong drops in neuroticism and increases in extroversion in

patients taking antidepressants, two of five traits thought to define

personality and shape a person's day-to-day thoughts and behavior. The findings

are striking, researchers said, because psychologists have long thought that

such fundamental traits are moorings of an adult's personality that shift very

little over a lifetime.

The medications would seem to relieve depression by chemically altering brain

processes that spawn negative thoughts rather than just alleviating symptoms

associated with a depressed state, said Northwestern University psychologist

Tony Z. Tang, the lead author of the study.

The findings, published in the journal Archives of General Psychiatry and funded

by the National Institute of Mental Health, could have significant implications

for depression treatment, researchers not connected with the study said.

It is unclear how long-lasting the changes in personality are, the authors said.

But the study found that patients whose personalities shifted the most were less

likely to relapse. And they said that monitoring those altered traits could be a

useful, early gauge of whether a medication is working and how probable a

recurrence would be.

The findings are likely to rekindle debate on the impact and effectiveness of

selective serotonin reuptake inhibitors, or SSRIs, on which Americans spent $9.6

billion last year alone. SSRIs increase the availability of serotonin, a key

brain chemical, low levels of which are linked to depression.

The trial involved 240 adults with moderate to severe depression. Of those, 120

were given the selective serotonin reuptake inhibitor paroxetine (Paxil) for 16

weeks. Another 60 received cognitive therapy but no medication for 16 weeks, and

60 others were given a placebo alone for eight weeks.

All subjects who reported improvements in their depression in response to

psychotherapy or medication were followed for a year.

Patients who received paroxetine were more likely to have their symptoms ease

than patients in the other two groups, and they showed more dramatic personality

changes.

Those given placebo pills reported early improvements in their depressive

symptoms almost as great as those reported by those on medication, but their

underlying personalities " didn't budge, " said Northwestern's Tang. And their

relief from depressive symptoms was briefer and more muted than the improvement

of those on medication or cognitive therapy. They were given the antidepressant

if their condition failed to improve after eight weeks.

That finding " pokes a hole " in the charges of many critics that SSRIs are little

more effective at treating depression than sugar pills, said UCLA psychiatrist

Leuchter.

Still, several researchers not involved in the study cautioned that the findings

might prompt greater use of medications for which U.S. physicians already write

164.2 million prescriptions a year. For insurers and healthcare policymakers

wary of the high cost of psychotherapy, the study might make the drugs look like

a better value.

That would be a mistake, said University of Illinois psychologist Brent .

Not all depressed patients respond to SSRIs so favorably. " And it would be

foolish to base policy on the findings of one study, " he said.

Other studies will be necessary before the cost-effectiveness of different

treatments can be established, added.

The personality changes in the study were striking, researchers said. While

adults typically become slightly less neurotic with age, it is a gradual change.

In the study, experimental subjects who responded to SSRI treatment changed

roughly twice as much on the neuroticism scale as most adults do in a lifetime.

And they did so in eight weeks.

" That is a dramatic change, " said McCrae, a leading researcher on

personality, now retired. " If you were these patients or someone in their

family, you'd notice a difference. "

The study also suggests a new measure to identify people at risk of developing

depression and to predict who would benefit most from a particular medication or

therapy. Doctors could refer to a personality inventory that would measure a

patient's " big five " traits -- neuroticism and extroversion, as well as

agreeableness, conscientiousness and openness -- to test a patient's early

response to a drug or psychotherapy.

Such a tool could improve the trial-and-error method of prescribing that is

common in the treatment of depression, UCLA's Leuchter said.

To drive down the rate of relapse in depression, Tang said, psychiatrists should

focus on helping patients achieve fundamental personality changes and not just

recover from a current episode of depression. Roughly half of those treated

successfully for the disorder can be expected to suffer a recurrence in the

following year.

" They should be thinking how to prevent relapse -- not just about short-term

recovery, which we're pretty good at -- as soon as the patient walks through

their door, " Tang said.

melissa.healy@...

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