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Critically evaluate the claim that SSRI antidepressant drugs work by altering emotional information processing and social behaviour.
Antidepressant drugs are used as a way to treat depression and serotonin has a role in the action of antidepressant drugs because selective serotonin reuptake inhibitors (SSRIs) have antidepressant effects in some patients with depression (Harmer & Cowen, 2013). There are multiple questions that arise from research that suggest positive effects for antidepressants, for example, why would only changing the levels of neurotransmitters in the brain treat depression, why does it take many weeks to see the effects of antidepressants if there is a direct link between the neurotransmitters and depression and should there not also be effects on individuals who do not suffer from depression. There are two models that try to answer these questions, the cognitive neuropsychological model (Harmer & Cowen, 2013) and the social interaction model (Young et al., 2014).
The cognitive neuropsychological model of antidepressant drugs, which was put forward by Harmer and Cowen (2013), suggests that from the start of the treatment, the drugs create implicit positive biases in attention, appraisal and memory. The delay in the effects is caused by the time it takes for these emotional biases to influence mood. The evidence backing up this model suggests that acute or sub-chronic administration of SSRI antidepressants will increase the recognition of happy facial expressions in depressed patients who have the tendency to classify ambiguous facial expressions as being negative, and also improve memory of positive adjectives (Harmer & Cowen, 2013; Young et al., 2014). The social interaction model (Young et al., 2014) also suggests that antidepressants alter responses to stimuli but in the social interaction model the stimuli are other people and the change is towards a more agreeable social behaviour. The difference between the two is in how the altered response to a stimulus improves mood, in the cognitive neuropsychological model the changes are only in the mind of the patient and in the social interaction model the change is in the behaviour of the patient. These two theories could be operating at the same time (Young et al., 2014). This essay will critically evaluate the claim that serotonin reuptake inhibitor (SSRI) antidepressant drugs work by altering emotional information processing and social behaviour.
Depressed individuals classify ambiguous facial expressions as negative more than individuals with no depression. Also, individuals with anxiety have attentional and interpretational biases towards threat, for example, an increase in initial orienting and the recognition of facial expressions that appear fearful. The decoding of these negative and threat-consistent biases of perception, memory and attention into thoughts, memories and actions have an important role in precipitating and maintaining states of depression (Harmer and Cowen, 2013).
Harmer and Cowen (2013) found that in an emotional processing task, a dose of SSRI could increase the recognition of happy facial expressions and attention to positive socially relevant stimuli. This shows that even acute administration of SSRIs could increase positive emotional processing, which would then reverse the negative biases that are found with depressed individuals. They also found that the acute administration of SSRIs increased threat processing in healthy participants. Research has found that the acute administration of SSRIs decreased the response to fear in the amygdala (Harmer & Cowen, 2013).
Studies have also found that a repeated administration of SSRI can increase affiliative problem-solving behaviour and decrease submissive behaviour in healthy participants (Harmer & Cowen, 2013). These findings show that antidepressant drugs may also not only increase the processing of positive affective stimuli but that they can also improve social interactions and behaviour. This shows that the drugs could offer a remedy for the dysfunctional social behaviour that is found in patients with depression (Harmer & Cowen, 2013). Harmer and Cowen (2013) also found that neuroimaging data suggests that the amygdala and the fusiform gyrus are modulated by SSRI drug administration, which shows that the antidepressant drugs could affect automatic emotional evaluation of these stimuli and related changes in attentional processing.
According to Young et al. (2014), it has been found that increasing serotonin in the body decreases unruly behaviours and increases agreeable behaviours in individuals. They suggest that antidepressant drugs act partly by effects on social behaviour leading to improvements in the individual’s mood. They explain this claim in a few different ways. Aggression is a dramatic aspect of social behaviour and it has been found that serotonin has an overall inhibitory effect on it. This has been studied in a number of animal trials. It has also been discovered from these animal trials that increasing serotonin with tryptophan or selective SSRI fluoxetine increased the animal’s behaviour of approaching and grooming other animals. It can be concluded from this that serotonin may actually alter social behaviour along the continuum from agnostic to affiliative. This has been studied in humans as well and it has been found that acute tryptophan reduction increase aggression in behaviour and decreases affiliative behaviour. Supplements containing tryptophan can decrease aggression while increasing positive social behaviour (Young et al., 2014).
Serretti et al. (2010) conducted a review of a lot of different studies that looked at how antidepressant drugs influence healthy participants. They found that there was no effect on mood for the most part in these studies when comparing the antidepressant with a placebo. They did however find that antidepressants do exert an influence in healthy individuals, for example there were effects on social behaviour.
Another study also found alterations on social behaviour on healthy individuals. Knutson et al. (1998) hypothesized that serotonergic function adjusts aspects of the normal spectrum of individual differences in affective experience and social behaviour. They gave SSRI or a placebo to healthy subjects in a double-blind design for 4 weeks. They assessed the subjects’ personality and social behaviour in weeks 1 and 4 of the study. They found that in the participants who received SSRI instead of placebo, it reduced hostility through a decrease in negative affect and increased affiliative behaviour.
Knorr et al. (2012) also looked at the effects of SSRI on healthy individuals. They gave escitalopram 10 mg or placebo every day to relatives of people suffering from major depression. They examined their personality throughout the trial. They found that there was no effect on neuroticism, extroversion, psychoticism, openness or conscientiousness but they found an increase in agreeableness. These studies show support for the fact that antidepressant drugs could decrease agnostic and increase affiliative social behaviour in individuals (Young et al., 2014).
There are many studies that have looked at the effect of antidepressant drugs, compared to placebo, on agnostic behaviour in patients with diagnoses different from depression. A study by Salzman et al. (1995) found in their 13-week double-blind study with participants with a diagnosis of borderline personality disorder that an antidepressant drug, fluoxetine, significantly decreased anger in patients. Coccaro and Kavoussi (1997) found in their 2-3-month double-blind placebo controlled study that fluoxetine, not placebo, decreased aggression and irritability in patients with different DSM-III-R personality disorders. These results show that SSRIs can help to decrease aggression and irritability, which contribute to social behaviour (Young et al., 2014).
Studies have found that more agreeable social behaviours are more likely to be reciprocated, which results in a better, more positive mood. It has also been found that unrulier social behaviours also are likely to be reciprocated, which also results in a worse, more negative mood (Young et al., 2014). So, if the antidepressant drugs can make someone act in a more agreeable social behaviour, this will also lead to a more positive mood. Based on the research mentioned it can be said that most antidepressant drugs boost the functioning of serotonin, which influences social behaviour. Depressed individuals a lot of the time are irritable and have aggressive behaviour. Since people tend to reciprocate this unruly social behaviour or they reciprocate agreeable social behaviour, the unrulier behaviours lead to a more negative mood while the more agreeable behaviour relate to a more positive mood. Because of all of this, it can be said that antidepressants can improve mood by altering social behaviours (Young et al., 2014).
There is evidence supporting the cognitive neuropsychological model and the social interaction model of antidepressant drugs (e.g. Coccaro & Kavoussi, 1997; Harmer & Cowen, 2013; Knorr et al., 2012; Knutson et al., 1998; Salzman et al., 1995, Serretti et al., 2010). However, since finding cause and effect in these studies can be hard, changes in mood could also happen in parallel with changes in cognitive appraisal and social behaviour. And changes in cognitive appraisal and social behaviour might interact with each other to change mood (Young et al., 2014). Further research should be done to determine how the antidepressant drugs truly work, however, based on current research, it can be seen from these studies that serotonin reuptake inhibitor (SSRI) antidepressant drugs do work by altering emotional information processing and social behaviour.
- Coccaro, E. F., & Kavoussi, R. J. (1997). Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Archives of General Psychiatry, 54(12), 1081-1088.
- Harmer CJ & Cowen PJ (2013). “It’s the way that you look at it” – a cognitive neuropsychological account of SSRI action in depression. Philosophical Transactions of the Royal Society B, 368: 20120407.
- Knorr, U., Vinberg, M., Mortensen, E. L., Winkel, P., Gluud, C., Wetterslev, J., … & Kessing, L. V. (2012). Effect of chronic escitalopram versus placebo on personality traits in healthy first-degree relatives of patients with depression: a randomized trial. PloS one, 7(2), e31980.
- Knutson, B., Wolkowitz, O. M., Cole, S. W., Chan, T., Moore, E. A., Johnson, R. C., … & Reus, V. I. (1998). Selective alteration of personality and social behavior by serotonergic intervention. American Journal of Psychiatry, 155(3), 373-379.
- Salzman, C., Wolfson, A. N., Schatzberg, A., Looper, J., Henke, R., Albanese, M., … & Miyawaki, E. (1995). Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. Journal of Clinical psychopharmacology, 15(1), 23-29.
- Serretti, A., Calati, R., Goracci, A., Di Simplicio, M., Castrogiovanni, P., & De Ronchi, D. (2010). Antidepressants in healthy subjects: what are the psychotropic/psychological effects?. European Neuropsychopharmacology, 20(7), 433-453.
- Young, S. N., Moskowitz, D. S., & Aan Het Rot, M. (2014). Possible role of more positive social behaviour in the clinical effect of antidepressant drugs. Journal of psychiatry & neuroscience: JPN, 39(1), 60.
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