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EV0794

Distinguishing anhedonia as a symptom of depression from antidepressant-induced anhedonia and managing both

DISTINGUISHING ANHEDONIA AS PART OF DEPRESSION FROM THE ANTIDEPRESSANT INDUCED ANHEDONIA AND MANAGING BOTH

SSRI-induced anhedonia should be distinguished from anhedonia as a core symptom of depression and managed by reducing the dose, adding a non-SSRI antidepressant, or switching to an antidepressant with a different profile.

The aim is to review the recognition and management of selective serotonin reuptake inhibitor (SSRI)-induced anhedonia and to distinguish anhedonia as a core symptom of depression from SSRI-induced anhedonia and their co-occurrence. The method is a literature review that also includes theses on the same topic. The findings indicate that although SSRIs are effective in improving depressive symptoms, they may be more effective for some symptoms than others, particularly depressed mood and anxiety, while being ineffective for anhedonia; catecholaminergic antidepressants are suggested to be more effective than SSRIs for anhedonia and emotional blunting in major depressive disorder (MDD). The primary effect of SSRIs is described as reducing the processing of negative stimuli rather than enhancing the processing of positive stimuli. Emotional blunting is reported to be associated with SSRI dose and possibly with serotonergic effects in the frontal lobes or serotonergic modulation of midbrain dopaminergic systems projecting to the prefrontal cortex (PFC). By enhancing serotonergic transmission, SSRIs may activate inhibitory gamma-aminobutyric acid (GABA) interneurons and suppress noradrenergic and dopaminergic input, whereas bupropion is reported to be less likely to cause emotional blunting as a side effect. The diagram in the poster illustrates that improvement remains incomplete when SSRI-induced anhedonia develops and that this anhedonia can occur in addition to the primary anhedonia associated with MDD. In conclusion, the proposed management steps are as follows: reduce the current SSRI dose, add a non-SSRI antidepressant to the reduced dose, add a non-SSRI antidepressant to the current dose, and gradually discontinue the SSRI and switch to an antidepressant with a different profile (an SNRI) that may improve the patient's emotional responsiveness.

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