Weighing the Emotional Impact of Common Depression Drugs
Carly Terracciano studies SSRIs and how they can affect people’s emotions and relationships.
As a child, Carly Terracciano watched as her younger sister grew up with a neurological disorder that severely impacted her speech, coordination, and overall brain development. The experience had a profound effect on Terracciano and sparked her interest in the human brain.
Terracciano (Ph.D. ’22, Psychology, Clinical Psychology training area) recently finished an internship at the University of Florida and is now working toward her license to practice as a clinical psychologist in New York and Connecticut.
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Much of her research centers on the emotional impacts of selective serotonin reuptake inhibitors (SSRIs), prescribed to treat depression. Terracciano (formerly Tocco) wrote about apathy and other forms of emotional blunting caused by anti-depressants in her Ph.D. dissertation. She took time this month to talk to the Graduate Center about her research on SSRIs, their uses and risks, and her future career plans.
The Graduate Center: What drew you to the psychology field?
Terracciano: I think this is two-fold. First, my sister was born with Rett Syndrome, an X-linked chromosomal disorder that severely impacts brain development, speech, coordination, muscle tone, etc. From a young age, I witnessed the ways the brain can simply "go wrong."
Secondly, I think I was always a mini budding scientist, as my mother described me as an overly curious child asking a minimum of 100 questions a day, (e.g., "Why are stop signs red?" "Why do people wear socks?"). My poor mother.
Combining my unique familial circumstances with my innately curious nature likely pulled me down the psychology aisle, as I wanted to become an expert on brain-behavior relationships.
GC: How does your experience in the Ph.D. program help you in your current work?
Terracciano: My Ph.D. program had incredible coursework (from neuroanatomy to psychopharmacology) that provided me with the foundational knowledge I needed to apply theory to practice. When I see patients with neurological disorders or depression or both, I know the underlying brain systems impacted by these conditions like the back of my hand and that helps combat the imposter syndrome I sometimes feel as a young clinician.
Outside of work, navigating the numerous hurdles of a Ph.D. program helped develop my tenacity. It truly is a marathon, and you learn to delay gratification. I also learned just how important it is to have a village of people behind you. My Ph.D. would never have been possible without the support of my parents and best friend. Having them as a sounding board was essential to my success, and I am forever grateful.
GC: Your dissertation looked at pharmacological side effects of anti-depression drugs, and how SSRIs can lead to emotional blunting. Can you explain what you found?
Terracciano: My dissertation looked at side effects of a specific class of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). These are currently the first line of defense in combating depression pharmacologically, as these medications have fewer side effects than other antidepressant medications such as tricyclics and monoamine oxidase inhibitors.
With this said, there was tons of anecdotal evidence that SSRIs were indeed decreasing depressed feelings, but that patients were feeling emotionally numbed or blunted all around. This means that many people on SSRIs were having difficulty feeling all emotions, even good ones, like joy, love, fear, etc.
This side effect had not been researched empirically prior to my dissertation, and isn't even listed in the Physician's Desk Reference as a possible side effect. My work found that people on SSRIs who report feeling emotionally blunted are able to identify other people's emotions just fine, they just report feeling them less strongly. More importantly, we found that individuals who had sexual dysfunction from their SSRI medication, which is a common and well-known side effect of antidepressants, were significantly more likely to experience emotional blunting from their medication.
GC: How does emotional blunting affect people in their everyday lives?
Terracciano: For people taking SSRIs who feel emotionally blunted, it can be challenging to weigh the pros and cons. Sure, feeling less sadness, guilt, or hopelessness is likely relieving, but it may come at the cost of feeling less joy, surprise, happiness, etc.
Past research has shown that some individuals with SSRI-induced blunting will report caring less about important relationships, which is problematic, as healthy, close relationships are protective against depression. For example, an individual with SSRI-induced blunting may be less expressive with affection towards their romantic partner.
While I think the impact on relationships is probably the most detrimental effect of emotional blunting, reduced feelings of urgency when a deadline is fast approaching or feeling apathetic about one's own physical appearance can also be impactful.
It is important for patients taking the medication and physicians prescribing the medication to be aware of its possible occurrence. If it occurs, patients and physicians should collaboratively decide if the benefits outweigh the blunting.
Of note, this side effect is dose-dependent, meaning the higher the dose, the more likely or stronger the blunting will be.
GC: What are some surprising facts about depression? Or the people who experience it?
Terracciano: Many individuals diagnosed and dealing with depression are high-functioning. We all have this notion of someone who is depressed as crying in bed for days on end, you know, like how you picture it in the movies. But this can be far from the reality of many people diagnosed with depression.
Many individuals with depression and taking SSRIs are working full time, keeping up with their social calendars, and are functioning at their baseline. Knowing this, it is even more important to intentionally check in on loved ones regarding mental health or emotional wellness, as it may be hard to pick up on.
While SSRIs are extremely helpful in treating depression, many individuals diagnosed with depression may not ever need them. It really depends on the severity of the depression. For individuals with mild to moderate depression or depression that is brought on by life circumstances, psychotherapy may be more impactful.
While research shows that a combination of both medication and psychotherapy is the most effective, some patients are averse to taking medication or cannot tolerate the side effects. Individualized treatment plans are imperative, as no two depressive episodes are alike.
GC: What are your next career steps?
Terracciano: I really love working directly with patients, so I know I will continue clinical work. I hope to do a mix of providing both neuropsychological assessments and psychotherapy. I also hope to provide clinical supervision to other trainees going through their doctoral training.
Providing peer mentorship to undergraduates applying to graduate school and graduate students navigating internship or dissertation defense has been surprisingly rewarding. It feels good to help others succeed on their paths, as so many people helped me succeed on my own.
GC: Do you have any advice to offer Ph.D. students just starting out, in the middle, or at the end of their program?
Terracciano: I would tell them to be kind to themselves.
I remember so many times throughout my journey when I needed to slow down or deviate from the trajectory for a while to take care of my health, family, emotional well-being. I always felt super shameful about it and in the end, it didn't matter. There is no one right way to get through the program. It is a journey, and it is all your own. I look back now and wish I wasn't so hard on myself.
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