Summary: Antidepressant medication for major depressive disorder appears to reduce the emotional response evoked by seeing others in pain. New findings indicate that antidepressant treatment—rather than the depressive episode itself—can diminish empathy for perceived pain.
Source: University of Vienna
Overview
Depression frequently disrupts social functioning, and impaired empathy has long been considered part of the clinical picture. However, much of the prior research examined patients who were already taking antidepressants, leaving it unclear whether reduced empathy is a consequence of the disorder or of its treatment. A new longitudinal study led by researchers at the University of Vienna and the Medical University of Vienna separates these effects and provides evidence that antidepressant therapy, most often with selective serotonin reuptake inhibitors (SSRIs), can reduce empathic responses to others’ pain.
An interdisciplinary team 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) conducted the study within the “Multimodal Neuroimaging in Clinical Neurosciences” research cluster. The goal was to distinguish the impact of an acute depressive episode from the effects of antidepressant medication on both behavioral and neural markers of empathy.
Study design and participants
The researchers recruited 29 patients experiencing an acute episode of major depressive disorder (MDD) who had not yet received pharmacological treatment, and a comparison group of 35 healthy controls. All participants completed two functional magnetic resonance imaging (fMRI) sessions: the patients were scanned once before starting medication and then again after three months of antidepressant treatment, mostly SSRIs. During scanning, participants watched short videos depicting people undergoing painful medical procedures, allowing the team to measure both subjective reports of empathy and brain activation patterns associated with empathic processing.
To separate effects specific to empathic reactions from generalized changes in negative emotion processing, the researchers also measured responses to experimentally induced electrical pain. Participants provided self-report ratings capturing both affective aspects of empathy (unpleasant affect when seeing others in pain) and cognitive components (perspective taking).
Key findings
Before starting medication, patients with MDD and healthy controls showed comparable levels of empathic response, both in self-report measures and in brain activation patterns. After three months of antidepressant therapy, however, patients demonstrated a significant reduction in affective empathy: they reported feeling less unpleasant affect in response to others’ pain, and fMRI revealed decreased activation in brain regions previously linked to empathy for pain. Specifically, activity decreased in three brain areas that had been selected a priori for their roles in affective empathy. Functional connectivity between regions associated with affective processing (anterior insula) and cognitive aspects of empathy (precuneus) also declined in the patient group between the two sessions.
Importantly, the study found no change in cognitive empathy (perspective taking) and no change in participants’ own experience of pain during the electrical pain task, indicating that the observed effects were selective to empathic responses toward others rather than reflecting a generalized blunting of negative emotion or sensation.
Interpretation and implications
These longitudinal results challenge earlier cross-sectional studies that attributed reduced empathy to the state of acute depression. Instead, the findings indicate that antidepressant treatment itself can attenuate the aversive emotional response triggered by witnessing others’ suffering. First author Markus Rütgen emphasizes that a moderated emotional response in social contexts might help some patients recover by reducing overwhelming negative affect, but he also notes that the broader consequences of decreased affective empathy for patients’ social relationships and behavior require further study.
The study highlights an important clinical consideration: antidepressant medications may alter emotional reactivity in ways that extend beyond symptom relief, with potential social and interpersonal consequences. Clinicians and patients might benefit from awareness of these effects, and future research should investigate how changes in empathy relate to social functioning and long-term outcomes.
Source:
University of Vienna
Media contacts:
Markus Rütgen – University of Vienna
Image source:
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
Abstract (summary)
In a longitudinal fMRI study of 29 patients with MDD scanned before and after three months of antidepressant therapy and 35 healthy controls, researchers assessed affective and cognitive components of empathy using a pain empathy task and self-report measures. Before treatment there were no group differences. After treatment, patients showed reduced affective empathy and decreased activation in empathy-related brain regions, along with reduced functional connectivity between affective and cognitive empathy areas. Cognitive empathy and responses to direct pain were unchanged. The findings suggest that antidepressant treatment, rather than depression itself, reduces emotional responses to others’ suffering.