Antidepressants may alter personality

Antidepressants may alter personality

Bruce Bower

A new generation of antidepressant drugs, led by Prozac (fluoxetine), has gained renown as a builder of better personalities through chemistry. In his 1993 book Listening to Prozac (Viking, New York), psychiatrist Peter D. Kramer of Brown University in Providence, R.I., argues that the drug enhances feelings of social ease and flexibility in people who constantly fear rejection by others but do not suffer from full-blown depression.

Kramer’s claims have sparked a vigorous debate among psychiatrists, much of which springs from clinical observations rather than scientific assessments. A new study, described at the annual meeting of the American Psychiatric Association in Philadelphia last week, suggests that Prozac and many other antidepressants may indeed alter one enduring aspect of personality as they diminish depression.

“Emotional and personality factors are intertwined in depression, so it’s really not surprising that some type of personality change would accompany improvement in this condition,” asserts study director Ron G. Goldman of Columbia University.

Goldman’s group employed a 100-item questionnaire, developed by psychiatrist C. Robert Cloninger of Washington University School of Medicine in St. Louis, that measures three broad personality dimensions (SN: 3/5/94, p.152). These consist of novelty-seeking behavior, harm avoidance, and dependence on rewards.

The researchers gave this personality test to 59 moderately or severely depressed individuals before and after random assignment to 6 weeks of treatment with a standard antidepressant, imipramine, or a placebo pill. Another 87 severely depressed persons treated with Prozac took the test before and after 10 to 12 weeks of treatment.

About two-thirds of those treated with imipramine or Prozac displayed a substantial dampening of their depression, compared with one-fifth of the placebo group. Regardless of treatment, participants whose depression eased also cited notable reductions in harm avoidance, the scientists contend.

Pessimistic worry about future problems, tapped by some harm-avoidance items, showed the greatest change as depression lifted, Goldman notes. Lesser change occurred for three other aspects of harm avoidance: fear of uncertainty, shyness of strangers, and a tendency to tire quickly in the face of stress.

Novelty seeking and reward dependence remained stable as depression lessened, the Columbia psychiatrist adds. “Harm avoidance may describe some basic aspect of depression, or antidepressants may have the capacity to change enduring personality traits,” Goldman maintains.

The latter possibility has yet to be tested in psychiatrically healthy people given Prozac or other antidepressants.

Goldman suspects that most antidepressants, not just Prozac, alter similar facets of personality as depression declines. However, Prozac causes fewer side effects than its chemically distinct counterparts, such as imipramine. Physicians may therefore prefer to prescribe Prozac to patients suffering from social unease or mild depression, producing obvious personality changes with only that drug, Goldman notes.

Personality disorders, which encompass a bevy of interpersonal problems, also attract the use of Prozac and its chemical cousins. Psychiatrists disagree about the extent to which antidepressants help in such cases, however.

“I suspect Prozac and other drugs have fundamental effects on personality,” argues Robert M.A. Hirschfeld of the University of Texas at Galveston.

Columbia’s Michael H. Stone disagrees. In personality disorders, Prozac and similar drugs transform a person’s enduring traits only to a limited extent, he contends.

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