Is anhedonia really manifested in that the patient no longer feels anything? Although this phenomenon has been known in psychiatry for a long time, the knowledge of society about it is still negligible. We talk to the psychiatrist Dr. Małgorzata Urban-Kowalczyk about the hardships of patients with anhedonia and depression.
Red. Marcelina Dzięciołowska: What is anhedonia? Although the term appears in the statements of mental he alth experts, relatively little is said about it.
Dr. Małgorzata Urban-Kowalczyk: Anhedonia, not only in the medical but also in the common sense, is most often understood as the inability to experience pleasure. However, this is a very large simplification. In psychiatry and scientific literature, this term appeared a long time ago, at the end of the 19th century, and it literally meant no pleasure.
However, based on experience from clinical practice and research on patients experiencing this symptom, we know that it is definitely something more, that it is a multifaceted phenomenon and reducing it only to not experiencing pleasure on an all-or-nothing basis would be too much very simplified.
Can this phenomenon be combined with a feeling of indifference?
Sometimes yes, because not every depressed patient always sees only sadness. Some patients say that they feel not so much sad as they feel indifferent and apathetic. Patients often complain that they cannot be happy or angry - they react indifferently to the environment.
Anhedonia is an emotional disorder that affects different aspects of the pleasure in our lives. It can be said that the phenomenon of experiencing pleasure has two dimensions. One of them can be called primal or instinctive, related to the maintenance of life, species - it is a biological experience of pleasure, which, as a rule, is related to the fact that we will get an emotional reward.
What are the pleasures?
For example, those related to sex, food, and interpersonal relationships that we need for our emotional development.
And the second group of pleasures?
These are secondary pleasures that are not instinctive, where the pleasure of reward is not guaranteed but must be learned. Is ite.g. pleasure connected with intellectual work, with experiences related to music and art, with altruistic activities, with experiences resulting from a walk along the seashore or enjoying the sound of the sound of the waves, etc. These are the pleasures we acquire and learn that we want to experience them. Anhedonia can affect patients in both respects.
How is anhedonia in relationships? Is a patient with this symptom of depression able to build or persist in relationships?
If we are talking about anhedonia, which is a symptom of depression, it can definitely hinder interpersonal relationships, whether in a relationship with a partner or in relations with the immediate family, but also in social and professional relationships.
Why is this happening?
This is due to the fact that the patient does not feel the need for these contacts because he does not receive gratification, i.e. a reward related to contact, he is not able to get emotionally involved. This is something completely different from social anxiety.
Depressed and anhedonia patients avoid social contact not because they are afraid of people or their negative evaluation, they just don't feel the need to do so. This contact in their depressedly altered perception is emotionally indifferent and sometimes even irritating.
He althy people naturally strive for these contacts, right?
If we enjoy contacts with other people, we naturally want this contact and strive for it. Then there is also the element of craving for that pleasure that gives us a reward. Patients with depression and anhedonia simply do not feel it, so these contacts with other people are not as important to them as before. Therefore, when we work and talk to patients, we often ask whether they have a need to talk to their wife or husband on a daily basis, whether they are interested in what is happening with their relatives, or whether they prefer to go to their room and shut up there. .
What answers do you hear to these questions?
Most of these patients, unfortunately, prefer to isolate themselves. This does not mean that they have stopped loving their partners or their children. They are simply not able to experience or experience these contacts as before, therefore they usually limit them.
How does a psychiatrist recognize anhedonia? Are these questions regarding the response to the given situations sufficient?
In a sense, yes, but we must emphasize that we can treat anhedonia as a condition associated with depression or as a temperamentally or personality trait. These are two completely different categories.It is possible to experience anhedonia but not to be depressed, but the vast majority of people with depression also have anhedonia.
Is anhedonia a symptom that clearly indicates depression?
Anhedonia is a symptom that is very important in the diagnosis of depression, but it is not sufficient. However, it is, apart from low mood, the key diagnostic criterion. We, as psychiatrists, must, in the context of the diagnosis of depression, assess the patient's functioning in various spheres of life.
So what questions are valid?
We ask about basic issues, such as sexuality and the pleasures associated with eating. Patients with depression usually have eating disorders, most often in the form of a decrease in appetite, with secondary weight loss and when we ask about the appetite, we often hear: "I eat because I have to", "I eat reasonably", "I don't care what I eat" .
Does this mean that the anhedonia patient is losing his sense of taste?
This is not the same as loss of taste, as is the case with COVID-19 infection, for example. It is not that the patient does not feel the taste in the sensual sense, but the perception of this taste in the context of the pleasure that comes from eating for him does not exist.
Does reluctance to eat pass in the process of recovery?
This is very evident in hospitalized patients, because in cases of severe depression, when they experience very deep anhedonia, they really eat at our request, and sometimes the staff have to make sure that they eat any meal. However, when they begin to heal, and thus the anhedonia wears off, patients ask their family to bring those foods they like, it becomes enjoyable to eat them. This is one of the many determinants of recovery.
What about other spheres of life?
We also ask patients about other daily activities, such as sports activities that they have practiced so far, whether they meet friends, go for a walk with the dog, which was relaxing for them in the past, do they take care of themselves, whether they go to the beautician or the hairdresser, if they used to do it regularly. Basically, these are all activities that the patient describes as giving him pleasure, both very important and prosaic and minor.
Can the patient feel reluctance and lack of pleasure only in a specific area of his life? Could it be selective?
Anhedonia can "act" globally, but it can also be selective. It does not happen that anhedonia in depression will only concern the sexual sphere, and in other cases it will be normal, because in a depressed patient there is nosomething like experiencing pleasure normally. However, the patient can feel the difference - e.g. in this particular area it is extremely bad, and in others the feeling of pleasure is still present to some extent.
So not every patient will feel a complete lack of pleasure?
The original definition of anhedonia was a complete inability to experience pleasure. Not all patients speak of such an extreme severity of pleasure experiences. They basically feel it, but have the feeling that their emotions are flattened, as if they are not enjoying themselves as they should be, according to the situation.
What can anhedonia look like in practice?
As recently as yesterday, I had a patient who was diagnosed with the first episode of depression in my life, she had not received psychiatric treatment before. Recently, she has experienced very difficult situations that endangered the lives of her relatives. The patient experienced it very much, she was worried, and when all these events ended positively and it seemed that it should make her happy and even euphoric, she was surprised herself that she could not be happy about it. She admitted that she was happy, but not as expected.
Sometimes it turns out that we have no idea about someone's depression, which leads to the conclusion that very often this disease is simply not visible from the outside.
Yes, but it should also be remembered that not all depression is very severe and requires quick intervention, for example related to suicidal thoughts or psychotic symptoms, and therefore will not always be noticed by the patient's surroundings. If depression begins in, for example, a highly functioning person, especially in one who does not like self-pity and is task-oriented, disease symptoms are sometimes rationalized and minimized, which may postpone effective treatment.
How does such a task-oriented person react suddenly to the fact that an illness "interferes" with his plans?
Functioning below her own norm is unacceptable for her, she will try to mask, rationalize, explain the worse functioning with fatigue, lack of vitamins, weather, lack of sun, etc. It often turns out that such people at the beginning, even when visiting a psychiatrist, try to present themselves very well and even downplay their problems, while when we examine them a little longer, it can be seen that the problem of depression develops there for months or even longer.
What if the patient does not realize that what is happening to him are symptomsdepression?
What happens mentally with such a patient is something completely different than his norm and significantly affects the deterioration of his daily functioning. If he and those around him notice it, a red lamp should light that it may be depression. Of course, it may or may not, but you should take into account such a possibility.
What do you recommend in such circumstances?
In order not to google what are the treatment options and, above all, not to make a diagnosis and not to use drugs on your own. This is why specialized doctors are able to make a diagnosis of depression or rule it out and propose appropriate diagnostic or therapeutic procedures. The most important thing is not to delay. Depression is a disease that can eliminate a well-functioning person for many months.
What are the most effective treatments for depression?
There are many treatment methods. In general, it can be said that depression is a serious, complex biological disease. We do not fully know her biology, which immediately determines the complexity of her treatment. There is no one medicine that is a panacea for every depression. I always say that treating depression is like making a made-to-measure suit. What may be the first effective drug for one patient may not help another, cause side effects. Of course, apart from pharmacotherapy, we also have other biological methods, such as electrotherapy, transcranial magnetic stimulation of the brain, and of course psychotherapeutic interactions.
What should be considered when selecting a drug?
There are many factors to consider. Certain antidepressants are treated as first-line drugs, but we always have to approach each patient very individually, take into account his current treatment, his comorbidities, other medications he takes, his preferences, drug tolerance so far, the possibility of cooperation with the patient, as well as the picture clinical depression.
Is pharmacotherapy always necessary in the treatment of depression? Are there people with known depression who do not take medication?
Pharmacotherapy should not be initiated immediately in all patients. In patients who have mild depressive episodes, behavioral-cognitive therapy is also a form of treatment, and those patients who have access to it can start treatment with psychotherapy. If the therapist sees that the patient is not making progress in the treatment, the symptoms worsen, then he or she refers him back to a psychiatrist.
There are cases where medications do not work for the patient.
This is unfortunately another problem. We have more and more treatments available for depression, but they cannot help everyone. About 60 percent. of patients respond to these drugs, while about 30 percent. patients with depression show the features of the so-called drug resistance. It is not about the so-called alleged drug resistance, where patients do not follow medical recommendations, do not take drugs in the right dose, long enough, or stop drug therapy. We are talking about patients who diligently follow the recommendations and have no effects.
What actions does the psychiatrist take then?
If we have a patient who is not affected by drugs, and we have ruled out the causes of the alleged drug resistance, we have various options for potentiating antidepressant treatment. There are several possibilities - most of them involve modifying pharmacotherapy by changing to another drug, combining antidepressants or adding drugs from other groups to increase the effectiveness of the treatment. In many drug-resistant patients, we obtain very promising results as a result of electrotherapy.
A lot has been said recently about esketamine, which acts relatively quickly.
Yes, the possibility of administering esketamine to drug-resistant patients has recently appeared in Poland. The drug is in the form of an intranasal spray that is used in combination with other antidepressants. Esketamine is a "prototype" of fast-acting antidepressants. Typically, after the initiation of a conventional antidepressant drug, a therapeutic effect can be expected in about 4-6 weeks. Esketamine is not used alone, but its antidepressant effect comes on faster and speeds up the healing process. However, I emphasize that there is no one universal therapy that could help everyone. It must be adjusted individually in each case.
What about the infamous electroshock therapy?
Electrotherapy is one of the methods used besides pharmacotherapy. Indeed, for a long time she was associated not very well with images like, for example, from the movie "One Flew Over the Cuckoo's Nest", which is absolutely not true. This method is extremely effective in the treatment of affective disorders, safe. We use it with very good results in our patients, also in drug-resistant ones.
That is why it is so important to break stereotypes and raise awareness about the effectiveness of various methods.
When it comes to electrotherapy, we have been using it successfully in the Clinic for many yearsPsychiatry in Lodz. When students come to our psychiatry class and see what an electrotherapy treatment looks like, they are often surprised that there is nothing spectacular about it, nothing reminiscent of "One Flew Over the Cuckoo's Nest".
We often joke that, for example, in women, such electrotherapy treatments work better than aesthetic medicine treatments, because when depression passes, they want to take care of themselves, they look completely different, they are younger, they simply become more beautiful. There are many treatment methods, the key to success is finding the right one for a specific patient. It must be emphasized that modern, effective treatment for depression is available.
When can a patient be considered to have drug-resistant depression?
When he has had at least two unsuccessful treatments with antidepressants from different groups, taken in the right dose and for a sufficiently long period of time. Practice shows that in these patients, there were often more than two unsuccessful treatments.
How do these patients react to the fact that the drugs work for others but not for them?
They have such a feeling that they have already used up all the treatment options that if they have been feeling unwell for the last two years, for example, there is nothing left to help them. Often, these patients, at our request, agree to another treatment attempt, because they themselves are already very much resigned. When the depression wears off, it often turns out that the patient changes his perspective on everything, because depression changes the optics so much.
When a patient begins to respond to pharmacological treatment for depression, does the anhedonia also disappear? Are there any other methods I should follow to get rid of it?
As depression is treated, it worsens and over time all symptoms, including anhedonia, disappear. Occasionally it is the case that certain drugs, for example the selective serotonin reuptake inhibitors group, the popular SSRIs, which are basically the drugs of first choice, may paradoxically give the impression of a flattened emotion. Patients begin to feel discomfort, they have the impression that their emotions are unnatural.
What should be done in this case?
This is a signal that a different antidepressant should be taken. Optimal treatment should bring the patient's well-being back to his individual norm.
If the patient is feeling well, the intuitive thought is that it is time to stop taking medication. Is improvement a signal to stop taking medication, or should treatment be continued for a certain period of time?
For treating depression, we have specific recommendations for how longtreatment should continue. As a general rule, if a first-ever depressive episode occurs, treatment after remission should last for at least six months. It is very important to educate the patient at every stage of treatment, especially when the patient begins to recover. The thing about depression is that it never comes overnight, and it never goes away overnight. In treating depression, both the patient and the doctor must be patient. Immediate effects cannot be expected, but when they do occur, drug therapy must be used long enough to avoid a quick recurrence of symptoms.
So it can be said that patient education contributes to increasing the effectiveness of therapy?
A patient who is educated always cooperates better in treatment. He should know that he is feeling better precisely because he is taking the medication, and if you stop taking it too quickly, that can change because it won't cure depression. Our psychiatric patients, not only depressive, do not differ much from other patients suffering from other chronic diseases when it comes to cooperation in treatment. They do not adhere to treatment as well as all other patients. About 40-50 percent. does not follow the doctors' recommendations.
The improvement stage, when the patient is relieved and begins to return to normal functioning, is always a temptation to stop taking medication. Some patients, even with education on our part, do it anyway. Every depressed patient needs to know that it requires long-term treatment.
So how do I explain to patients why they should use these drugs for a certain period of time?
The duration of treatment is based on numerous scientific studies and clinical experience. It should be remembered that the treatment of depression involves not only the acute treatment phase, but also the consolidation phase of mental improvement. Remember that the early stage of treatment is very fragile ice and it takes little for any factor or a small stressor to intensify or induce depression again.
After improving he alth and completing the pharmacotherapy process, should the patient attend psychotherapy in order to be able to work with stress and emotions on an ongoing basis, which could help minimize the risk of recurrence of depression?
Not every patient has to benefit from psychotherapy and not in all cases psychotherapy has to be long-term. If the patient already uses it, the psychotherapist decides at what stage of advancement in the therapy the patient is, whether he is ready to end the therapy, or whether it should be continued. Thesedecisions are made on a case-by-case basis.
Can stress trigger a relapse of depression in a patient in remission?
Not every stressor has to induce depression, but you should know that people already have different personalities of resistance to stress. Stress can always worsen your mental state and can lead to depression coming back. We are also talking about stress, which is positive (e.g. professional promotion), but is associated with great emotions, the need to change, make decisions, and this can be a burden for the patient. The sensitivity of patients suffering from depression is often greater than that of he althy people.
Does it often happen that the patient has difficulty ending psychotherapy?
Patients have different personalities. There are people who, apart from experiencing depression, are strong, decisive, resilient and they do well, want to return to such decision-making and independence when depression is far away. Such patients often do not want to benefit from psychotherapy at all. There are also those who, regardless of the symptoms of the disease, have personality traits that contribute to depression, for example a high level of anxiety, perfectionism. For them, the possibility of constant contact with a psychotherapist may increase the sense of security, which is why this group of patients may expect a prolongation of psychotherapy.
What should a psychotherapist not do?
Some patients may need to consult the therapist on decisions of various importance, often these patients expect advice on life, which, of course, therapists should not do. The therapist may, for example, correct depressive cognitive distortions, negative self-perception by the patient, but cannot make decisions for him.
Is there anything a depressed and anhedonia patient can do to help control these symptoms?
There is no way to control the symptoms of depression on your own, especially if you are severely depressed. Patients with severe depressive episodes are sometimes unable to get out of bed. For this reason, they often have intense remorse, believe that they are a burden for the family, which sometimes does not understand their condition. It happens that people who have never experienced mental disorders treat it as a whim, laziness, but believe me, in severe depression there is no possibility for the patient to do anything by himself. Only at the stage of recovery should he be more involved in the therapeutic process, motivated to gradually become more active in various spheres of life.
What happens when a patient shows significant improvementmental he alth?
You could say that his world is changing. Life starts to make sense again, there are plans, aspirations, interest in the environment, the desire to take care of their appearance, spontaneous laughter … This is the time when, apart from using medications, the patient has to give something from himself - to activate, try to return to his normal functioning, try with the help of a doctor or therapist, to deal with the remaining symptoms of depression not only with medication.
For example?
This is what they serve, among others therapeutic laboratories in psychiatric wards. There, various forms of activity are available, where the patient can deal with fairly simple activities, but those requiring concentration, dedication and motivation. In my ward, this activity is graded for the patient. I always ask the patient to go to the laboratory for as long as he can. If he manages to stay there for 15 minutes, sometimes it's still a success. Next time, maybe it will be longer. We encourage patients with milder symptoms treated on an outpatient basis to gradually return to their daily duties, meetings with friends, family, attempts to return to their previous interests, physical activity, etc.
However, ordering or reprimanding a patient with severe depression will not bring the expected result, but will only increase the feeling of guilt. This intervention must be proposed at the appropriate stage of symptom worsening and treatment. The patient must feel at least a little better so that he has the motivation and strength to do more.
What if the patient lives in an environment where depression is underestimated, medication use is negated and discouraged?
This is, unfortunately, a paradox, because we see that there is more and more information on mental he alth in the media. It seems that the awareness of the society is still growing, but it is not at the level we would expect. What you said may be a factor preventing the patient from seeking help, because firstly it will be stigmatization, secondly it will be a disgrace for the person that he cannot cope like others or there will be doubts as to whether this is really a problem and the patient will start wondering if maybe he is really lazy or not trying enough.
What could be the consequences?
This, unfortunately, postpones getting professional and effective help, and thus may aggravate or even perpetuate the symptoms. In the most dramatic cases, untreated depression can result in the patient's death by suicide. The more social campaigns there will be to say that depression can be treated, that it isa common disease that can take a person out of life, cause long absenteeism from work and serious he alth consequences, including loss of life, the awareness of our current and potential future patients and their relatives will also be greater.
Please remember that about 15 percent depressed people commit suicide. Later it turns out that something has happened to the patient much earlier, only nobody has seen it. We have signals, e.g. from patients who suffer from depression during pregnancy or in the postpartum period, that difficulties in taking care of a baby or anhedonia are often interpreted by the environment as being a bad mother who is lazy and does not enjoy the baby. These patients really are in a huge crisis, not only because of the symptoms of depression, but sometimes, unfortunately, because of the lack of support and understanding in their immediate environment.
What convinces patients from the perspective and observation of the doctor that they should seek professional help?
My practice shows that patients often decide to talk about their disease and visit a psychiatrist at the urging of relatives or friends who have experienced psychological problems themselves and benefited from such help with a visible effect. I have a depressed patient who I am very proud of because she comes from a small town where she is recognizable and fulfills an important function. She fell ill a few years ago. Before her illness, she was a very well-functioning, active, sociable person, and depression made her unable to cope even with household chores. He is currently in full symptomatic and functional remission. This patient in her local community says that if someone feels unwell and is sad, she should go to a psychiatrist and show by her example that it has helped her. I am very happy that she had the courage to reveal it, because her opinion may have a positive impact not only on the perception of mental problems, but also on the decision to start treatment by someone from the town.
A person who has faced the hardships of depression may have more empathy, understand the mechanisms of this disease and be willing to help others who also find themselves in this difficult situation.
Examples should be shown of how much the patient's functioning can change to the detriment of the disease and how much it can improve after successful treatment. As a psychiatrist, I often see that patients who recover from depression are completely different people, because it turns out that I was visited by a hunched old lady for the first visit, and after treatment she is an attractive woman with colored hair.fingernails, smiling and content in her new suit. It is a great satisfaction for a doctor to see a patient recover so spectacularly.
Let's go back to the topic of depression in pregnant women. Are there any contraindications to pharmacotherapy in such cases?
This is a complicated topic because so far there is no antidepressant drug that we can consider completely safe for the developing fetus. Previously, there was a belief that a pregnant woman should not take any medications, which is now slowly changing. There are drugs that are very dangerous that should definitely not be administered, but there are also drugs whose safety is relatively high, although not 100% safe. Treatment of depression in pregnancy is always a clinical challenge, it should be carried out taking into account the balance of profits and losses that may be associated with both the administration of drugs and the failure to treat depression. The cooperation of the psychiatrist with the obstetrician in charge of the patient's pregnancy is always very important.
Are cases of depression during pregnancy and postpartum depression common?
You must always bear in mind that pregnancy, contrary to popular belief, is not a protective period for a woman. Pregnancy and the perinatal period carry the greatest risk of developing affective disorders in a woman's life. Postpartum and perinatal depressions are often very severe depressions, which should be absolutely treated by specialists.
Why?
Because they threaten not only with suicide, but in extreme cases also with infanticide. These are extremely suffering women who are sometimes ashamed to tell about their symptoms, because the environment expects that the mother should be happy and take care of her child. These women require additional support and the decision of a psychiatrist to start treatment should be made with extreme caution, because not only the safety of the child, but also the mother should be taken into account in order to give the patient a chance to experience motherhood to the full, and in depression there is no chance for that. There are drugs that can be selected to provide optimized treatment of perinatal depression.
It can be difficult. Some women may be concerned about the effects of medication during pregnancy and may decide to postpone treatment until delivery.
Yes, but some of these women are in such a terrible condition that they rather give up not so much fear as helplessness and the belief that they do not hope to improve their condition. Usually, in such situations, we try to discuss the situation not only with the patient, but also with the child's father.
So whatdecides whether pharmacological treatment will be introduced in a pregnant patient?
The decision to start pharmacotherapy should be made jointly. We always weigh the pros and cons of what can happen if we give the medication and if we stop taking the treatment. Cooperation with a psychotherapist or obstetrician is also important. Especially with interdisciplinary treatment, the patient can be cured of a really severe depression and let her enjoy motherhood. The appearance of mental disorders during pregnancy should, for example, prompt you to make an appointment with a psychiatrist. Obstetricians are also educated in this regard and during pregnancy monitoring they obligatorily perform the so-called The Edinburgh Depression Scale, which is a kind of screening for the diagnosis of mood disorders in pregnancy. Of course, it is not sufficient for a diagnosis of depression, but it does signal to the doctor that this patient is at risk and should be referred to a specialist.
To sum up - anyone who experiences persistent depressed mood, sadness or helplessness should consult a doctor?
I think this is the best method. I will use the analogy that oncologists also refer to. Many women are able to palpate for a lump in their breasts during self-examination. Before they go to the oncologist, they read on the Internet, ponder, check, think about whether it's cancer, and time goes by. This is an extreme comparison, because cancer is scary, but you can also die of depression. Depression does not hurt at first, but then it hurts all the time, emotions hurt, sometimes also the body. It can cause tremendous suffering, even suffering that leads to suicide. Certainly, many cases of worse well-being and low mood are not depression and do not require intensive treatment, the diagnosis of depression is sometimes overused. However, among them there may be someone for whom a proper diagnosis and early treatment will save he alth, and sometimes life.
What should people with depression know?
First of all, don't be afraid to ask your doctors questions. There are no stupid questions. It is really better to ask a doctor than to search for information on the Internet yourself and make your own interpretation of this knowledge. Especially patients who have a high level of anxiety should not do this, so as not to further reinforce their fears. Patients should also know that depression is a common disease that cannot be underestimated and may lead to disability, but that it can be successfully treated and you can return to your current life.
Are patients afraid ofthe occurrence of side effects may refuse pharmacological treatment?
Patients are very afraid of this, so educating yourself about what will happen with antidepressants and how to deal with side effects is very important. There is a group of common side effects that occur frequently and the patient must be prepared for them so as not to get scared and stop the treatment. If the patient has this knowledge, his anxiety will be lower, which in turn can significantly improve cooperation in the therapeutic process.
What are the symptoms?
It depends on the group of drugs, but when we talk about, for example, popular SSRIs, most often these are actions related to the gastrointestinal tract, for example nausea, sometimes vomiting, loose stools, abdominal discomfort, sometimes excessive sleepiness, dizziness headache, dry mouth. These are the most common side effects and are usually not dangerous but cause you discomfort. If the patient knows that after about 7-10 days they will disappear and if they are not very severe, he is able to wait them out.
What if the patient still cannot cope with the severity of these symptoms?
In some patients the sensitivity to certain mechanisms of drug action may be greater, so it does not make sense to force the patient forcibly and sometimes it will be necessary to change the drug. The ideal choice of an antidepressant should make the patient feel only the beneficial effects of its use and not experience any side effects. In some difficult clinical situations, it is sometimes necessary to choose the lesser evil and, in consultation with the patient, accept some type of side effects at the cost of a significant improvement in his mental state, including, for example, minimizing the suicidal risk.
There is a lot of talk about sexual dysfunction resulting from the use of antidepressants. Is it true that it may even be about 20-30 percent? patients?
Yes, especially SSRIs cause sexual dysfunction in both women and men. It is also a side effect that should be reported. Unfortunately, both patients and doctors are sometimes ashamed to talk about it. So if the doctor avoids talking about it, much less the patient will. Remember, however, that anhedonia can also affect the sexual sphere, and as a result of the treatment, libido improves along with all other symptoms of depression, of course it is a symptom of recovery.
And if all depression symptoms go away and sexual dysfunction remains?
If, after pharmacological intervention, all symptoms disappear and the patient reports sexual dysfunction, it may mean that we caused them by our treatment and this should be discussed with the patient. We treat a person "as a whole", we do not deal with "a fragment" of their well-being. Our task is to choose the drug in such a way that there is a general feeling of good functioning. The patient is expected to return to normal and if it is possible to modify the treatment to treat depression and not impair sexual function, then it should be done. Of course, it should be remembered that sexual dysfunction can be caused by completely different causes, not related to depression or the use of psychotropic drugs.
Then there is only a decrease in libido? What about erection in men?
Usually it is a decrease in libido, but women also have difficulty reaching orgasm, men have erectile dysfunction. It is worth signaling to patients that if such adverse effects of drugs appear, it should be reported to the doctor.
Thank you for the interview.
Expert
Małgorzata Urban-Kowalczyk, MD, PhDHead of the Diagnostic and Observation Department of the Central Teaching Hospital of the Medical University of Lodz. Assistant professor at the Department of Affective and Psychotic Disorders, Medical University of Lodz. A psychiatrist, he deals with clinical and scientific work. University teacher, author of numerous scientific publications.
About the author
Marcelina Dzięciołowska Editor for many years associated with the medical industry. He specializes in he alth and an active lifestyle. A private passion for psychology inspires her to take up difficult topics in this field. Author of a series of interviews in the field of psycho-oncology, the aim of which is to build awareness and break stereotypes about cancer. He believes that the right mental attitude can work wonders, therefore he promotes professional knowledge based on consultations with specialists.