title: Reversal of SSRI-associated apathy syndrome by discontinuation of therapy.
abstract: OBJECTIVE
  To report 6 cases of selective serotonin reuptake inhibitor (SSRI)-associated apathy syndrome.
  
  
  METHODS
  In all 6 cases, the patient reported loss of motivation while being treated with an SSRI. Loss of motivation was of new onset and temporally associated with the use of the SSRI. A trial of discontinuation of the SSRI was performed in all 6 patients and 2 were started on bupropion while cross-tapering from the SSRI. During the treatment trials, depression and apathy were monitored in all patients. Each case was assessed using the Apathy Evaluation Scale, Clinician version (AES-C), and by evaluating how the patient responded to discontinuation of the SSRI.
  
  
  CONCLUSIONS
  Scores on the AES-C improved significantly in all 6 cases after the SSRI was discontinued. Improvement was also seen in the motivation, novelty, and persistence subdomain scores of the AES-C. A pretreatment AES-C score was available only in the first case. Based on the Naranjo probability scale, there was a probable cause of apathy syndrome with SSRI therapy in the first case and a possible association in the rest of the cases.
  
  
  CONCLUSIONS
  In some patients SSRIs may cause an apathy syndrome that can be reversed through discontinuation of the agent. When evaluating patients being treated with an SSRI, clinicians should have a high degree of suspicion and specifically inquire for this iatrogenic form of apathy syndrome.
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, AR, USA. Prasad.padala@va.gov
authors.forename: Prasad R
authors.initials: PR
authors.lastname: Padala
authors.forename: Kalpana P
authors.initials: KP
authors.lastname: Padala
authors.forename: Varun
authors.initials: V
authors.lastname: Monga
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Ramirez
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Sullivan
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects*; D057565:Apathy / Q000187:drug effects*; D015283:Citalopram / Q000009:adverse effects; D003866:Depressive Disorder / Q000188:drug therapy; D005473:Fluoxetine / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013577:Syndrome
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors