title: Effects of mineralocorticoid receptor blockade on empathy in patients with major depressive disorder.
abstract: The mineralocorticoid receptor (MR) is highly expressed in the hippocampus and prefrontal cortex and is involved in social cognition. We recently found that pharmacological stimulation of the MR enhances emotional empathy but does not affect cognitive empathy. In the current study, we examined whether blockade of the MR impairs empathy in patients with major depressive disorder (MDD) and healthy individuals.
  
  
  
  In a placebo-controlled study, we randomized 28 patients with MDD without psychotropic medication and 43 healthy individuals to either placebo or 300 mg spironolactone, a MR antagonist. Subsequently, all participants underwent two tests of social cognition, the Multifaceted Empathy Test (MET) and the Movie for the Assessment of Social Cognition (MASC), measuring cognitive and emotional facets of empathy.
  
  
  
  In the MET, we found no significant main effect of treatment or main effect of group for cognitive empathy but a highly significant treatment by group interaction (p < 0.01). Patients had higher cognitive empathy scores compared to controls in the placebo condition but not after spironolactone. Furthermore, in the spironolactone condition reduced cognitive empathy was seen in MDD patients but not in controls. Emotional empathy was not affected by MR blockade. In the MASC, no effect of spironolactone could be revealed.
  
  
  
  Depressed patients appear to exhibit greater cognitive empathy compared to healthy individuals. Blockade of MR reduced cognitive empathy in MDD patients to the level of healthy individuals. Future studies should further clarify the impact of MR functioning on different domains of social cognition in psychiatric patients.
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany. katja.wingenfeld@charite.de.
authors.forename: Katja
authors.initials: K
authors.lastname: Wingenfeld
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Linn K
authors.initials: LK
authors.lastname: Kuehl
authors.affiliation: Berlin School of Mind and Brain, Humboldt-University Berlin, Berlin, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Dziobek
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Roepke
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Otte
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Kim
authors.initials: K
authors.lastname: Hinkelmann
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology*; D004645:Empathy / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology*; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000494:pharmacology*; D018161:Receptors, Mineralocorticoid / Q000378:metabolism; D012938:Social Perception; D013148:Spironolactone / Q000494:pharmacology*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D011619:Psychotropic Drugs; D018161:Receptors, Mineralocorticoid; D013148:Spironolactone
keywords: Cognitive empathy; Cortisol; Emotional empathy; Major depressive disorder; Mineralocorticoid receptor; Social cognition