An article from University of Oslo

Revealing the truth about antidepressants

Just after the first pill has been swallowed, the human body starts to react. A new study at the University of Oslo can be the first step towards an individualized treatment of mental illnesses.

University of Oslo

The University of Oslo is Norway's leading institution of research and higher education.

Picture the following scenario: For the past two weeks you have felt continuously dejected. You have lost interest for what normally makes you happy. Perhaps you’ve slept poorly or lost your appetite. There is a risk that you have the most common - and costly - illness in the world: depression.

You decide to see a doctor. She considers different treatments and finally she gives you a prescription for a small box of antidepressants. Whether they will help you, no one knows. Some patients report an effect after two or three weeks, others don’t notice any change at all. Some even get even more depressed.

A few years into the future the visit to the doctor’s may have become very different.

An immediate effect

The use of antidepressants has surged across developed countries over the past decade, according to the Organisation for Economic Co-operation and Development. Doctors in some countries write prescriptions for more than one in ten adults, with Iceland, Australia, Canada and the European Nordic countries topping the list. There are concerns that pills are being overprescribed.

Students and scientists at the Departments of Psychology at University of Oslo wanted to test antidepressants in a new way. Instead of asking patients which effect they experience, which is a common method in studies performed by the industry, they gave a group of healthy, young women a single dose of the antidepressant citalopram. Then they studied how this dose affected the women’s eye movements.

“Some of those that take the medication seem to look away from other people’s eyes. This effect occurs quite immediately,” says Rune Jonassen, a postdoctoral fellow at the Department of Psychology.

The women were presented photos of neutral human faces on a computer screen. Below the screen an eye tracker registered the reflection of light from the women’s eyes. The eye tracker could measure the exact eye movements of the women.

Symptoms of anxiety

What does it mean when our eyes avoid other peoples’ eyes? Earlier research has pointed to this being a sign of anxiety and unrest. Usually we first look at other people’s eyes, then their nose and mouth, to register moods and feelings. If we are restless or anxious, we might subconsciously avoid eye contact.

“Several women had a reaction that reminded us of such an anxiety effect. We didn’t see the same reaction in the control group. It is well known that antidepressants can give a feeling of unrest in the first period of use. Previously branded a side effect, it now rather looks like a part of the actual effect of the medications,” Jonassen said.

Avoiding the uncomfortable

The researchers believe that this subconscious tendency to avoid other people’s eyes remains during the treatment, and that this can get us thinking along different lines. We avoid observing the uncomfortable.

”Many people on antidepressants explain that their emotions become flatter. Our findings support this. Antidepressants don’t seem to change the mood directly, instead they seem to change what we notice in our surroundings,” Jonassen said.

For depressed people this can be a favorable effect.

“Depression is characterized by getting stuck in negative thinking patterns. Antidepressants may help us to break these patterns. They seem to make us more flexible.”

The doctor of the future 

Even though there was a significant difference between the group of women who received the medications and those that didn’t, there were also large differences inside the groups. Not all that received the medications changed the way they looked at human faces.

“Using one kind of treatment for all patients may be a dead end,” Jonassen said.

A lot of money is being spent on research that can help individualize treatment of mental illness. Going back to the scenario in the beginning of this article, let’s imagine a scenario where you bring your depressive symptoms to a doctor in the future. Instead of giving you a prescription, she asks you to do a test. The test will help her understand what kind of treatment will work for you specifically.

“We might see a future where health workers use information from studies like ours to predict who will benefit from a certain kind of treatment. This study is a first step towards a more individualized treatment. In order to get there we need more research on the basic mechanisms of human beings,” Jonassen said.

The study has been conducted at the Research unit for clinical neuroscience, lead by professor Nils Inge Landrø. It came out of a cooperation with professor Catherine Harmer at the University of Oxford, who is widely known for studies of early effects of antidepressants. The material was collected by students at the Department of Psychology, University of Oslo.

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