# Motivation and emotion/Book/2022/Antidepressants and motivation

* Multimedia presentation (3 min)

## Overview

Motivation's Latin origin means "to move," and psychologists that specialise in motivational psychology research what causes people to act the way they do. We concentrate on people's decisions on the activities they do, their pursuit of those tasks with perseverance and intensity, their level of involvement throughout those tasks, and their perceptions of their performance and objectives in line with this comprehensive perspective of motivation (Eccles et.al., 1998). A person's motivation is the reason(s) they act or behave in a particular way. A person's motivation often fuels their drive to perform something. This is a key component in achieving one's life objectives. These objectives may be societal, personal, or competitive.
Depression and other mental diseases might develop as a result of a lack of drive. Almost all facets of human conduct depend on motivation. Your motivational condition affects your decision-making process. However, these theories have nothing to do with the ones studied in social psychology or organisational psychology. Additionally, cognitive/affective neuroscience has fundamentally distinct definitions and theories of motivation (Simon, 1994). There are two different motivation theories put out by psychologists. The two categories of motivation in dualistic theories are intrinsic and extrinsic. Contrarily, multifaceted theories acknowledge a variety of genetically unique motivations. Construction validity, measurement dependability, and experimental control are at least three areas where intrinsic-extrinsic dualism falls short (Reiss, S. 2012). The most popular definition of intrinsic drive is "doing something for its own sake," as in a young toddler playing baseball solely out of desire. Contrarily, extrinsic motivation refers to the pursuit of an instrumental aim, such as when a young child plays baseball to win over a parent or a competition. The self-determination hypothesis of Deci and Ryan (1985) contends that extrinsic rewards conflict with intrinsic motivation. Let's say a young man who enjoys baseball for its own reason is given the chance to earn money. Self-determination theory contends that the boy's intrinsic pleasure of baseball is compromised by extrinsic incentives (such as money and success). Without external motivation, the youngster is likely to play baseball less in the future.
Major depressive illness, some anxiety disorders, some chronic pain problems, and some addictions are all treated with antidepressants, a family of drugs. Dry mouth, weight gain, headaches, dizziness, sexual dysfunction, and emotional blunting are typical adverse effects of antidepressants. When children, teenagers, and young adults use these medications, there is a modest increase in the risk of suicidal thoughts and actions (McCain, 2009). Antidepressants can cause withdrawal symptoms after ceasing use, including visual, cardiovascular, and gastrointestinal problems as well as issues with sleep and impulsive and/or aggressive behaviour (Fava et al., 2018). In a study by Padala et al., (2020), patient's being treated with selective serotonin reuptake inhibitors (SSRIs), a medication that is frequently prescribed to treat depression, had clinically significant levels of apathy.
* Focus questions:
* How do antidepressants function?
* How do antidepressants generally affect people?
* Which elements of motivation are affected by antidepressants?

## The relationship between motivation and antidepressants

Patients taking antidepressants, such as selective serotonin reuptake inhibitors (SSRI), occasionally attribute the symptom of emotional blunting as a side effect of their medication (Ma et al., 2021). However, emotional blunting has also been viewed as an untreated, residual symptom of depression itself (Ma et al., 2021). In both psychiatric and general care settings, selective serotonin reuptake inhibitors (SSRIs) have become widely used as pharmaceutical therapies for a variety of mental problems. The prescription of antidepressant drugs has increased over the last several decades due to an improved understanding of mood disorders, the development of safer antidepressant medications, and reduced stigma surrounding the use of antidepressant drugs (Santarsieri & Schwartz, 2015). However, behavioural and emotional indifference may be linked to an unfavourable clinical side effect of SSRIs. The clinical trait of apathy or poor motivation as a behavioural condition has been highlighted in relation to SSRI medication (Marazziti et al., 2019). It appears that some people are aware of this potential adverse effect (Sansone et.al., 2010)
Research conducted by Fava et al. (2006), which included participants from both the United States and Italy, found that almost one-third of antidepressant users expressed apathy, with 7.7% of those reporting moderate-to-severe impairment, and nearly 40% admitted a loss of motivation, with 12.0% indicating such impairment[Provide more detail].

## Motivation

The word motivation is derived from the Latin verb 'movere' which means “to move" (Reeve, 2018). Motivation is a psychological construct that describes the mechanism by which a person chooses, and endures with, a particular behaviour (McInerney, 2019). There are several different motivational theories that attempt to explain why, and how, people are motivated towards achieving a goal or maintaining a behaviour. B.F. Skinner's incentive theory of motivation argues that behaviour is primarily motivated by extrinsic motivations, such as praise or money, rather than intrinsic motivation, where one performs a behaviour simply due to personal interest (Vi & Thuy, 2020). Competence motivational theory (CMT) states that a person will engage in a behaviour only if they believe they can perform that behaviour successfully (Zou et al., 2012). Furthermore, if the person’s peers respond to these behaviours with approval and reinforcement, the individual will experience an increase in their perceptions of their own competence, increase in positive affect, and increased motivation to continue the behaviour (Zou et al., 2012).

#### Incentive theory

A behavioural theory called the incentive theory of motivation contends that people are more motivated by extrinsic motivations than intrinsic motivations (Vi & Thuy, 2020). Incentive theory suggests that people avoid behaviours that can result in punishment and behave in ways they think will lead to rewards. Incentive theory started to develop in the 1940s and 1950s. The incentive hypothesis contends that people are drawn toward behaviours that result in rewards and driven away from acts that can result in adverse effects, rather than emphasising more internal causes driving motivation. There are many distinct circumstances in which the prospect of reward or punishment directly affects conduct. Perhaps preparing for a test to achieve a good mark, competing in a marathon to be recognised, or taking on a new role at work to get promoted are some examples. An incentive to get something in exchange for efforts affected each of these acts. According to incentive theory, behaviour is driven by an organism's need for reinforcements and rewards, which also controls behaviour. The environment's incentives control how creatures behave. In that it emphasises how much the environment affects conduct, this theory is a behaviourist one. If the results of an action are favourable, an organism is more likely to continue that activity. If a behaviour has negative effects, an organism is less likely to repeat it. Environment-based factors act as driving forces behind motivation. An organism is more likely to continue engaging in actions that result in these rewards in the future when there are reinforcements present, such as food and money (Incentive Theory. n.d.).

#### Competence theory

Competence motivation theory is a conceptual framework created to explain why people are motivated to take part, stick with something, and put in a lot of effort in any given situation for accomplishment. The main tenet of the idea is that people are drawn to engaging in things they feel competent or skilled at (Horn, 2014).

## Antidepressants

Antidepressants are a type of medication that lessen the symptoms of mood disorders (Van Leeuwen, 2010). There are several different types of antidepressants such as tricyclic mood stabilizers (TCAs), selective serotonin reuptake inhibitors (SSRIs), and selective serotonin and noradrenaline reuptake inhibitors (SNRIs).

### Chemical components of antidepressants

Numerous researchers believe that the therapeutic effects of antidepressants stem from their influence on specific brain circuits and the substances known as neurotransmitters, responsible for transmitting signals between nerve cells in the brain. These neurotransmitters include norepinephrine, dopamine, and serotonin. Different antidepressants seem to impact the behaviours of these neurotransmitters in distinct ways. The main categories of antidepressants are outlined below.
Research by Andrade & Kumar Rao (2010) suggests that stress and depression lead to the reduction of synapses, dendritic spines, and dendritic atrophy in the hippocampus and prefrontal cortex. Additionally, glial cells experience a decrease in size and quantity. As a result, both the nucleus accumbens and the hypothalamus, along with downstream structures such as the hippocampi and the prefrontal cortex, exhibit impaired functionality.
Antidepressant medications are linked to the stimulation of neurogenesis, gliogenesis, dendritic arborization, and the development of new synapses in areas including the hippocampus and prefrontal cortex. Because these modifications reverse the neurohistological effects of stress and may enable the relearning of healthier cognitions, healthier emotional reactions, and healthier behavioural expressions, they may be the mechanisms underlying the antidepressant response because their time course of development parallels that of antidepressant action.

### Treatment

Our brain's nerve cells transmit information via a variety of substances. Although there are still many unanswered questions, researchers believe that depression is brought on by an imbalance of certain chemical messengers (neurotransmitters), such as serotonin, which prevents appropriate signal transmission along the neurons. The goal of antidepressants is to make these substances more readily available. Different medications accomplish this in different ways. Most people with diagnosed depression take antidepressants every day. In the initial weeks and months, the objective is to reduce the symptoms and, where feasible, make the depression disappear. After achieving that, the course of therapy is maintained for at least four to nine months to prevent the symptoms from reappearing (Institute for Quality and Efficiency in Health Care [IQWiG], 2020). In order to avoid relapses, the medicine may occasionally be used for longer (IQWiG, 2020). The length of therapy also relies on the progression of the symptoms over time and the likelihood of relapse. Some people use antidepressants for a long period of time. The dose is progressively decreased over a number of weeks toward the conclusion of the treatment (IQWiG, 2020). When stopping antidepressants, transient sleep issues, nausea, or restlessness may occur. In particular, if you abruptly quit using antidepressants, these symptoms are more likely (IQWiG, 2020). When patients start feeling better, they occasionally stop taking their medicine, although doing so raises the likelihood that their depression will return (IQWiG, 2020). Antidepressants don't lead to physical dependency or addiction, unlike many sedatives and sleeping medications (IQWiG, 2020).

### How well can antidepressants prevent relapses?

To avoid relapses, antidepressants are often used for one to two years, and occasionally longer. Relapse prevention might be beneficial for those whoː
* have a history of relapses
* are determined to prevent a relapse,
* or suffer from persistent depression (IQWiG, 2020).
Taking frequently prescribed antidepressants like TCAs, SSRIs, or SNRIs can reduce the chance of relapses but cannot totally avoid them, according to studies on adults (IQWiG, 2020).
* Without preventative care: Of 100 persons who received a placebo, almost 50 experienced a recurrence within one to two years.
* When receiving preventative care, 23 out of every 100 persons who took an antidepressant experienced a relapse within a year to two years.
* To put it another way, long-term antidepressant use effectively avoided a relapse in an average of 27 out of 100 people

## Uses of antidepressants and their effects on the human body

[Provide more detail]

### Types of antidepressants

There are several antidepressants available to treat mental illness. They can be divided into many groups. The major focus of this chapter is on the most popular antidepressants:
* Tricyclic mood stabilizers (TCAs)
* Inhibitors of the selective serotonin reuptake (SSRIs)
* Inhibitors of the selective serotonin and noradrenaline reuptake (SNRIs)
* The most time has been spent on the market for tricyclic antidepressants. They are regarded as antidepressants of the first generation. The second generation of antidepressants includes SSRIs and SNRIs.
Less frequently administered medications include:
* Antagonists of the adrenergic alpha-2 receptor
* Inhibitors of monoamine oxidase (MAO)
* Selective inhibitors of noradrenaline reuptake
* Selective inhibitors of noradrenaline and dopamine reuptake
* Serotonin 5-HT2C receptor antagonists and melatonin receptor agonists

### Side effects on the human body

Many people take antidepressants, with more than half experiencing side effects, which often occur in the first several weeks of therapy and become less frequent over time (IQWiG, 2020). Some of these adverse effects, which are common to many medications in the same class, are thought to be a direct result of the drug's impact on the brain. Dry mouth, headaches, vertigo, restlessness, and sexual issues are a few examples. Although these issues are frequently thought to be pharmaceutical adverse effects, they could be brought on by depression itself (IQWiG, 2020).
Some adverse effects are more frequent with specific medications:
Tricyclic antidepressants are less likely to induce diarrhoea, headaches, sleep issues, or nausea than SSRIs are.
Tricyclic antidepressants are more likely than SSRIs to result in visual issues, constipation, dizziness, a dry mouth, shaking, and trouble urinating (peeing).
Tricyclic antidepressants frequently have more negative side effects than SSRIs and SNRIs. Because of this, more individuals tend to cease using tricyclic antidepressants: Research has shown that around 15 out of 100 individuals using tricyclic antidepressants stopped doing so, compared to approximately 10 out of 100 those taking SSRIs. If tricyclic antidepressants are used in excess, there is also a higher chance of experiencing severe adverse effects (IQWiG, 2020).

### Severe side effects

Antidepressants might make you feel lightheaded and unsteady, which raises your chance of falling and breaking a bone, especially if you're older. This risk may rise as a result of drug interactions. Very few people have experienced liver damage, cardiac issues, or epileptic seizures while using antidepressants. These antidepressant side effects are thought to be uncommon. According to several research, adolescents who use SSRIs or SNRIs are more likely to consider killing themselves (suicide) and are more likely to make suicide attempts. Teenagers should visit their doctor or therapist more frequently at the start of treatment as a result, allowing for the early detection of any suicide risk (IQWiG, 2020).

### Quizzes

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## Conclusion

Depression is known to cause a persistent lack of motivation. Incentive theory and competence theory shed light on the ways in which reinforcement can increase an individual’s motivation to perform, and endure particular behaviours. Popular antidepressants affect human motivation in a variety of ways. They can increase energy and motivation, which may be very low when you are depressed. Before your feelings of hopelessness have started to fade, you may have increased energy and inspiration early on in your treatment. Treatment for apathy and a lack of motivation can be challenging. Numerous medications that help with various depressive side effects do not work well for these issues. Additionally, becoming discouraged may lead to a decreased desire to finish particular tasks or take part in routine activities. It is believed that depression is caused by an imbalance of neurotransmitters within the brain, causing problems with the passage of brain signals (Nutt, 2008). Antidepressants increase the availability of these neurotransmitters, which may help depressed people think more clearly and motivate themselves better. The use of serotonin reuptake inhibitors has been associated with behavioural apathy and emotional blunting (Sansone & Sansone, 2010). Although these two effects of SSRI use are sometimes portrayed as distinct entities, they may be combined under the single term "selective serotonin reuptake inhibitor-induced indifference"; a syndrome that is under-recognised by both clinicians and patients (Sansone & Sansone, 2010).