The other face of depression, reduced positive affect: The role of catecholamines in causation and cure

David Nutt, Koen Demyttenaere, Zoltan Janka, Trond Aarre, Michel Bourin, Pier Luigi Canonico, Jose Luis Carrasco, Steven Stahl

Research output: Review article

229 Citations (Scopus)


Despite significant advances in pharmacologic therapy of depression over the past two decades, a substantiaL proportion of patients faiL to respond or experience onLy partiaL response to serotonin re-uptake inhibitor antidepressants, resuLting in chronic functionaL impairment. There appears to be a pattern of symptoms that are inadequateLy addressed by serotonergic antidepressants - Loss of pLeasure, Loss of interest, fatigue and Loss of energy. These symptoms are key to the maintenance of drive and motivation. ALthough these symptoms are variousLy defined, they are consistent with the concept of 'decreased positive affect'. Positive affect subsumes a broad range of positive mood states, incLuding feeLings of happiness (joy), interest, energy, enthusiasm, aLertness and seLfconfidence. ALthough preLiminary, there is evidence to suggest that antidepressants that enhance noradrenergic and dopaminergic activity may afford a therapeutic advantage over serotonergic antidepressants in the treatment of symptoms associated with a reduction in positive affect. Dopaminergic and noradrenergic agents, incLuding the duaL acting norepinephrine and dopamine re-uptake inhibitors, have demonstrated antidepressant activity in the absence of serotonergic function, showing simiLar efficacy to both tricycLic and serotonin re-uptake inhibitor antidepressants. Moreover, the norepinephrine and dopamine re-uptake inhibitor bupropion has been shown to significantLy improve symptoms of energy, pLeasure and interest in patients with depression with predominant baseLine symptoms of decreased pLeasure, interest and energy. Focusing treatment on the predominant or driving symptomatoLogy for an individuaL patient with major depression couLd potentially improve rates of response and remission.

Original languageEnglish
Pages (from-to)461-471
Number of pages11
JournalJournal of Psychopharmacology
Issue number5
Publication statusPublished - szept. 1 2007


ASJC Scopus subject areas

  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Nutt, D., Demyttenaere, K., Janka, Z., Aarre, T., Bourin, M., Canonico, P. L., Carrasco, J. L., & Stahl, S. (2007). The other face of depression, reduced positive affect: The role of catecholamines in causation and cure. Journal of Psychopharmacology, 21(5), 461-471.