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The effects of sertraline on psychopathic traits

Dunlop, Boadie W.a; DeFife, Jared A.a; Marx, Laurena; Garlow, Steven J.a; Nemeroff, Charles B.b; Lilienfeld, Scott O.a

International Clinical Psychopharmacology: November 2011 - Volume 26 - Issue 6 - p 329–337
doi: 10.1097/YIC.0b013e32834b80df
Original Articles

We examined whether antidepressants alter expression of psychopathic personality traits in patients with major depressive disorder (MDD). Data were collected from a double-blind, placebo-controlled 8-week trial evaluating the efficacy of sertraline (50–200 mg/day) combined with either tri-iodothyronine (T3) or matching placebo in adult outpatients with major depressive disorder. Administration of sertraline was open-label; T3/placebo was double-blind. At the baseline and week 8 visits, patients completed the short form of the Psychopathic Personality Inventory (PPI), a well-validated self-report measure assessing two major factors of psychopathy: Fearless Dominance (PPI-1) and Self-Centered Impulsivity (PPI-2). Change in PPI scores were assessed using paired t-tests for all participants who completed a baseline and postrandomization PPI. Ninety patients (84 completers and six who terminated the trial early) were eligible for the analysis. Both PPI factors changed significantly from baseline to endpoint, but in opposing directions. The mean score on PPI-1 increased significantly during treatment; this change was weakly correlated with change in depression scores. In contrast, the mean score on PPI-2 decreased significantly, but these changes were not correlated with changes in depression scores. Independent of their effects on depression, antidepressants increase adaptive traits traditionally observed in psychopathic individuals, such as social charm and interpersonal and physical boldness. Antidepressants reduce other, more maladaptive, traits associated with psychopathy, including dysregulated impulsivity and externalization.

aEmory University School of Medicine, Atlanta, Georgia

bMiller School of Medicine, University of Miami, Miami, Florida, USA

Correspondence to Dr Boadie W. Dunlop, MD, Emory University School of Medicine, 1256 Briarcliff Road NE, Building A, 3rd Floor, Atlanta, GA 30306, USA Tel: +1 404 727 8474; fax: +1 404 727 3700; e-mail:

Received February 17, 2011

Accepted August 1, 2011

© 2011 Lippincott Williams & Wilkins, Inc.