Effects of psychotropic drugs used in the treatment of anxiety disorders on the recognition of facial expressions of emotion: Critical analysis of literature

- Few drugs recommended for the treatment of anxiety were assessed with regard to the RFEE.
- Changes in RFEE were associated with the mechanism of action in the CNS, duration of use, and administration route of the tested drug.
- The recognition of positive emotions increased with the use of SSRIs but not with benzodiazepines.
- The acute use of SSRIs increased the identification of negative emotions, whereas benzodiazepines had an impairing effect.
- The acute and chronic use of citalopram and reboxetine resulted in different effects on RFEE.

Deficits in recognition of facial expressions of emotion (RFEE) play a central role in the manifestation of anxiety disorders (AD). We systematically reviewed the literature to determine effects of drugs used in AD treatment on RFEE, based on outcomes of accuracy rate, reaction time, and intensity. Electronic databases, including Pubmed, PsycINFO, and Scielo, were used without time constraints. Twenty-six clinical/experimental studies on healthy subjects, focusing on 11 drugs, published in English, Portuguese, and Spanish, were selected. We found that increased recognition of happiness was associated with acute use of citalopram, fluoxetine, duloxetine, and reboxetine. Increased and decreased recognition of negative emotions were associated with the use of selective serotonin and/or norepinephrine reuptake inhibitors, respectively. Benzodiazepine favored recognition of negative emotions. Differences in reaction time were rarely observed. Stimuli with distinct emotion intensities produced similar effects. Specific changes occurred in RFEE depending on the drug, its administration route and dose, and emotion valence. Evidences indicate significant effects on emotional processing relevant to clinical practice, particularly in treating patients with emotional disorders.