Comparison of Alexithymia Between Patients with Major Depressive Disorder and Healthy Controls: The Role of Antidepressant Use

Aim: Alexithymia, characterized by difficulties in emotional awareness and expression, is commonly observed in individuals with major depressive disorder (MDD). This study aims to compare alexithymic features between patients with MDD and healthy controls, and to investigate the potential impact of antidepressant use on alexithymia levels in patients experiencing ongoing depressive symptoms.Materials and Methods: A total of 160 participants were included: 80 patients diagnosed with MDD and 80 healthy controls. The Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia. Within the MDD group, participants were categorized as antidepressant users (n = 46) or non-users (n = 34). Sociodemographic characteristics, depression severity (via the Hamilton Depression Rating Scale [HAM-D]), and alexithymia subdimensions were compared across groups.Results: Alexithymia (alexithymic + possibly alexithymic combined) was 70% in MDD patients and 7.6% in controls (p < .001). Patients with depression scored significantly higher on the TAS total and all subscales. Within the MDD group, non-users of antidepressants had significantly higher scores on the “Difficulty Identifying Feelings” (TAS-A) subscale (p = .038). No significant differences were found in total TAS scores or other subscales between AD users and non-users (p > .005).Conclusion: Individuals with MDD exhibit significantly higher levels of alexithymia compared to healthy controls. Among depressed patients, those not receiving antidepressant treatment reported greater difficulty identifying their emotions. After adjusting for age, antidepressant use was associated with lower scores on the “Difficulty Identifying Feelings” subscale; however, causal inferences cannot be drawn from this cross-sectional design. Routine assessment of alexithymia may help inform treatment strategies for MDD, but longitudinal studies are warranted to clarify the direction of these associations.