Emotional blunting (side effect or symptom?)

In this guide, we will discuss what emotional blunting is, what are the reasons for having emotional blunting, if it can be considered as a side effect of antidepressant medication or an unresolved symptom, some articles comparing perceived emotional blunting on depressed vs controls, medication vs psychotherapy and some biological basis to consider when talking about emotions.

Emotional blunting

Emotional blunting or emotional numbing refers to when your feelings and emotions are so dulled that you don’t feel up or down, just simply feel like in a neutral kind of state. What may have affected you in the past won’t affect you anymore and what you used to enjoy is not a reason for excitement. If you experience emotional blunting, you are more likely to present the following symptoms:

• Being less emotional or able to cry when the context suggests it.
• Feeling less empathy or care less about other people’s feelings.
• Loss of motivation and drive.
• Things you used to enjoy have lost their excitement or don’t represent a source of enjoyment anymore.

Imagine losing your emotions, even if it is temporary. Think about how the people around you would feel if you stop caring about them as you used to or if you start having a hard time expressing your emotions. It is not ideal, right? And many people may debate between taking the medicine that is going to get them to feel better but losing a part of themselves. 

As indicated on progress.im (Psychiatry & Neurology Resource Center), “Emotional blunting may have adverse effects on decision-making and relationships, and result in poor self-care and even thoughts of self-harm in an effort to feel emotion.” Subsequently, experts have many questions still such as if emotional blunting is a consequence of MDD or a consequence of the treatment? Do SSRIs inhibit emotional responses? Here we will talk more about it.

What causes emotional blunting?

Emotional blunting often present in combination (or co-occurs) with other symptoms such as slowed thinking, decreased libido and difficulties concentrating. But you may wonder why is this happening? Well, according to several studies, emotional blunting is believed to be a consequence of starting antidepressant treatment, but the ones that seem to belong to this category corresponds to one of the three classes:

• Selective norepinephrine reuptake inhibitors or SNRIs. In this category, we can observe antidepressant medication such as Cymbalta (duloxetine), Pristiq (desvenlafaxine), Effexor XR (venlafaxine), among others.
• Selective serotonin reuptake inhibitors or SSRIs. In this category we can find medicine such as Lexapro /escitalopram), Prozac (fluoxetine), Zoloft (sertraline) and Paxil (paroxetine).
• Tricyclic and tetracyclic antidepressants such as Elavil (amitriptyline) and Remeron (desvenlafaxine).

However, some evidence indicates that emotional blunting could be the result of an unresolved feature of major depressive disorder. It is common for patients with MDD to report emotional blunting (feelings of detachment, loss of interest and pleasure) while taking antidepressants and it is one of the common reasons why they suddenly stop taking them but if you are experiencing emotional blunting and you are taking antidepressant medication, consider talking to your doctor before stopping your treatment.

Emotional blunting as a side-effect

As we have discussed, many experts believe emotional blunting to be a consequence of antidepressant medication. Some studies have demonstrated how depressed patients have an increased ability to recognize negative vs facial expressions, being more focused on the negative (negative attentional bias). Subsequently, patients who are being treated report a decreased recognition or ability to detect some negative stimuli.

Moreover, the decreased response of the amygdala seems to be a neural correlate after starting the antidepressant treatment which in people not medicated with MDD appears with increased response. Data from studies also suggest that treatment can cause emotional blunting but it may be resolved by lowering the dose or when stopping the medication. However, it is not recommended to stop the medication without medical supervision. 

A study from the International Journal of Neuropsychopharmacology in 2002 indicates how some patients treated with SSRIs experience a diminution in emotional responsiveness. Fifteen participants reported SSRI-induced sexual dysfunction and completed the Laukes Emotional Intensity Scale (a questionnaire about various emotions).  

When compared to controls, this group of patients reported a reduced ability to cry, irritation, care about other people’s feelings, sadness, erotic dreaming, creativity, surprise, anger, expression of their feelings, worry over things or situations, sexual pleasure and interest in sex. They concluded that emotional blunting may be an underappreciated side-effect of the treatment with SSRIs that may seem to contribute to treatment non-compliance or reduced quality of life.

More scientific evidence

A study from 2017 implemented an internet-based survey in 669 patients on treatment and 150 recovered (formerly depressed) controls.  They found that the rate of emotional blunting in treated depressed patients was 46%, being more frequent in males than females and those with higher scores in the Hospital Anxiety and Depression (HAD) scale.

Depressed patients with emotional blunting rated higher on the Oxford Questionnaire on the Emotional Side-Effects of Antidepressants (OQESA) than controls and there was a correlation suggested between total blunting scores and HAD-Depression score. 

Finally, they indicated in the conclusions of their study that emotional blunting was reported by nearly half of depressed patients that were on antidepressant medication and it appears to be common to all monoaminergic depressants rather than a specific one. They also indicate that emotional blunting can’t only be described as a side effect of the antidepressant medication but also a symptom of depression.

Medication vs Psychotherapy

We have talked so far about medication treatment for depression. Medication is said to work better when combined with psychotherapy but as suggested, emotional blunting may be dose-dependent and it is altering your brain’s neurochemistry instead of the root cause. 

One of the most used psychotherapies is CBT because it is intended to change how you think and your behaviour. It has a huge acceptance among mental health professionals due to the scientific evidence on the positive results with clinical populations. Here, there is no consideration or interest in a biological reason, instead, it provides a pragmatic rationale to the psychotherapy separate from the brain function. 

Biological basis and functionality

With modern neuroimaging techniques, we have been able to study the brain and suggest how certain areas have certain functions. Emotions have been specially investigated by neuroscientists, where the idea that the brain can represent emotional aspects from the interpretation of environmental stimuli in certain brain areas has become a widely accepted and used theory.  

For instance, we know that in the emotional response, there is a special emphasis on the role of the limbic system and structures such as the striatum, amygdala, and thalamus due to several neuroimaging clinical studies with animals and humans. In the specific case of the amygdala, there have been studies showing how important this structure is during emotional processing of basic and instinctive emotions such as fear.

However, as indicated by Dr Guy Goodwin from the University of Oxford, “Findings in depression have generally been less consistent in demonstrating simple biases in emotional processing, despite the overwhelming clinical evidence for negative biases at a conscious level. In part, this will reflect at a behavioural level the impact of global impairments of memory and executive function that make depressed subjects difficult to test.”

Emotional blunting and impact on the quality of life

There is not much information out there about the impact of emotional blunting or as some scientists prefer to call it: emotional side effects of the treatment. However, a qualitative study that investigated those effects in patients with chronic antidepressant use and modest levels of depression.

The suggested that the impact on emotional side effects on the participants’ daily lives varied widely (in extent and perceived helpfulness). Some of the participants described those effects as helpful since they could notice a reduction in some of the emotional responses (i.e. anger, aggression or worry) which in the term, was beneficial for their relationships. Also, the emotional detachment and a reduction in anxiety might allow people to think more clearly and objectively about certain situations in life.

In contrast, other participants were concerned that the blunting of their emotions might mask or hide problems as indicated by Dr Goodwin, “This might prevent them resolving their own emotional issues, prevent them engaging with other problems or issues requiring their attention, and “cover-up” who they were. “Just not caring” had an unhelpful effect on everyday responsibilities, resulting in financial problems and problems at work or college.”

Finally, emotional detachment from family and reduced emotional responsiveness had a negative impact on the participant’s family life and perceived parenting. They also reported reduced inspiration, imagination. Motivation and passion for/and enjoyment of creative activities. Moreover, the reduced emotional response had affected some participant’s sociability. 

Why is this blog about Emotional blunting important?

There is still a lot of research needed to be done about emotional blunting, especially since there are still conflicting opinions on whether emotional blunting being a side effect of antidepressant medication or an unresolved symptom of depression. 

Besides, you are more likely to be experiencing emotional blunting if you become less emotional or able to cry when the context suggests it, feeling less empathy or care less about other people’s feelings, loss of motivation and drive and when things you used to enjoy have lost their excitement or don’t represent a source of enjoyment anymore. Finally, we know how important it is to have emotional responses whether we perceive them as negative or positive, and how those responses can potentially impact your life. 

However, if you are taking SSRIs don’t just simply stop the medication on your own but consult it with your doctor first. Please feel free to leave any comments or thoughts about the content of this article!

References 

• Adam Opbroek, Pedro L. Delgado, Cindi Laukes, Cindy McGahuey, Joanna Katsanis, Francisco A. Moreno, Rachel Manber, Emotional blunting associated with SSRI-induced sexual dysfunction. Do SSRIs inhibit emotional responses?, International Journal of Neuropsychopharmacology, Volume 5, Issue 2, June 2002, Pages 147–151, https://doi.org/10.1017/S1461145702002870
• Progress.im: “Emotional blunting: unresolved MDD symptom or effect of treatment?”
• Goodwin GM, Price J, De Bodinat C, Laredo J. (2017) Emotional blunting with antidepressant treatments: a survey among depressed patients. Journal of Affective Disorders https://dx.doi.org/10.1016/j.jad.2017.05.048
• Medicographia.com: “Emotional blunting or reduced reactivity following remission of major depression”
• Medicographia.com: “Emotional blunting in anxiety and depression: neurobiology and psychopathology”