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Emotional blunting describes an indifferent, unresponsive affect and inability to feel emotions experienced by people with major depressive disorder (MDD) treated with antidepressants.1,2 Dampening of dopaminergic and noradrenergic input to the prefrontal cortex is thought to play an important role,3 and management can be guided by understanding the neuropathophysiology.3
A negative impact on patient outcome
46% of patients on antidepressants report emotional blunting
Emotional blunting is a residual symptom of MDD, which is a symptom experienced by patients with MDD despite antidepressant therapy. Such patients are at risk of relapse.4
Emotional blunting can impact everyday patient function and prevent a full functional recovery.5 More severe emotional blunting is associated with a poorer quality of remission.6
Nearly half of patients on all types of monoaminergic antidepressants report emotional blunting,6 and it is associated with serotonin reuptake inhibitor (SSRI) therapy as follows:2,5
What causes emotional blunting?
Higher doses of SSRI are more likely to cause emotional blunting9,10
The primary effect of SSRIs is reduced processing of negative stimuli rather than increased positive stimuli.9
Emotional blunting is related to SSRI dose,9,10 and possibly serotonergic effects on the frontal lobes and/or serotonergic modulation of midbrain dopaminergic systems projecting to the prefrontal cortex (PFC).10 By enhancing serotonergic transmission, SSRIs can activate GABA interneurons, thereby dampening the noradrenergic and dopaminergic input.11
Dorsolateral PFC appears to play a critical role in MDD through a defect in regulation of negative affect
Imaging studies suggest a critical link between the automatic processing of emotional signals in the amygdala and the regulation of this activity in the frontal cortex.16
Lowering SSRI dose8 or changing antidepressant are therapeutic options
Options to resolve emotional blunting are therefore to:
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.