Abstract
Emotional blunting is frequently reported by patients with major depressive disorder (MDD) and has been identified as one of the most prominent side effects of antidepressants leading to medication discontinuation. However, antidepressant-induced emotional blunting remains largely unexplored—there lacks a clinical definition of this condition, and no agreeing conclusion has been reached regarding its etiology. Current research suggests that the onset of diminished emotional response may be related to antidepressant dose, with higher doses being more likely to induce emotional blunting. Consequently, most clinicians either reduce the dose or switch to another drug when treating this symptom. Overall, more comprehensive clinical assessments or interviews specifically designed to evaluate antidepressant-induced emotional blunting in MDD patients are in need to elucidate the neuropsychological mechanisms behind this increasingly prevalent symptom.
Highlights
Depressive disorders have been estimated to be the third leading cause of years lived with disability for all ages worldwide, and the global prevalence of major depressive disorder (MDD) has significantly increased over the last few decades [1]
The Hospital Anxiety and Depression (HAD)-D subscale measures the severity of current depressive symptoms, and the results showed that higher HAD-D scores correlated with the presence of emotional blunting, indicating it might be a residual symptom of depression rather than a side effect of antidepressant treatment
The dorsal medial prefrontal cortex (dmPFC) is thought to be involved in emotional processes, the intensity of emotions [37]. These results provide a potential explanation for the lower rate of emotional blunting (33%) in patients taking bupropion [20] and suggest that antidepressants can induce changes in neural mechanisms underlying diminished emotional experiences, even in healthy controls without depression
Summary
Depressive disorders have been estimated to be the third leading cause of years lived with disability for all ages worldwide, and the global prevalence of MDD has significantly increased over the last few decades [1]. A more recently developed instrument is the Oxford Questionnaire on the Emotional Side-effects of Antidepressants [OQuESA or OQESA; [33]] It is a self-report questionnaire comprising three sections for a total of 26 items focusing on the patient’s emotional experience over the past week. Section three a Residual Symptom of MDD comprises six items asking the patients to what extent they believe there is an association between their current antidepressant medication and emotional blunting and whether this affects treatment compliance. The OQuESA was tested on a previous sample of depressed patients and demonstrated high construct validity and reliability Later studies employing this instrument all showed significant differences in scores between patients with and without emotional blunting [20, 39]. Questionnaires administered by trained professionals should be developed to of emotions could be a residual symptom of MDD due to ensure the respondents have interpreted the questions correctly. incomplete treatment
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