Emotional Blunting with SSRI’s – Prof Malcolm Hopwood
Prof. Hopwood is the Ramsay Health Care Professor of Psychiatry at the University of Melbourne. His research areas of interest include psychopharmacology, clinical aspects of mood and anxiety disorders and psychiatry aspects of acquired brain injury and other neuropsychiatric disorders.
Take Home Messages:
SSRI’s are effective at reducing negative affect. However, there is a notion that many patients are left feeling flattened in some way when they recover.
According to the study by Nutt et al.,–
There appears to be a pattern of symptoms that are inadequately addressed by serotonergic antidepressants — loss of pleasure, loss of interest, fatigue and loss of energy. These symptoms are key to the maintenance of drive and motivation. Although these symptoms are variously defined, they are consistent with the concept of `decreased positive affect’. Positive affect subsumes a broad range of positive mood states, including feelings of happiness (joy), interest, energy, enthusiasm, alertness and selfconfidence.
This emotional constraint with SSRIs was evaluated in a qualitative study by Jonathon Price (2009).
The emotional side-effects of SSRIs were summarised into the following key themes.
1.General effects on all emotions
Reduced intensity, or even absence of emotions, which are flattened, numbed, dulled or blanked; thoughts rather than feelings; difficulty understanding emotions; emotions feel fake or artificial; improved emotional control
2.Reduction of positive emotions
Reduced intensity and frequency of e.g. excitement, enjoyment, happiness, love, affection, passion, enthusiasm
3.Reduction of negative emotions
Reduced intensity and frequency of e.g. sadness, anger, aggression, anxiety and worry. Reduced ability to cry
Detachment or disconnection from the environment; from the self; and from other people, including children, partner and friends
5.Just not caring
Not caring about self, about others, about responsibilities; apathy; reduced interest and motivation; disinhibition; thoughts of self-harm
Aspects of personality are altered or removed; behaviour is out of character
7.Effects on everyday life
Helpful and/or unhelpful; often helpful initially, but becoming unhelpful as recovery occurs; masking or hiding problems; impact on responsibilities, on own behaviour, on relationships with others, on creativity, on judgement and decision-making
8.It’s because of my pills!
Emotional side-effects are distinct from emotional illness; vary with dose, with specific medicine, and with adherence; vary with time; and may have an impact on treatment adherence
A study conducted by McCabe et al. (2010) evaluated the effects of positive and negative stimuli on the brain of participants taking citalopram, reboxetine and placebo. The results suggest that both citalopram and reboxetine blocked the normal functional neuroimaging correlates of an aversive response. The citalopram group, however, in addition did not have a striatal response to a positive stimulus.
This is consistent with the notion of some sort of restraint of hedonic response