More than half of the patients who took part in a study in Thailand reported emotional blunting, meaning a weakened response to what happens around them. The phenomenon was less common when depression was in remission, but still affected 45% of that group. The research, published in BMC Psychiatry, thus documents a difficulty that can remain even after the main depressive symptoms have eased. However, the data cannot establish whether this difficulty stems from the disorder itself, medication or a combination of factors.
Emotional blunting includes experiences such as apathy, reduced motivation, emotional numbness, limited empathy and anhedonia, meaning a reduced ability to feel pleasure. It can occur during an acute depressive episode and persist after treatment, affecting everyday functioning. It is also reported as a side effect of some antidepressants, particularly selective serotonin reuptake inhibitors. This makes it more complicated to interpret in people taking medication.
The team at Khon Kaen University examined 106 outpatients at a university hospital: 61 with major depressive disorder, 19 with persistent depressive disorder and 26 with bipolar I disorder. Their average age was 29, and 73% were women. Participants were required to have mild to moderate symptoms or be in remission, have no suicide risk and have been taking the same antidepressant medication for at least one month. Half met the criteria for remission, with few remaining symptoms on a rating scale completed by a clinician.
First, patients answered a screening question from the Oxford Depression Questionnaire. The question asked whether, over the previous six weeks, they had felt emotionally numb, cut off from the world or indifferent to things that had once interested them. They then completed the full 26-question questionnaire, which examines different dimensions and the intensity of blunting. They also completed a questionnaire on adverse childhood experiences and two measures of depression severity.
In response to the initial question, 56% reported emotional blunting. The individual rates were 51% for major depressive disorder, 63% for persistent depressive disorder and 62% for bipolar disorder, with no statistically significant differences between them. On the full questionnaire, most participants fell into the minimal-intensity category, 36% into the mild category and one into the severe blunting category. Frequent reporting of the phenomenon therefore did not mean that most experienced it intensely.
Among those in remission, the rate of emotional blunting was 45%, compared with 66% among those not in remission. Across the sample, greater severity of depressive symptoms and more previous episodes of mood disorder were associated with more intense blunting, but the associations were limited. In the remission group, by contrast, the intensity of blunting was not associated with the severity of depressive symptoms. The researchers note that remission was associated with a lower frequency of the phenomenon, although it remained common.
The relationships with adverse childhood experiences were weak and concerned specific aspects of blunting. Indifference to things was associated with more frequent emotional or physical abuse in childhood and less emotional support from the family. The overall blunting score, however, had no statistically significant relationship with any type of childhood adversity. The results therefore do not establish a general link between adverse childhood experiences and the phenomenon as a whole.
Among patients in remission, the associations of indifference with emotional abuse and low family support remained, while emotional detachment was associated with more frequent domestic violence in childhood. When the researchers accounted for the extent to which participants attributed blunting to their antidepressants, only the relationship between indifference and low emotional support remained statistically significant. The assessment of childhood experiences relied on patients' present-day memories, leaving room for recall bias.
The study's design does not allow conclusions about what causes emotional blunting. All participants were taking antidepressants, and more than 90% attributed at least some of their blunting to their medication; this assessment does not in itself prove a causal relationship. There was no comparison group of patients in remission who were not taking antidepressants. The main finding is that reduced emotional responsiveness remains common in this particular sample even after depression has eased, while its origin remains unclear.
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