Emotional blunting is common in depression and bipolar disorder, even after symptoms ease

A study of Thai outpatients receiving treatment for depression found that more than half reported emotional blunting, a dulling of emotional responses. Rates did not differ significantly among people with major depressive disorder, persistent depressive disorder, and bipolar disorder, and emotional blunting was less common among patients whose depression was in remission, though it remained common in that group as well. The paper was published in BMC Psychiatry.

Major depressive disorder is one of the most common mental health conditions worldwide, affecting hundreds of millions of people. Estimates suggest that its global prevalence rose by roughly 27% in 2020 alone, as the COVID-19 pandemic brought stress, isolation, and economic disruption.

Major depression does not have a single cause but instead develops through a combination of biological, genetic, physical, behavioral, and environmental influences. Adverse childhood experiences such as abuse, neglect, bullying, and domestic violence are particularly important risk factors and are also associated with poorer treatment response and a greater chance of depression recurrence.

One common feature of depression is emotional blunting, in which people experience reduced emotional responsiveness. The term covers experiences such as apathy, loss of motivation, anhedonia (a reduced ability to feel pleasure), emotional numbness, and diminished empathy. Emotional blunting appears to be especially common during acute episodes of depression and may persist after treatment.

Emotional blunting is also a known side effect of some antidepressants, particularly selective serotonin reuptake inhibitors, which can leave people feeling emotionally indifferent or unable to cry. It can impair daily functioning, and in one recent study, up to 40% of patients said they had considered stopping their antidepressant because of it.

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Study author Narak Chadbunchachai and colleagues at Khon Kaen University in Thailand set out to measure how common emotional blunting is among patients whose depression was mild to moderate or in remission, and to examine its links to childhood adversity. They expected emotional blunting to be more intense among remitted patients who had experienced more adversity in childhood.

Participants were 106 outpatients at a university hospital in Thailand who had major depressive disorder (61 of them), persistent depressive disorder (19), or bipolar I disorder (26). Persistent depressive disorder is a long-lasting form of depression in which a person has a depressed mood for most of the day, on more days than not, for at least two years, often with additional symptoms such as low energy, poor self-esteem, and hopelessness. Participants’ average age was 29 years, and 73% were women.

To take part, patients had to have mild to moderate symptoms, could not be at risk of suicide, and had to have been on the same antidepressant treatment for at least a month. Half of the participants met the criteria for remission, meaning they had few remaining symptoms on a clinician-rated depression scale.

Participants were first asked a single screening question from the Oxford Depression Questionnaire about whether, in the past six weeks, they had felt emotionally numbed or blunted, detached from the world around them, or as if they no longer cared about things they used to care about. They then completed the full 26-item questionnaire, which measures the intensity of emotional blunting across several dimensions, along with a questionnaire on adverse childhood experiences and two measures of depression severity.

Based on the screening question, 56% of participants reported emotional blunting. The rate was 51% among those with major depressive disorder, 63% among those with persistent depressive disorder, and 62% among those with bipolar disorder, differences that were not statistically significant. On the full questionnaire, most participants scored in the “minimal” range, 36% scored in the “mild” range, and one person scored in the “severe” range.

Emotional blunting was less common among participants whose depression had remitted (45%) than among those whose depression had not (66%). Across the whole sample, people with more severe depressive symptoms and more past mood episodes tended to report more intense emotional blunting, though these associations were modest. Among remitted patients, blunting was not linked to symptom severity.

The links with childhood adversity were limited to specific parts of the questionnaire and were weak. One aspect of emotional blunting, not caring about things, tended to be stronger among participants who reported more frequent emotional or physical abuse in childhood and among those who reported less emotional support from their families. Overall emotional blunting scores were not significantly linked to any type of childhood adversity.

Among remitted patients, the links between not caring and both emotional abuse and low emotional support held, and a second aspect, feeling emotionally detached, was associated with more frequent domestic violence in childhood. When the researchers accounted for how much participants attributed their blunting to their antidepressants, only the link between not caring and low emotional support remained statistically significant.

“Remission was associated with a lower prevalence of EB [emotional blunting]; however, the prevalence remained high even among remitters,” the study authors concluded.

The study contributes to the scientific knowledge about depression. However, it should be noted that the design of this study does not allow any causal inferences to be derived from the results. Additionally, the assessment of adverse childhood experiences was based on participants’ current memories of their childhood events, leaving room for recall bias to have affected the results.

All participants were taking antidepressants, and more than 90% attributed at least some of their emotional blunting to their medication. Because the study had no comparison group of remitted patients who were not taking antidepressants, it cannot separate emotional blunting as a lingering symptom of depression from emotional blunting as a side effect of treatment.

The paper, “Prevalence of emotional blunting and its association with childhood adverse experiences in depressive episodes,” was authored by Narak Chadbunchachai, Papan Vadhanavikkit, Sirinapa Aphisitphinyo, Pattharee Paholpak, Nawanant Piyavhatkul, Parinda Pienroj, and Pongsatorn Paholpak.