Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada.
Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada.
J Affect Disord. 2022 Dec 1;318:29-32. doi: 10.1016/j.jad.2022.08.066. Epub 2022 Aug 24.
Emotional blunting is theorized to be an adverse effect of antidepressants, particularly serotonin reuptake inhibitors, but this has not been firmly established. Another possibility is that emotional blunting represents a residual depressive symptom.
We analyzed data from adult outpatients with acute major depressive disorder who participated in three 8-week randomized controlled trials. Trials 1 and 2 were pooled (venlafaxine, n = 378; bupropion, n = 389; placebo, n = 383) and Trial 3 (escitalopram, n = 254; bupropion, n = 260) was analyzed separately. Emotional blunting was measured with the "inability to feel" item from the Montgomery-Åsberg Depression Rating Scale.
Emotional responsiveness improved, on average, in all treatment groups. Only a minority of participants (≤6 %) experienced more emotional blunting post-treatment, compared to baseline, with no significant differences between treatment groups, although roughly 20-25 % continued to report an inability to feel normal emotions at the final assessment. In Trials 1 and 2, emotional blunting was associated with poorer outcomes in terms of depressive symptoms, suicidal ideation, and sexual function, but these correlations were nearly identical in the placebo group.
The trials were short and cannot speak to the possibility of emotional blunting from long-term treatment. Emotional blunting was measured with a single item.
The study medications did not significantly decrease emotional responsiveness, and there was no evidence that emotional blunting mediated treatment response. In acute treatment, emotional blunting may be better conceptualized as a residual symptom than as an adverse drug effect.
情绪迟钝被认为是抗抑郁药的一种不良反应，尤其是选择性 5-羟色胺再摄取抑制剂，但这尚未得到明确证实。另一种可能性是，情绪迟钝代表一种残留的抑郁症状。
我们分析了参加三项 8 周随机对照试验的急性重度抑郁症成年门诊患者的数据。试验 1 和 2 合并（文拉法辛，n=378；安非他酮，n=389；安慰剂，n=383），试验 3（艾司西酞普兰，n=254；安非他酮，n=260）单独进行分析。情绪迟钝通过蒙哥马利-阿斯伯格抑郁评定量表的“无法感受”项目进行测量。
在所有治疗组中，情绪反应平均均有所改善。与基线相比，治疗后仅有少数（≤6%）患者出现更多的情绪迟钝，各组之间无显著差异，尽管大约 20-25%的患者在最后一次评估时仍报告无法感受到正常情绪。在试验 1 和 2 中，情绪迟钝与抑郁症状、自杀意念和性功能恶化相关，但在安慰剂组中这些相关性几乎相同。
这些试验时间较短，无法说明长期治疗可能出现的情绪迟钝。情绪迟钝通过单一项目进行测量。
研究药物并未显著降低情绪反应性，也没有证据表明情绪迟钝介导了治疗反应。在急性治疗中，情绪迟钝可能更好地被视为残留症状，而不是药物不良反应。
