Dissertations, Theses, and Capstone Projects

Date of Degree

9-2022

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Claudia Brumbaugh

Committee Members

Nancy Foldi

Justin Storbeck

Joan Borod

Joel Sneed

Subject Categories

Clinical Psychology | Cognition and Perception

Keywords

emotional blunting, selective serotonin reuptake inhibitors (SSRIs), depression, emotional processing

Abstract

Objective: In recent years, approximately 12.7% of the American population are on a prescribed antidepressant medication. Selective Serotonin Reuptake Inhibitors (SSRIs) are a widely used pharmacological treatment for depressive and anxiety disorders, primarily due to their tolerance levels, mild side effects in comparison to other antidepressants, and broad range of clinical indications. However, there are still numerous concerns about SSRIs’ ability to improve depressive symptoms without adding side effects such as sexual dysfunction, gastrointestinal upset, and a restricted range of emotions. Although patients typically claim that they have less emotional pain while on SSRIs than they do during a depressive episode, they also report feeling constrained in the range of emotions they experience, such as the inability to cry or feel enjoyment. When linked to antidepressant treatment, this phenomenon has been described as emotional blunting, or a numbing of emotion. While emotional blunting has been established qualitatively, detecting emotional blunting can be difficult for both patients and clinicians since patients may have little insight about the side effect. This study specifically seeks to address gaps in the literature by collecting information on subjects with long-term SSRI use for depression. This work explores the breadth of emotional blunting in long-term SSRI-users by determining if emotional blunting can alter cognitive processing of emotional information.

Participants and Methods: One hundred and twenty-two adults (61 controls and 61 SSRI-users with remitted depression) participated in an online survey. SSRI-users reported on emotional blunting, mood, demographic characteristics, and SSRI-related side effects including sexual dysfunction. All participants were asked to identify emotional expressions via a facial Affect Naming task and attend to emotionally charged words with accuracy and speed via an Emotional Stroop task.

Results: Findings revealed that SSRI-users who reported sexual dysfunction were more likely than SSRI-users without sexual side effects to experience SSRI-induced emotional blunting. Contrary to hypotheses, there were no differences in identifying or processing emotional stimuli between controls and SSRI-users, between SSRI-users with and without subjective emotional blunting, or between SSRI-users with or without sexual dysfunction.

Discussion: The connection between sexual dysfunction and emotional blunting in long-term SSRI-users has been established and needs further exploration, as the two side effects may follow similar biological pathways and have relevant clinical implications on pharmacologically treating depression. Further study of the overlap between sexual dysfunction and emotional blunting will allow prescribers to find optimal dosages while taking into consideration the significant social side effects demonstrated in many long-term SSRI-users. Other clinical implications include the need to elucidate objective and accessible ways to measure SSRI-induced emotional blunting in long-term SSRI-users. While emotional blunting in SSRI-users was not detectable through cognitive assessments in the current study, physiological changes in SSRI-users may provide an objective way to measure emotional blunting, as these reactions are less likely to be impacted by conscious awareness and may be more sensitive to subtle nuances. Ultimately, it is crucial that antidepressant prescribers become more aware of emotional blunting, recognize its overlap with sexual dysfunction, and find a way to objectively track it over time in order to provide optimal care to patients with depression.

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