SSRI Emotional Blunting — MRCPsych Paper B MCQ

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ModerateMood DisordersSSRI Emotional BluntingMRCPsych Paper B

A 50-year-old man with recurrent depressive disorder has remained euthymic for 6 months on sertraline. Soon after the dose was increased to 200 mg daily, he noticed that he could no longer experience strong joy, affection or sadness. He remains motivated, continues his usual activities and has no persistent low mood, sleep disturbance or impaired concentration. Which phenomenon best accounts for this change?

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Correct answer: E — SSRI-associated emotional blunting

SSRI-associated emotional blunting is a reduction in both positive and negative emotional responsiveness. The temporal relationship to the dose increase, sustained remission, preserved motivation and reduced capacity to feel sadness as well as joy favour this over residual depressive anhedonia, which primarily concerns pleasure and interest and commonly accompanies other depressive symptoms. Affective lability involves excessive or rapidly changing affect. Depersonalisation is an altered or unreal sense of self, while alexithymia is difficulty identifying and describing emotions rather than diminished emotional experience. Emotional blunting can be overlooked or mistaken for residual depression. Management requires reviewing the diagnosis, treatment benefit and relapse risk; collaboratively reducing the dose or switching antidepressant may be considered.

Reference: Masdrakis VG, Markianos M, Baldwin DS. Apathy associated with antidepressant drugs: a systematic review. Acta Neuropsychiatrica. 2023;35(4):189-204. https://pubmed.ncbi.nlm.nih.gov/36644883/