Emotional blunting and depression: symptom or side effect?

When we treat a patient for depression, after ensuring safety, we aim to provide relief from the depressive symptoms, restore functioning, enhance quality of life and develop relapse prevention strategies. However, the principal focus is on symptom reduction; this is understandable as this is our basis for assessing evidence-based treatments for depression. The focus of clinical trials is on how well a particular treatment performs (compared with placebo or an active comparator) in reducing symptoms, using standard symptom rating scales, and the proportion of patients who either respond (a 50% reduction in symptoms) or remit (scoring below a specific cut-off on a rating scale) from their depressive episode. Less attention is paid in clinical trials to functional improvement, and little to quality of life, despite these aspects often being more important to patients. When patients are asked what they want from their treatment, they generally prioritise a return of positive mental health, accompanied by a return of optimism, vigour and self-confidence, ahead of symptom relief. They want to ‘feel like their usual self’, have a sense of wellbeing, feel in emotional control and be able to participate in, and enjoy, relationships with friends and family.

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