Emotional side-effects of selective serotonin reuptake inhibitors: qualitative study
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Background: Some people who take selective serotonin reuptake inhibitor (SSRI) antidepressants report that their experience of emotions is ‘blunted’. This phenomenon is poorly understood. Aims: To understand patients' experiences of this phenomenon. Method: Qualitative study, gathering data through individual interviews, a group interview and validation interviews; and searching patient websites for relevant posts. Results: There was strong evidence that some people taking SSRIs experience significant emotional symptoms that they strongly attribute to their antidepressant. These emotional symptoms can be described within six key themes. A seventh theme represents the impact of these side-effects on everyday life, and an eighth represents participants' reasons for attributing these symptoms to their antidepressant. Most participants felt able to distinguish between emotional side-effects of antidepressants and emotional symptoms of their depression or other illness. Conclusions: Emotional side-effects of SSRIs are a robust phenomenon, prominent in some people's thoughts about their medication, having a demonstrable impact on their functioning and playing a role in their decision-making about antidepressant adherence.
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Emotional blunting is clinically important because it affects patients' functioning in work life, social life, and family life and prevents full functional recovery.
“Emotional blunting is clinically important as it affects patients' functioning in work life, social life, and family life, and thus prevents full functional recovery (Price et al., 2009).”
From Effectiveness of Vortioxetine on Emotional Blunting in Patients with Major Depressive Disorder with inadequate response to SSRI/SNRI treatment (2021) · cites this paper as Price et al., 2009
The “Effects on everyday life (helpful and unhelpful)” section (page not provided) reports problems at work, reduced sociability, and adverse effects on family life for some participants. The “It’s because of my pills!” section says flattening could persist as participants’ emotional state improved, but the paper does not establish that it prevents full functional recovery. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMany patients with MDD treated with SSRIs describe a restriction or diminution in the intensity or frequency of emotions common in everyday living and essential for daily functioning.
“Many patients diagnosed with MDD and treated with SSRIs described a restriction or diminution in the intensity or frequency of emotions common in everyday living and essential for daily functioning (24, 25).”
From Emotional Blunting in Patients With Major Depressive Disorder: A Brief Non-systematic Review of Current Research (2021) · cites this paper as [25]
The Reduction of positive emotions and Reduction of negative emotions sections report diminished intensity or frequency of everyday emotions, and the Discussion describes effects on daily functioning. But the Interviews section says participants had taken SSRIs for various reasons and were selected because they attributed emotional symptoms to them. The study therefore does not establish the claim for many patients diagnosed with MDD specifically. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn a qualitative study of 220 participants who had been depressed and were taking or had taken SSRIs, most respondents specifically attributed the numbing of emotions to their medication.
“For example, in one qualitative study, experimenters interviewed 220 participants who had been depressed and were either taking or had taken SSRIs (25). Most respondents specifically attributed the numbing of emotions to their medication.”
From Emotional Blunting in Patients With Major Depressive Disorder: A Brief Non-systematic Review of Current Research (2021) · cites this paper as [25]
The Interviews section says study details were mailed to 220 people, but the Interview participants section reports that only 38 were interviewed. The Results and “It’s because of my pills!” sections support that most participants distinguished emotional side-effects from depression and attributed them to their SSRI. The study’s inclusion criteria allowed SSRI use for any reason, so the source does not establish that all participants had been depressed. (LLM, conf=0.92)
Experimental — accuracy not yet measuredSome patients noticed reduced emotional responses while on SSRIs and returned to normal emotional states after discontinuing the medication or lowering the dose.
“Some patients noticed reduced emotional responses while on their SSRIs and returned to their normal emotional states after discontinuing the medication or lowering the dose (25).”
From Emotional Blunting in Patients With Major Depressive Disorder: A Brief Non-systematic Review of Current Research (2021) · cites this paper as [25]
In “It’s because of my pills!” (page not provided), participants reported reduced emotional experience while taking an SSRI and a return of emotional experience after discontinuation. The section also links changes in emotional experience to changes in dose, but does not say that lowering the dose restored normal emotional responses. (LLM, conf=0.85)
Experimental — accuracy not yet measuredEmotional blunting may be an adverse effect associated with certain classes of antidepressants; up to 60% of patients treated with SSRIs or SNRIs report some degree of emotional blunting.
“It has been suggested that emotional blunting may be an adverse effect associated with certain classes of antidepressants; for example, up to 60% of patients treated with SSRIs or SNRIs report some degree of emotional blunting [8–11].”
From Emotional blunting in patients with depression. Part I: clinical characteristics (2022) · cites this paper as [8]
The Discussion (page unavailable) says emotional blunting may be a side-effect of SSRIs, supporting the first part of the claim. This qualitative study does not establish that up to 60% of patients experience it or report a rate for patients treated with SSRIs or SNRIs. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Anhedonia (i.e., the inability to experience pleasure) is a common symptom of depression and other mental health disorders.
“Anhedonia (i.e., the inability to experience pleasure) is a common symptom of depression and other mental health disorders [8, 16].”
From Emotional blunting in patients with depression. Part I: clinical characteristics (2022) · cites this paper as [8]
The “It’s because of my pills!” section says reduced positive emotions and interest are similar to symptoms of depression. The “Reduction of positive emotions” section describes reduced enjoyment, but the paper does not establish that anhedonia is common in depression or other mental health disorders. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe results have important clinical implications as they may reflect the blunting effect often reported by patients with neuropsychiatric disorders receiving chronic SSRI treatment.
“The results have important clinical implications as they may reflect the blunting effect often reported by patients with neuropsychiatric disorders receiving chronic SSRI treatment.”
From Chronic escitalopram in healthy volunteers has specific effects on reinforcement sensitivity: a double-blind, placebo-controlled semi-randomised study (2023) · cites this paper as [41]
The Introduction says some people taking SSRIs report emotional blunting, and the Discussion describes similar experiences among study participants. The Discussion also says the sample was skewed toward long-term users, but explicitly states that the study cannot establish how common these effects are. It therefore supports the clinical relevance of reported blunting, not the claim that it is often reported across patients with neuropsychiatric disorders. (LLM, conf=0.84)
Experimental — accuracy not yet measuredLower reinforcement sensitivity in response to chronic SSRI administration may reflect the 'blunting' effect often reported by patients with MDD treated with SSRIs.
“Lower reinforcement sensitivity in response to chronic SSRI administration may reflect the ‘blunting’ effect often reported by patients with MDD treated with SSRIs.”
From Chronic escitalopram in healthy volunteers has specific effects on reinforcement sensitivity: a double-blind, placebo-controlled semi-randomised study (2023) · cites this paper as [41]
The Background and Discussion report that some people taking SSRIs describe emotional blunting, and that participants attributed reduced emotional intensity to their medication. The Discussion also says the study cannot establish how common these effects are or draw robust causal conclusions. It does not test whether lower reinforcement sensitivity reflects emotional blunting, so the proposed link and the word “often” go beyond this source. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEmotional blunting is regularly reported by depressed patients on antidepressant treatment.
“Emotional blunting is regularly reported in depressed patients on antidepressant treatment but its actual frequency is poorly understood.”
From Emotional blunting with antidepressant treatments: A survey among depressed patients (2017) · cites this paper as Price et al., 2009
The Oxford Questionnaire on the Emotional Side-Effects of Antidepressants (OQESA) was systematically constructed on the basis of qualitative assessments of emotional blunting in patients on SSRIs using data collected in individual interviews and from patient websites.
“The questionnaire was systematically constructed on the basis of qualitative assessments of emotional blunting in patients on SSRIs using data collected in individual interviews and from patient websites (Price et al., 2009).”
From Emotional blunting with antidepressant treatments: A survey among depressed patients (2017) · cites this paper as Price et al., 2009
Many patients strongly attribute their emotional symptoms, either in total or in part, to their antidepressant medication.
“many patients strongly attribute their emotional symptoms either in total or in part to their medication (25).”
From Emotional Blunting in Patients With Major Depressive Disorder: A Brief Non-systematic Review of Current Research (2021) · cites this paper as [25]
Patients with emotional blunting experience a reduction in a broader range of emotions, including love, affection, fear, and anger.
“Patients who suffer from emotional blunting are subject to a reduction in a broader range of emotions, including love, affection, fear, and anger (25).”
From Emotional Blunting in Patients With Major Depressive Disorder: A Brief Non-systematic Review of Current Research (2021) · cites this paper as [25]
In the same qualitative study, several patients were uncertain whether their emotional blunting was caused by the SSRI or by changes in life events.
“However, several patients were uncertain whether it was the SSRI they took or changes in life events that had caused their emotional blunting.”
From Emotional Blunting in Patients With Major Depressive Disorder: A Brief Non-systematic Review of Current Research (2021) · cites this paper as [25]
Patients with emotional blunting very frequently experience anhedonia; however, the emotions that are blunted are not limited to pleasure, and other emotions, including negative emotions, are also blunted or toned down.
“Patients with emotional blunting very frequently experience anhedonia; however, the emotions that are blunted are not limited to pleasure, and other emotions, including negative emotions, are also blunted or toned down [8].”
From Emotional blunting in patients with depression. Part I: clinical characteristics (2022) · cites this paper as [8]
Patients often report experiencing a 'blunting' effect.
“Patients’ often report experiencing a ‘blunting’ effect [40–42].”
From Chronic escitalopram in healthy volunteers has specific effects on reinforcement sensitivity: a double-blind, placebo-controlled semi-randomised study (2023) · cites this paper as [41]
Most antidepressant users can distinguish accurately between symptoms of the original disorder and adverse drug effects.
“However, it has been shown that most antidepressant users can distinguish accurately between symptoms of the original disorder and adverse drug effects.50”
From Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum (2020) · cites this paper as [50]
Small scale qualitative research has often highlighted negative experiences or noted considerable ambivalence amongst some antidepressant users.
“Small scale qualitative research has often highlighted negative experiences [11–14] or noted considerable ambivalence amongst some antidepressant users [15, 16].”
From ‘In my life antidepressants have been…’: a qualitative analysis of users’ diverse experiences with antidepressants (2016) · cites this paper as [13]
A potential detrimental manifestation of long-term treatment with antidepressants may be the emotional blunting phenomenon or otherwise depressogenic phenomena.
“A potential detrimental manifestation of long-term treatment with antidepressants may be the emotional blunting phenomenon (vide infra) or otherwise 'depressogenic' phenomena [33-36].”
A high proportion of patients receiving SSRIs may exhibit emotional blunting.
“A high proportion of patients receiving SSRIs may exhibit a clinical phenomenon referred to as emotional blunting.”
Current standard treatment of MDD, particularly SSRIs, fails to sufficiently treat reward-related symptoms of depression.
“It was proposed that current standard treatment of MDD, particularly selective serotonin reuptake inhibitors (SSRIs), fail to sufficiently treat reward-related symptoms of depression (Dunlop and Nemeroff, 2007; Price et al., 2009; Di Nicola et al., 2013).”
From Circuit Mechanisms of Reward, Anhedonia, and Depression (2019) · cites this paper as Price et al., 2009
Anhedonia has a rather low response to SSRI treatment compared with other symptoms.
“These results could reflect the fact that anhedonia has a rather low response to SSRI treatment compared with other symptoms (Opbroek et al., 2002; Price et al., 2009).”
From Circuit Mechanisms of Reward, Anhedonia, and Depression (2019) · cites this paper as Price et al., 2009
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- Authors
- Price, J., Cole, V., & Goodwin, G. M.
- Affiliations
- Warneford Hospital (GB)
- Corresponding author
- Price, Jonathan
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2009-09
- Volume
- 195
- Issue
- 3
- Pages
- 211-217
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2150537415
- Cited by
- 362
- References
- 16
- Citations by year
- 2026: 31 · 2025: 18 · 2024: 25 · 2023: 28 · 2022: 42 · 2021: 16 · 2020: 22 · 2019: 14 · 2018: 15 · 2017: 29 · 2016: 20 · 2015: 25 · 2014: 15 · 2013: 17 · 2012: 14
- FWCI
- 10.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Oxford
- Servier
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- selective serotonin reuptake inhibitors, antidepressant side effects, emotional blunting, emotional symptoms, patient experience, antidepressant adherence, depression, impact on daily life
- MeSH terms
- Adult, Aged, Aged, 80 and over, Depressive Disorder, Emotions, Female, Humans, Male, Middle Aged, Personality, Psychiatric Status Rating Scales, Patient Satisfaction, Selective Serotonin Reuptake Inhibitors, Internet, Young Adult
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