Emotional blunting, sexual dysfunction and SSRIs
The recent interesting report on SSRI-associated emotional blunting and its possible association with SSRI-induced sexual dysfunction (Opbroek et al., 2002) presents a somewhat confusing concept and raises far more questions than it provides answers.
First is the question of the concept of emotional blunting. The authors (Opbroek et al., 2002) state that up to 80% of their patients described ‘a treatment emergent blunting of certain emotions’. Which of the symptoms or blunted emotions are part of the emotional blunting and which are part of the patient's personality or residual symptoms of depression? As the authors pointed out, their outcome measure for emotional blunting lacks evidence of validity (what about reliability?) and thus it is not clear what this scale really measures. Other reports on emotional blunting in the literature are not very clear about this concept, either. Hoehn-Saric et al. (1990) reported apathy, indifference, loss of initiative and disinhibition in panic disorder and depressed patients on SSRIs. In another report, Hoehn-Saric et al. (1991) described apathy, indifference, inattention, and perseveration in an obsessive–compulsive patient taking fluoxetine. These changes were associated with a decrease in cerebral blood flow in the frontal lobes on SPECT and changes in neuropsychological tests generally associated with frontal lobe impairment. Oleshansky and Labbate (1996) described rapid improvement of excessive or inappropriate crying, without apathy or indifference, in depressed patients treated with SSRIs. Similarly, Vinar (2000) reported that eight depressed women spontaneously mentioned that for years they cried during moving scenes in the theatre, cinema, or on TV.(Received July 24 2002)
(Reviewed August 20 2002)
(Revised August 20 2002)
(Accepted August 20 2002)
c1 Address for correspondence: Dr R. Balon, UPC-Jefferson, 2751 E. Jefferson no. 200, Detroit, MI 48207, USA. Tel.: 1-313-9933416 Fax: 1-313-9933422 E-mail: firstname.lastname@example.org