Emotional blunting in patients with depression. Part IV: differences between patient and physician perceptions

Abstract

Background Emotional blunting is common in patients with depression. An online survey was undertaken to assess the experience of emotional blunting, and its impact on functioning and quality of life, in the acute and remission phases of depression from the perspective of patients and healthcare providers (HCPs). This paper presents data on the level of concordance between patient and HCP perspectives. Methods This was a cross-sectional, observational study. Patient respondents were adults with a diagnosis of depression, who were currently using a prescribed antidepressant, and who reported emotional blunting during the past 6 weeks. HCPs completed the survey for the last two eligible patients they had seen, one in each phase of depression. Assessments included the Oxford Depression Questionnaire (ODQ) ‘antidepressant as cause’ domain and the Functioning Assessment Short Test (FAST). Results Mean ODQ ‘antidepressant as cause’ domain scores were significantly higher in the patient-reported cohort (n = 752) than in the HCP-assessed cohort (n = 766) in both the acute (18.0 vs 12.5, respectively; p < 0.01) and remission phases (17.6 vs 12.6; p < 0.01). Overall, 45% of patients believed that their antidepressant medication was negatively affecting their emotions and 39% were considering stopping or had stopped their antidepressant because of perceived emotion-related side effects. In the HCP-assessed cohort, the antidepressant was considered responsible for emotional blunting in 30% of patients and only 18% of patients were believed to be considering stopping their medication due to emotional blunting. Patients reported a greater impact of emotional blunting on activities of daily living than HCPs. Mean FAST score was significantly higher in each phase of depression in the patient-reported cohort than in the HCP-assessed cohort (acute phase, 47.0 vs 39.1; remission phase, 33.5 vs 19.4; both p < 0.01). Conclusions Compared with previous studies, our results suggest that HCPs may underestimate the prevalence of emotional blunting in patients with depression. HCPs also appear to underestimate the severity and impact of emotional blunting on patient functioning and treatment adherence compared with patients’ own perspectives. Differences between patient and HCP perspectives were most pronounced during the acute phase of the disease.

A web‐based survey on the occurrence of emotional blunting in patients with major depressive disorder in Japan: Patient perceptions and attitudes

“…This lack of acknowledgment remains a significant barrier to recovery. Studies have shown that healthcare professionals may also underestimate the prevalence, severity, and impact of EB on patient functioning and treatment adherence when compared with the patients' own perspectives 14 . Interestingly, about half of the patients with EB in our study reported that they would like their physician to ask about their EB symptoms, and nearly two‐thirds of the patients with EB symptoms found them distressing and likely to negatively impact recovery.…”

“…Studies have shown that healthcare professionals may also underestimate the prevalence, severity, and impact of EB on patient functioning and treatment adherence when compared with the patients' own perspectives. 14 Interestingly, about half of the patients with EB in our study reported that they would like their physician to ask about their EB symptoms, and nearly two‐thirds of the patients with EB symptoms found them distressing and likely to negatively impact recovery. Overall, this suggests that increasing awareness of EB symptoms in both patients and physicians is necessary to improve detection and reduce suffering in patients with MDD.…”

“… 11 A higher degree of EB has also been shown to be associated with a poorer quality of remission in patients with unipolar depression on treatment, 10 and the influence of EB on decision‐making may also affect treatment adherence and the risk of relapse. 12 , 13 , 14 However, the effect of EB on the overall functional recovery in patients with MDD has not been fully examined, and although international reports on EB have increased, there are no published reports on the prevalence and impact of EB in patients with MDD in Japan. It is therefore important to know whether the detrimental effects of EB on functional recovery from MDD are universal, regardless of the medical environment and geography.…”

“…Results from an online survey of 896 patients with unipolar and bipolar depression showed that EB was among the common reasons for medication discontinuation, as reported by over one‐third of respondents in the study 11 . A higher degree of EB has also been shown to be associated with a poorer quality of remission in patients with unipolar depression on treatment, 10 and the influence of EB on decision‐making may also affect treatment adherence and the risk of relapse 12–14 . However, the effect of EB on the overall functional recovery in patients with MDD has not been fully examined, and although international reports on EB have increased, there are no published reports on the prevalence and impact of EB in patients with MDD in Japan.…”

Can antidepressant use be associated with emotional blunting in a subset of patients with depression? A scoping review of available literature

“…Emotional blunting is highly clinically relevant in depressed patients as it compromises their quality of life by reducing their ability to process social interactions, self‐reflect, and be empathic. Numbness of feelings and emotions may result in indifference toward loved ones and friends, negatively impacting interpersonal relationships and social judgments (Christensen et al., 2022). Therefore, clinical recognition and screening for emotional numbness along with other symptom domains (i.e., cognitive and somatic) of depression is imperative to achieve an increase in quality of life, social relationships, and premorbid functionality.…”