Emotional Blunting with antidepressants. Many people who take antidepressants will say they feel flat, numb or like they can't experience normal emotions. In this video I discuss why that happens and what can help it.
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Hi doctora. Didn't know about this effect at all, such an useful information. I thought that it was an effect of mood regulation in the way I was no longer "so needy" of other's approval and I found it fantastic, but I have become more distant and less affective with my family as well... my anxiety was triggered by wittness or found out someone was in pain or struggling with serious issues, street animals especially; to the point I avoided going out because I was afraid to witness lonely animals, homeless people etc... now I deal better with that. I guess in my case the benefits are greater than the unexpected "less" affective Aza...
Hi Az Abarca. Thanks for sharing your experience. Yes, sometimes the dampening down can be a good thing so you're not so reactive to everything. Thanks for bringing this out, it's an important point. The "blunting" isn't always bad. 🙂
+817linda Hmmm, fatty liver. You should talk to your doctor about whether you should continue taking it. Fatty liver is an early stage of liver disease usually caused by being overweight, insulin resistance, alcohol, etc. I'm not sure how nefazadone affects the liver, but given you already have some liver compromise (early stage and possibly reversible), you may not want to stay on something that could accelerate the problem. There are lots of newer meds out there. If none of the new stuff has worked for you, take a look at this video I did on treatment resistant depression. https://youtu.be/2z5krS51pNg
Dr. Tracey Marks I’ve been on it a very long time. I’m not sure it’s doing anything for me these days. It’s expensive & I can’t understand it since it’s been around for so long. Pharmacies never have it on hand, they always have to order it & most don’t even know how to pronounce it. I’ve known of the black box warning. My liver function has been ok over the years but now it’s been discovered I have a fatty liver so I wonder if I should be taking it. Nothing seems to work for me anyway.
I know about 15 years ago or so it took on a black box warning about liver failure. They stopped making the brand Serzone. Since then, I haven't prescribed it. But I did have good results with it when I did prescribe it.
Can you help us about bipolar type 2 , when given antidepressants a lone, it causes hypomania, and when given with a mood stabilizer such as Lamictal, it stops working? What’s the solution please? Why is that?
Hi Leena. Usually bipolar disorder responds best to mood stabilizers, either one or two. In my experience, Lamictal works best when taken with something else and is not enough alone (but it can be for some). So if Lamictal alone stops working for you, you may need two mood stabilizers - on in the anticonvulsant class like Lamictal, Depakote and one in the antipsychotic class like Seroquel or Abilify. Also, different generics can change the effectiveness of the drug. That may be why it seems to stop working. I did a video on generic medications here https://youtu.be/VDqsHl3lBlA
I came here because I realized that I haven't been crying as much before I took Prozac. Which is good considering I was crying a lot due to intrusive thoughts, and thankfully my intrusive thoughts have dulled down, but when I feel sad in my heart, I just can't react no more. No tears, not facial expression, I'm just there.
I would go back to my therapist, but my parents said I can go when it's needed and I don't think that something like this is urgent enough for them to take me.
I was prescribed 50mg Escivex (generic escitalopram) last Aug 2017. I've taken it for about 1-2 months. I quit it because of the emotional blunting. I COULDN'T LAUGH AT ALL. The most I can do is smile. Until today, 1 year after quitting I still can't laugh. Please dr what can I do?
+playcold32 Coincidentally I went to a lecture this evening on depression and asked the speaker this question about protracted or extended discontinuation symptoms. The speaker (a researcher on this topic) said some people have reported to have this go on for years. The proposed treatment is to return to a long acting antidepressant like prozac or Trintellix (new drug even longer than Prozac and better with cognition so a better choice for this). Your doctor would add that back for several weeks until the blunting goes away, then wean you off it. He referred me to a study that speaks to this issue https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606297/ I haven't read the article yet so I don't have any thoughts about it yet. Just passing on the info since you asked. But I plan to look into this further. In my own experience, the symptoms went away after the patients stopped taking the medication. So I haven't had anyone tell me they still had the problem years later.
+playcold32 I can't say that I'm familiar with it being a permanent effect of the medication. You may want to look at this video on depersonalization https://youtu.be/umAgSGTGr8M and see if you can relate to any of it.
+Dr. Tracey Marks Is there any way to reverse the emotional blunting damage caused by generic escitalopram? Supplements? Just wait it out? This has been going on for over a year and is so painful to have a decreased range of emotions and not laugh at all. Added info: I'm not on any medication also for over a year after that thing blunted me. :(
Hmmm...the dulling effect coming from the medication should have worn off by now. You may be experiencing depersonalization that is independent of the medication and can come along with depression. I have a video on this topic - it was scheduled for January, but since you're asking about this, I'm going to move it up to publish this Wednesday. So look out for it.
I'm on Celexa 40 mg. Going through a breakup and a job loss and feel almost nothing, which is very unlike me. Starting to realize that maybe this isn't a good fit for me and I need to try something else for my depression/anxiety. Going on almost four years and I get dizzy spells, I'm extremely tired all of the time...I never thought these were side effects of my medication, but it sounds like I need to be transparent with my doctor about these issues. Kind of eye opening.
Have tried SSRIs, SNRIs and Tricyclic and all blunted my emotions even on very low doses. They turned off my ability to feel love. I have bipolar and borderline diagnosis. Unmediated my emotions go all over the place but I can always feel love for loved ones, medicated I am suspended in a low grade depressive state and can not feel love or desire. I have always had to come off the medication due to other side effects virtigo, dizzy spells, fainting, extreme excessive sleeping, physical pain and rage among the side effects. Once off the medication my ability to feel range emotions returns often very painfully but ability to feel love is also restored. After 20 years on and off medications I am left with very little faith psych medications have much good to offer me.
Thank your for this vid! I took prozac for a while and I didn’t felt myself better just « flat » that was not helping me. Today I took some lamyctal and weirdly it just makes me 1000 better even if it’s absolutly different
I had this! Felt like a robot and came off it as soon as I could. Never tried another one. Didn’t help as I already had bad depersonalisation.
I think I never needed meds, once I took the steps to change my life with support, cbt I wasn’t badly depressed anymore. It took a time but I think people can sometimes be too quick to jump to pills without looking at someone’s life and if that is an understandable reason to be depressed that can be addressed instead.
Dr. Tracey Marks wow! Thanks again. It is of great comfort to know you're in my neighbor town Atlanta. Hopefully Ill get to meet you in person one day. Looking forward to that video as zi have already derealized before.
Hi Swearveit. You're welcome. Your dull is normal? Not sure how that works 🙂 One thing to think about though - that dull feeling can be what's called a depersonalization symptom (I have an upcoming video on that). Depersonalization can also be a symptom of depression. So having that dull or numb feeling after you stopped your med could have been part of depression returning. Just a thought...
I call this feeling the nothingness, you can’t feel happy but your not sad either. I’m taking mitrazipine and feel this nothingness, which I think is better than feeling depressed but it is sad to not feel the happiness or joy I could previously. I feel it helps me as I have bpd and my moods aren’t triggered to make me upset or sad. Also call it that numb inside feeling. I’m weaning off my medication now and on the lowest dose I can be on of it. But I haven’t yet got back any normal feelings.i previously had serotonin syndrome so dubious to try any new meds in case I get that again. This meds the only one so far that’s helped my mood.
Hi Dr I have been emotionally Numb for two months now, Dr. Has giving me prozac zoloft ,abilify and lexapro. The lexapro worked for one day then i became emotionally numb again a couple days ago the Dr Gave me wellbutrin but I am afraid to take it due to the failures of other medications. In your professional opinion what should i do. I can cry, i have no joy and i feel irritable a lot of the time..
Hi Brian. I can't give you a professional opinion on what drug to take since I'm not treating you. However, the numbness is much less likely with Wellbutrin (though it is possible). Wellbutrin is not always a good choice for people with a lot of anxiety, some is ok, but not a ton because Wellbutrin is an activating antidepressant. But if your doctor prescribed it as an alternative, he/she must think it's an appropriate choice to try. It's a very good antidepressant for some people.
Thanks for the transparent information about these meds. It's weird, I never got the flattening effect, I only ever felt the same or worse with every anti-depressant I tried (olanzapine + prozac was very very VERY bad). Why would most psychiatrists prefer anti-depressants over serotonin/dopamine precursor-supplements like tyrosine, tryptophan or 5HTP? I'm sure there must be a valid reason, but I can't find any. In my country supplements are even frowned upon by (most) psychiatrists.
Hi Simon. Not sure if you saw them, but have a videos on alternative medications for depression and anxiety within this playlist. https://goo.gl/e1xweX
Because pharmaceuticals are regulated by the FDA, there's more predictability in how the drug is expected to work. The over the counter supplements can be very hit or miss as far as efficacy and side effects. So I prefer to prescribe a pharmaceutical to help a patient who is seeing me for a moderate to severe depression because I expect the prescription medication to work more consistently than the over the counter option. However, the choice is still up to the patient. If they prefer the alternative med, they don't need me to get it.
+Dr. Tracey Marks no not until recently wen I started realizing how numb my emotions are am on a high does of anti depressions for over ten year's but I still have periods of desperation and suicidal thoughts but there flitting so I can only image how I would be with out my meds. So it's kinda like a am screwed if I do and screwed if I do 🤷♀️
I was prescribed Celexa and experienced the emotional blunting. I ended up not taking the medication anymore bc it interfered with my menstrual cycle. Is it common for medications like antidepressants to do such a thing?
Hi Marrissa. I'm not familiar with the antidepressants interfering with menses or hormones. I'm not saying it can't, but it's not something I hear about. It makes sense for some of the antipsychotic meds that can increase prolactin levels, but I cant think of why the antidepressants would do that.
Thank you so much. I have had this feeling of the dulling of emotions only 5 weeks into taking anti depressants, which I've been worrying about. Now I know I have this problem, I'll definitely be talking to my dr. Do you think that by changing to another anti depressant would fix this or only what you suggested?
Thank you so much for replying and so quickly Dr Marks. You have given me fantastic advice about my problem. I will take the names to him and your video and hopefully he'll listen more than he usually does. Thank you once again and I'm a true new fan👍😘
Hi Carliegh. Sometimes adding buproprion can reverse it. Using buproprion alone can work if that's the right med for you to take for your condition. If you can't take buproprion, sometimes changing antidepressants can help as it may not happen with the next one (or it may). Also reducing the dose can help too. Some of the newer antidepressants like Trintellix and Vibryd may have a reduced incidence of it since they work by a little different mechanism than the reuptake inhibitors but that's just guess and hasn't been proven to be true. Good luck.
I've been taking 50mg of Sertraline for panic disorder, during the first 4 weeks I felt the blunting effect really strongly, mid way through week 5 I was at work and, very literally like a switch, suddenly felt normal. The emotions I experienced before starting had returned - minus the anxiety. Several months later and I'm feeling the same, if it wasn't for the lack of anxiety, I'd think the medication wasn't working at all. It's been life changing for me.
Hi Brendan. The sudden change week 5 makes me wonder if the difference is because of a change in your generic version of the medication. That change can make a difference in the side effects. I'm glad though the medication has been life changing for you.
Hi NaTasha. I'm working on a video right now on OCD vs OCPD. But it's more about the difference btw the two rather than a heavy focus on treatment. Maybe I'll do a follow up on treatment - which includes medication + CBT for OCD and probably interpersonal therapy for OCPD. Thanks for the suggestion.
You're right Alberto it is. It's a receptor agonist drug in addition to SSRI, and that's what is supposed to make the difference with the cognitive issue. They don't speak directly to the blunting, but it's implied that it's less. So I just say it's "supposed" to be less flattening. I haven't used it a ton, but so far I haven't had patients complain of it.
Hi Shashrank. The flatness from the meds is not permanent. It lifts after the medication is discontinued. I talked about antidepressants in this video, but antipsychotics like Latuda can do it to (unfortunately). Talk to your doctor about it - there may be another one that does it less. There are also side effect pills like Cogentin that we use with some antipsychotics to help with physical slowness. Not sure if it would help with emotional flatness, but maybe...
Hi I'm new to your channel.Great content so appreciated!! My stimulant medication has me feeling low and the depression has come back! What anti depressant would you suggest that I can take with elvanse(I'm in the UK) and my HRT tablet .I look forward to hearing from you
Just so happens I"m not a fan of it because I haven't seen it work that well at doses under 40mg. Docs would push the dose up to get the desired effect, then the FDA put out a warning not to go above 40mg in people under 65 and 20mg over 65. Doses above this are associated with heart side effects. So I tend to use escitalopram instead, which I think works better.
Hi Sharon. I can't make direct medication recommendations for you. But speaking generally - first I assume you mean Vyvanse (the US version of lisdexafetamine). Second - I would tend not to use buproprion with a stimulant because it's a stimulating antidepressant on its own. So with a stimulant sometimes it's too much. So that leaves the serotonin-enhancing antidepressants and we have so many to choose from. What is best for you depends on your history of taking things in the past. Some are a little more weight gaining than others like paroxetine. Some of the newer meds help a little more with thought processing like vortioxetine. Your doctor can make a decision with you based on what you tell him/her about the kinds of symptoms your have and what you've taken in the past. I hope this helps.
Aah yes - for OCD. I forgot about that. That one is still fairly popular to use for that reason - but the TCA's in general have become less popular because they carry a lot more side effects than the newer drugs. But if you don't have problems with it, it's still an effective drug.
Hi Tino. Yes I can. However, we don't use them a lot anymore (maybe I can talk about why in the video 🙂)
We tend to use them for sleep in low doses, pain management docs use them for pain. Neurologists for migraines. Are you taking one in a full dose for depression?
Yes Haydn, that's getting to be quite the cocktail of meds. Seroquel can cause the blunting too because it blocks dopamine. We usually use trazodone for sleep and not depression. We usually use Buspar for anxiety. I can't really say what you need, but the Seroquel/lithium combo is a very good one; both of them are heavy hitters and usually don't need other meds to help them out.
I tried Zoloft and it was very strange. It seemed to work a bit but definitely very numb and distant. had previously tried wellbutrin and it made my anxiety incredibly difficult so I knew it wasn't for me. Cymbalta has been really great for me and I'm currently trying a low dose add on of Lamictal. Fingers crossed!
I had this problem really bad when I was on a dosage of Paxil and still experiencing anxiety. (this was in the early 2000's) I was prescribed the Paxil for depression with anxiety, 20 mg initially but still having the problems with anxiety. The dosage was incrementally increased to 40 mg. I found that I had no desire to do anything. I just didn't see the point. I would stay up all night and not get tired. And I still had anxiety! I was brought down to 20 mg and still had the depression and anxiety but I think I just gave up, figuring nothing was going to help me anyway. I stayed on Paxil for 9 years. Eventually I just stopped takng it. I was a little more depressed but that's it. Oh, and I had pretty bad brain zaps during withdrawal.
Thanks for watching week after week! The antipsychotics are commonly used for bipolar for mood stabilization. They come with their own set of side effects, but on the up side you don't have to deal with the blood levels. You don't with Lamotrigine either - but it may not be enough on it's own. If it is, that's a good thing. It's fairly easy to take. Lithium is still the first choice for bipolar - but it's not easy with the blood levels and long-term side effects. FYI - if you and your doctor look at the antipsychotic options, seroquel-lamotrigine tends to be a good/popular combo and seroquel can be very calming. Just food for thought when looking at options with your doc. Have a good week.
Thanks for taking the time to reply Dr. Marks,
I had brain zaps on Remeron (yuck! heavy sedation!) and Effexor too, even though the doctor assured me it wouldn't happen because it was extended release. I now have a diagnosis of Bipolar II, and take propranolol to ameliorate the tremors from lithium. I'm hoping to switch to Lamotrigine though, as I am worried about the long term effect on my kidneys and also hate the monthly serum level checks necessary with Lithium. So I'll likely stop the propranolol. I do have a prescription for clonazepam, but I don't take it often because I have a healthy fear of benzos. All said, I still have anxiety! I'll check out your video on natural meds, I've tried valerian, skullcap, and prescribed blood pressure meds (am no longer on them, BP is good) and lately have been trying a bit of CBD. (I am not currently on AT-antipsychotics and from my research this should be ok but I don't think my dr. will understand)
I think your videos are great, I look forward to seeing them every week, very easy to understand and informative.
Oh Thorney, I'm sorry about your experience. Also sorry you were on Paxil so long even though you still had anxiety. I'm glad things didn't change much after getting off. I have a video coming up on brain zaps. It's more common with the short acting antidepressants. If you're still having anxiety, I have a video on natural meds for anxiety https://youtu.be/9B7mzzGqIeg Something else to think about is using a medication called propranolol - it's a beta blocker and tends to work better for people with physical anxiety vs worry-type anxiety. That's only if you want to revisit medications - you can ask you doctor about it. Best wishes.
Hi Kimberly - it's variable for the sexual side effects. It's usually a dose dependent effect which means the higher the dose, the greater the effect. So some people may not experience them for weeks while they are are a low dose, then they appear weeks -to months later at a higher dose. But once you start the medication, if it is at a dose where it is going to have the effect for you, then I would say maybe a within a week of starting that dose. Sorry that's not a clear cut answer, but there really isn't one because it doesn't happen the same in everyone.
As for the dulling effect, that tends to come on a few months in (maybe a month at the earliest).
I mentioned Wellbutrin to my doctor and he said it didnt work with most of his patients :( .... Ive changed meds three time this year so I am honestly tired of having to switch back and forth. Doing research now on more natural supplements. It has gotten better, but I am not back to my old self. At least not yet.
For most of my male patients, it tends to be a deal breaker. Wellbutrin is the only one that doesn't have that effect. Sometimes adding it to your antidepressant can help (but not always). Sometimes switching meds even to another serotonin antidepressant can help.
Hi Dr. Tracy I’m experiencing this dulling and not enjoying anything anymore. I’m on Remeron and Abilify and have been for about 8 months now, however my current psychiatrist doesn’t think we should add or change anything but I feel that something needs to change. But my question is how do I fix this “dulling” effect or perhaps overcome it if possible?
Hi Greg. Usually the way we fix it is by decreasing or changing the Serotonin agent (in your case Remeron) or adding Wellbutrin. It might be that your psychiatrist is afraid to rock the boat if you've been on other meds without success. Another thing though is the Abilify. That's a whole other issue. Abilify can cause a similar problem. So depending on how important your Abilify is, your psychiatrist could consider adjusting the Abilify first.
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