Early and effective treatment of depression must be the aim
One of many symptoms experienced by people who suffer from depression is emotional blunting. This is where both positive and negative emotions are dulled so people don’t feel the full range of emotions that those without depression experience in daily life.
This may sound trivial, but the impact can be serious – particularly for close relationships with family or a partner. Imagine not being able to feel the positive effects of being with friends and family, as the rewarding chemicals released by the brain involved in reinforcing this type of interaction are significantly reduced.
Up until now, the difficulty has been discerning if the cause of this emotional blunting is triggered by depression, or the antidepressant medication prescribed to treat the mental health problem. New research has finally shed light on this, concluding that it is long-term use of antidepressants that appears to be the predominant culprit. However, it is likely that rather than medication being the sole cause of emotional blunting, they actually amplify the effect already being produced by clinical depression.
This is critical new intelligence, as those who experience emotional blunting may (understandably) want to come off their medication prematurely so they can experience their full range of emotions. The hazard with this is that the depression is then left untreated, which can (somewhat paradoxically) make symptoms more problematic.
All evidence suggests that combining psychological therapy with medication provides the most effective approach to treatment. Medication plays a key role in treating and recovering from depression. Without medication, this process is extended. There are several types of antidepressant medications available, so it is worth considering changing a prescription if you experience emotional blunting on one type of antidepressant to see if this helps to reduce symptoms (or eliminate them altogether).
Unfortunately, this can take some time, and in the intervening period the overall symptoms can be severe even when people are complying with the prescription they are given. It is a big ask to have an individual take medication for a number of weeks before they feel any benefit.
An obvious way to avoid – or at least reduce – the impact of emotional blunting and other symptoms of depression would be
to detect those likely to experience depression as early as possible. By doing this, we reduce the need for medication, and instead can provide access to psychological therapies that have been shown to be effective in the early stages of depression.
At the moment we wait for symptoms to appear before assessing and offering specialist treatment
Although this type of early intervention makes sense and has the potential to reduce mental suffering, it would require a complete change in our approach to mental health. At the moment we wait for symptoms to appear before assessing an individual and offering specialist treatment. This would have to change, as clinicians and services reorientate to focus on prevention rather than simply providing acute treatment.
This shift in approach would need significant investment and training of staff, as well as communicating how this would work to potential patients. The problem is that we can’t even provide timely and accessible treatment to those who are already experiencing depression, never mind those who might be at risk of developing a problem. There are long waiting times and lists for these services known as IAPT, or Improving Access to Psychological Therapies.
Despite this government’s rhetoric about investing in mental health, the experience of those manning and accessing services suggests little has changed. Years of under-investment in mental health treatment, accompanied by rising demand, has contributed to the current long waiting times to secure treatment – an issue that shows no signs of changing anytime soon. The government has been clear that it intends to reduce the funding of public services by driving “efficiency savings” – essentially code for cuts.
There are no shortcuts to treating mental health. These services need to be resourced and provided in sufficient numbers to enable those who need support to be able to get it, and in a timely way. It makes no economic sense to try to save money today on these services when it means that in the long term they will end up needing treatment that lasts longer than it would have had they been able to access support when it was initially required.
Our politicians view mental health treatment as a “nice to have” optional extra, rather than as a core service. Sadly, we are leaving millions of people without the support they deserve. Despite the government recognising that employment is not just the route out of poverty, but also helps people maintain good mental health, they are failing to invest in treatment that enables people to gain or stay in employment.
None of this makes any sense, and it is those with depression who are on the receiving end of this lack of political will and care.
Ian Hamilton is a senior lecturer in addiction and mental health at the University of York
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