"Emotional Blunting" 

One of the mechanisms put forward for how antidepressants work to treat depression and anxiety is the phenomenon of "emotional blunting", the inability to experience emotions fully, both "negative" and "positive".

Instead of healing or curing depression it seems that, for the percentage of people who actually experience significant relief by taking antidepressants, they work by turning down the strength of emotional signals in the brain.

Take this 2023 quote from researchers at the University of Cambridge...

Professor Barbara Sahakian, senior author, from the Department of Psychiatry at the University of Cambridge and a Fellow at Clare Hall, said: “Emotional blunting is a common side effect of SSRI antidepressants. In a way, this may be in part how they work – they take away some of the emotional pain that people who experience depression feel, but, unfortunately, it seems that they also take away some of the enjoyment. From our study, we can now see that this is because they become less sensitive to rewards, which provide important feedback.” (my emphasis in bold)

This agrees with anecdotal reports I've read, and today I discovered a new piece to the jigsaw puzzle. Some antidepressants are given for pain relief. 

Suddenly, I made the connection to someone suffering from depression being in emotional pain, and the fact that there's overlap between the physical and emotional pain "circuits" in the brain. 

Meta-analytic maps of brain activations (Figures 1A and 1B ), as well as within-subject studies that incorporate experimental manipulations of both pain and emotion paired with multivariate analytic approaches (Corradi-Dell’Acqua et al., 2016, Krishnan et al., 2016), identify both functionally dissociable, as well as shared neural, coding within brain regions, such as the insula and cingulate cortices. This highlights the need to study pain and emotions together, especially their bi-directional influence, and how and which peripheral and central circuits mediate their experience. (Neuron, my emphasis in bold)

Could it be that this "blunting" effect applies to both physical and emotional pain, and that's how these antidepressants work?

Here's what one person on Reddit said (my emphasis in bold):

"60mg a day and it's been wonderful for post-cancer treatment pain. I think most people expect too much from it as a pain medicine because they don't understand how it works. Cymbalta doesn't 'stop' the pain, it allows you to deal with it in a much more constructive way. I still get a lot of pain with my cancer area but now I can elect to just ignore it and it doesn't dominate my thinking. I think a lot of people will focus through the medicine and still pay way more attention to the pain than it requires and it just disallows Cymbalta to do much of anything."

Neuropathic Pain vs Non-Neuropathic Pain

When you have a headache and take a "painkiller", you're taking an analgesic to deal with pain originating in nerves. Nerve pain is a shooting, stabbing or burning sensation resulting from nerve damage.

Non-neuropathic pain, by contrast, doesn't originate with nerve damage. Instead it's the dull ache of fibromyalgia or chronic pain.

The antidepressant isn't functioning as an analgesic and stopping the pain, it's providing distance from the pain, much as you'd expect "emotional blunting" to work for depression.

The problem with this mechanism of action in depression is that emotional blunting doesn't address the core drivers of depression. It's masking the depression. The depressed person actually needs the exact opposite. They need to listen to their emotional pain and not try to escape it. That's the realm of self-work and therapy, not drugs.

Also, the person taking the drugs, without any further help, needs them for life, because as soon as they stop taking them, they'll relapse, assuming all other conditions in their life remain the same.

Indeed, all it probably needs is an additional stress in their life and they'll either relapse or need a stronger dose of the antidepressant. The person isn't learning the life skills necessary to cope with their own psychological and emotional response to stress.

Also, how is someone supposed to escape the clutches of depression and get more in tune with their feelings and emotions, when they're taking medication which blunts those emotions and feelings? If anything, antidepressants make any therapy work focused on feelings more difficult.