Your Scientific Guide To Anhedonia
By Sarah Fader
Updated December 14, 2018
Reviewer Lauren Guilbeault
The World Health Organization estimated that there are around 300 million people all over the world suffering from depression. If you suffered from depression at some point in your life, you might have experienced this looming feeling of sadness. Despite the pleasurable things around you, you might be wondering, "why is it so difficult to be sincerely joyful?" You are not alone. What you are suffering from is anhedonia.
Anhedonia is a common experience than you may think, especially among people who suffer from depression. People who have this condition lose interest in pursuits that they used to delight in. Their capacity to feel pleasure is lessened. While it is one of the main symptoms of a major depressive disorder and other mental disorders, some experience this condition even if they have perfect mental health.
What Is Anhedonia?
Also called anadonia and anedonia, it is the loss of interest in activities that people used to enjoy before they experienced such symptom. People may experience an overall feeling of pessimism. The term was first described and used by Ribot in 1986. People suffering from anhedonia lose interest not only in their hobbies but also friends, work, and food. Even the loss of interest in sex-also called ejaculatory anhedonia-is common among clinically depressed individuals. The thing is that the pleasure circuit of the brain shuts down or reduces its hedonic capacity. As defined by Paul Meelh, the hedonic capacity of the brain is the ability to experience a positive effect in response to situations that are rewarding. A reduced hedonic ability has a big impact on how one sees life.
Simply put, people who suffer from anhedonia are unable to produce positive feelings like happiness, joy, gratitude, interest, connection, excitement, caring, love, and positive anticipation. Most often, it also causes diminished ability to experience extreme negative emotions. This is the reason why anhedonia is also called "emotional flatlining." So how do you know if you are suffering from it? There are so many ways to tell but one thing is certain, if you are unable to feel happy with things that used to delight you, then you might be suffering from it. But before you make any self-diagnosis, it is crucial that you do due diligence and seek professional help.
But why does it happen? Studies have shown that the brain's pleasure circuits have this uncanny ability to be modified based on the stimuli that it receives. An anhedonic individual's brain circuitry is changed such that it becomes numb to receive impulses that are related to pleasure. But it is important to know that adhedonia may not shut the entire pleasure circuits of the brain as some sufferers may still experience pleasure. It's just that they find it hard to sustain good feelings over time.
There are 2 main types of anhedonia: physical anhedonia and social anhedonia. While the former is the inability to feel pleasure obtained from the senses (tactile) such as touching, eating, or sex; the latter is the loss of interest in social contact and social situation.
But aside from social and physical anhedonia, there are other types of anhedonia that have been identified by psychiatrists and these include sexual anhedonia, musical anhedonia, consummatory anhedonia, motivational anhedonia, and anticipatory anhedonia.
Musical and sexual anhedonia is characterized by being unable to achieve pleasurable feelings related to sex and music; while motivational anhedonia is not having the motivation to do something. Anticipatory anhedonia is defined as not having the ability to feel excited about the future. People can exhibit one or more types of anhedonia. On the other hand, if they experience the loss of interest in just about anything in their lives, they are likely to suffer from complete or total anhedonia.
Oftentimes, an anadonic individual suffers from anhedonia symptoms such as social withdrawal, lack of relationship, persistent physical problems, loss of libido, negative feelings towards self as well as other people, problems in adjusting to most social situations, reduced emotional abilities, reduced verbal expressions, or tendency to show fake emotions.
It is crucial to take note that an anadonic person is not suffering from a disease but rather than a symptom of a primary condition. Thus said, anhedonia is what many psychologists look for when diagnosing mental disorders like depression, schizophrenia, post-traumatic stress disorder and substance abuse.
As mentioned earlier, anhedonia is the main symptom of depression, although more importantly not everyone who is depressed suffers from it. There are so many reasons why an individual may suffer from anhedonia, but everything stems from the brain. When it comes to the regulation of emotions, there are two major players: the ventral and dorsal system. The ventral system of the brain is involved in identifying emotional significance of different types of stimuli as well as the production of affective states (feelings).
The ventral system is comprised of the ventral striatum, amygdala, and the ventral regions of the prefrontal cortex and anterior cingulated gyrus. The dorsal system, on the other hand, includes the hippocampus and the dorsal regions of the prefrontal cortex and anterior cingulated gyrus. This part involves the effortful regulation of the affective states through selective planning and attention.
In a study published in Dialogues in Clinical Neuroscience, hedonic feelings are associated with the activity within the ventral system particularly the nucleus accumbens. This particular part of the brain responds to emotional intensity and relatedness of different stimuli. It receives information from different regions including the emotion centers (amygdala, medial prefrontal cortex, and orbitofrontal cortex) as well as the motor and memory regions.
Studies have shown that the amygdala is the most important structure in extracting the affective importance from different environmental stimuli and habituates to them. This means that every time you experience a hedonic feeling, the amygdala identifies the stimuli and create associations regarding the positive feelings. On the other hand, anadonic people have shown to have significant activities of the anterior insular cortex that is a region of the brain that is less involved in hedonic emotions. It also increases the activity of other regions involved in distressing and negative emotions such as the insula.
The pleasure pathway is very important in maintaining the hedonic capacity of individuals. Other studies suggest that anhedonia is linked to the lower activity of the prefrontal cortex, which is involved in the pleasure pathway. The pleasure pathway is a complex process, but it involves the areas that are associated with reward and motivation such as the nucleus accumbens and the prefrontal cortex.
To make it simpler, the nerve impulse travel in both directions of the brain to maintain both reward and motivation. The "feel good" signal travels back and forth between the prefrontal cortex and the nucleus accumbens for normal brains. Depressed brains, however, have trouble using the prefrontal cortex in sustaining the activities of the nucleus accumbens over time. This is the reason why people are less motivated to do the things that they love.
It is important to take note that anhedonia does not occur in everyone who suffers from depression. However, there are some risk factors involved that dictate if a particular person is likely to suffer from it or not. The risk factors can comprise of physical abuse, substance abuse, traumatic experiences, major illnesses, and eating disorders among the few. However, many experts believe that the risk factors for anhedonia are not clear and complicated. Aside from the ones already mentioned, genetics can play a very important role among people who suffer from this condition.
Anhedonia, if left untreated, can be debilitating not only in your personal life but also in your relationships. It is crucial to seek treatment if you suffer from it. The first stage in treating this condition, you need to seek help from a psychiatrist. They are trained to listen to your problems as well as help you get back on your feet again. They might require you to get anhedonia test to determine if you are indeed suffering from this particular symptom. The psychiatrist can prescribe antipsychotic or antidepressant medications to improve your mental health.
Aside from medication, another way of treating this symptom of depression is ECT or electroconvulsive therapy. With this treatment, doctors will put you under general anesthesia and on the head electrodes are placed where an electric current can flow. The electric current stimulates a brain spasm to change the wiring of the brain. Another method of treating anhedonic symptoms is the TMS or transcranial magnetic stimulation wherein no general anesthesia is used because the current applied is so minimal. Remember, both treatments are used only when other therapies fail to deliver.
Since it is treated as a symptom rather than a disease, some physicians also include personal therapy aside from medication and electroconvulsive therapy. This is to ensure that the patient is also able to handle and manage their life stressors that can trigger the decrease of their hedonic capabilities.
In A Nutshell
The inability to feel pleasure can greatly impact the quality of your life. If you believe that you are suffering from depression and anedonia, make sure that you talk to your doctor so that you can start treatment. There is no standard anhendonia cure, but your doctor will find the best one that is suitable for you. When depression is controlled, anhedonia usually goes away. Feel free sign up for help here.