Anhedonia
For some people, pleasure can seem elusive. They may not experience it when listening to music, spending time with loved ones, or eating delicious food. Things that may have once brought them pleasure just don’t have the same effect anymore. This is a condition called anhedonia (also sometimes called anadonia and anedonia), and it’s one of the core symptoms of major depressive disorder. However, anhedonia can also be caused by other conditions.
Below, we’ll look at anhedonia and its causes, manifestations, and potential treatments.
What is anhedonia?
Anhedonia may occur when the brain's pleasure circuit (e.g., ventral tegmental area, nucleus accumbens, and prefrontal cortex) shuts down or reduces its capacity. In the context of psychology, the term was first coined by French psychologist Theodule Ribot as “l’anhédonie” in 1896. He found that people with social anhedonia can lose interest not only in their hobbies but also in friends, work, and food. They may also experience chronic pain and have difficulty experiencing positive emotions of any kind.
Research suggests that the brain's pleasure circuits may have the ability to be modified based on the stimuli they receive. The brain circuitry of individuals with anhedonia may change so that it becomes unable to receive impulses related to pleasure. However, anhedonia may not shut down all the brain's pleasure circuits. Some people with depression still experience pleasure; they may simply find it difficult to sustain good feelings over time.
People who have anhedonia may experience difficulty producing positive feelings like happiness, joy, gratitude, interest, connection, excitement, love, and positive anticipation, and social anhedonia can cause a disruption to social life as a result of little desire to engage in social activities.
Anhedonia may also cause a diminished ability to experience extremely negative emotions. For this reason, anhedonia is also sometimes called "emotional flatlining."
Types of anhedonia
There are several types of anhedonia, and it’s possible to exhibit multiple types of anhedonia at once. It’s also possible to experience total anhedonia or a loss of interest in everything. The most common types of anhedonia include:
- Physical: the inability to experience pleasure from the senses
- Social: the loss of interest in social contact and situations
- Sexual: the inability to derive pleasure from sex
- Musical: the inability to enjoy music
- Motivational: the loss of motivation to do something
- Anticipatory: the inability to feel excited about the future
What are the symptoms of anhedonia?
The symptoms of anhedonia may vary depending on the type of anhedonia an individual experiences. For instance, people with social anhedonia may experience feelings of social isolation and negative feelings toward others. People with anticipatory anhedonia may feel a lack of motivation and fatigue.
Common anhedonia symptoms include:
- Social withdrawal and isolation
- Problems with personal relationships
- Physical health problems and fatigue
- Negative feelings toward self and others
- Lack of pleasure in things that were formerly enjoyable
- Irritability and defiance
- Lack of motivation
- Reduced ability to express emotion
- Trouble communicating verbally
- A tendency to show false emotions
Anhedonia isn’t necessarily a disease but rather a symptom of another primary condition. For this reason, psychologists may look for symptoms of anhedonia when diagnosing mental health disorders like depression, schizophrenia spectrum disorders, post-traumatic stress disorder, and substance use disorder.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
Causes of anhedonia
The causes of anhedonia are unclear, but it is largely associated with physiological brain function. Based on the role of the brain, genetics may affect whether someone is likely to experience anhedonia. Other risk factors may include early trauma, brain injury, substance use disorder, major illnesses or diseases that affect brain functioning, eating disorders, and more.
Treatment for anhedonia
Regardless of whether anhedonia accompanies another mental illness, treatment is usually the same: a combination of medication and psychotherapy. In addition to these formal treatments, there are informal treatments or lifestyle changes that may help as well, such as a healthy regimen of self-care and time off work or school if possible (anhedonia and depression may be associated with burnout).
In extreme cases, a doctor may prescribe electroconvulsive therapy (ECT) for treating anhedonia. With this treatment, doctors administer general anesthesia and place electrodes on the scalp to initiate an electric current. The current then stimulates a brain spasm to change the wiring of the brain.
Transcranial magnetic stimulation (TMS) is a similar process, but no general anesthesia is required because the current applied is minimal. TMS and ECT can be controversial, and both treatments are generally used only when other therapies have failed.
When left unaddressed, anhedonia can have a significant impact, negatively affecting a person’s relationships, work life, and mental health. Since anhedonia is often cited as a symptom of a primary mental illness, it may help to seek treatment from a doctor. When anhedonia presents as a symptom, doctors typically conduct a physical assessment to determine if there is a physical cause, such as a thyroid problem or a vitamin deficiency. If they don’t find a physical cause, they may refer you to a psychologist, psychiatrist, or other mental health professional to study your symptoms of anhedonia in the context of your overall mental health. You might be prescribed both medication, such as a selective serotonin reuptake inhibitor, and talk therapy as part of your treatment plan.
However, not everyone feels comfortable visiting a therapist in person. Some may have limitations on their schedules that make it difficult to speak with a therapist during normal office hours, while others may not feel comfortable interacting with a therapist in person, especially if they are experiencing depression.
In cases like these, online therapy can be a convenient alternative to in-person therapy. Evidence suggests that virtual therapy is as effective as in-office therapy for treating conditions that can include anhedonia as a symptom, such as depression. A systematic review of 65 publications found that client satisfaction with online therapy was positive and clinical outcomes were comparable to those of traditional therapy for a diverse population receiving different therapeutic treatments.
With an online therapy platform like BetterHelp, you can connect with a therapist via phone or videoconferencing from the comfort of your own home or anywhere with an internet connection. You can also contact your therapist at any time via in-app messaging, and they’ll respond as soon as they can. This may prove to be helpful if you experience anhedonia or symptoms of major depressive disorder in between sessions.
Below are some reviews of BetterHelp therapists who have helped people with similar challenges:
Counselor reviews
"Tamera is straightforward and supportive. She's not afraid of pointing out what to work on and give you the right tools immediately. It is highly personalized just for your unique symptoms and situation! Tamera helped me manage my depression and anxiety and I became more empowered to have more control in my life. I feel a lot happier."
"Evie has helped me get back on my feet! She is so sweet and understanding, she loves getting to see my dog who joins me on the couch for our video sessions, and she has offered me so many ideas on how to be happier in my day-to-day life. I love that I have someone who helps me set goals and holds me accountable. She also is caring, kind, and understanding when I don't meet those goals and helps me figure out why."
Takeaway
Frequently asked questions on anhedonia
Does anhedonia go away?
Anhedonia is a mental health condition, and like other mental health issues such as depressive disorder (or major depressive disorder), it can be treated. Recommended treatment involves seeing a mental health professional, such as a therapist or psychiatrist. They may recommend prescription medication as well as talk therapy and other possible therapeutic methods.
What is anhedonic behavior?
Anhedonic behavior can vary widely. In general, anhedonia may mimic symptoms of depression. There’s sexual anhedonia, physical anhedonia, social anhedonia, and others. In any case, anhedonia involves an inability to feel pleasure. This is often a symptom of major depressive disorder, in which people may no longer feel pleasure when engaging in activities they used to enjoy. Anhedonic behavior may seem asocial or anti-social, considering that the person cannot experience pleasure and may not have normally functioning reward processes in their brain physiology.
How do you fight anhedonia?
Anhedonia involves disruption to a normally functioning reward system. This may be considered a form of mental illness, so as with any other mental health concern, it may be best to seek medical advice or speak with a licensed therapist.
Anhedonia may be treated like a variety of mental illnesses. It may be treated as simply a symptom of another mental health disorder, whether that’s a mood disorder like depression or bipolar disorder, schizophrenia spectrum disorder, or others. If there is only mild social anhedonia, talk therapy may suffice to stimulate the experience of positive stimuli again. If there is full-blown physical anhedonia, then different treatments may be used.
When it comes to medication, selective serotonin reuptake inhibitors (SSRIs) may be used. Selective serotonin reuptake inhibitors are commonly used to treat depression; therefore, they may be effective for anhedonia. In any case, consult with a doctor if you are having trouble experiencing rewarding stimuli.
Why do I have no feelings for anything?
According to the Diagnostic and Statistical Manual of Mental Disorders, depression may be a cause of anhedonia, which is the reduction (or near total lack) of the capacity for pleasure. The inability to experience feelings of any kind is common to many mental illnesses. If you have no feelings for anything, it’s vital to speak to your doctor, as untreated anhedonia can lead to more serious symptoms.
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