Your Scientific Guide To Anhedonia
By: Jon Jaehnig
Updated December 24, 2020
Medically Reviewed By: Lauren Guilbeault
Anhedonia may sound like a complex word, but it's easy to explain. People with anhedonia are unable to feel pleasure or happiness. It's one of the major symptoms of depression, even if it sometimes manifests without depression's other tell-tale symptoms or causes.
The scientific community isn't entirely sure what causes anhedonia. Like depression, it's probably a complex combination of factors. Whether or not it accompanies depression, treatment is usually the same – medication, therapy, or a combination of the two. In addition to these formal treatments, there are informal treatments or lifestyle changes that may help as well.
If you are dealing with anhedonia or depression, you might experience a looming feeling of sadness. Despite the pleasurable things around you, you might wonder why it's so difficult to be sincerely joyful. Know that you're not alone. The World Health Organization estimates that there are around 300 million people all over the world who have depression. The good news is that most people can find relief with some basic treatments and the help of health and wellness experts.
What Is Anhedonia?
Also called anadonia and anedonia, anhedonia is defined as the loss of interest in activities that people used to enjoy, resulting in an overall feeling of pessimism. The term was first described and used by Ribot in 1986. He found that people with anhedonia lose interest not only in their hobbies but also in friends, work, and food. Even losing interest in sex, also called ejaculatory anhedonia, is common among individuals who are clinically depressed.
Anhedonia occurs when the pleasure circuit of the brain shuts down or reduces its capacity. As defined by Paul Meelh, the hedonic capacity of the brain is the ability to experience a positive effect in response to rewarding situations. Unsurprisingly, a reduced hedonic ability has a big impact on how one sees life.
Studies have shown that the brain's pleasure circuits have an uncanny ability to be modified based on the stimuli they receive. It seems that the brain circuitry of the individual who has anhedonia changes so that it becomes numb and unable to receive impulses related to pleasure. However, it's important to know that anhedonia may not shut down all of the brain's pleasure circuits because some people with depression still experience pleasure. They simply find it hard to sustain these good feelings over time.
That said, people who with anhedonia are generally unable to produce positive feelings like happiness, joy, gratitude, interest, connection, excitement, love, and positive anticipation. Often, it also causes diminished ability to experience extreme negative emotions. This is why anhedonia is also called "emotional flatlining."
If this sounds familiar to you, how do you know if you have it? There are many ways to tell, but if you're unable to feel happy about things that used to delight you, then you might be experiencing anhedonia. Before you self-diagnose, however, it's crucial that you seek professional help. We'll talk more about this important step toward the end of the article. For now, read on to learn about other key signs and symptoms.
There are two main types of anhedonia: physical anhedonia and social anhedonia. While the former describes the inability to feel pleasure from the senses, such as touching, eating, or sex, the latter describes the loss of interest in social contact and social situations. In addition, psychiatrists have identified other types of anhedonia, including 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 occurs when an individual lacks the motivation to do something. As you might guess, anticipatory anhedonia is defined as not having the ability to feel excited about the future. It's possible to exhibit multiple types of anhedonia at once. But if someone experiences a loss of interest in just about everything, they're likely to have complete or total anhedonia.
Oftentimes, an individual with anhedonia symptoms may exhibit any of the following: social withdrawal, lack of relationships, persistent physical problems, loss of libido, negative feelings toward self as well as others, problems adjusting to most social situations, reduced emotional abilities, reduced verbal expressions, or a tendency to show fake emotions.
It's crucial to take note that the individualwith anhedonia has a disease, but rather a symptom of a primary condition. For this reason, anhedonia is what many psychologists look for when diagnosing mental disorders like depression, schizophrenia, post-traumatic stress disorder, and substance use disorder.
As previously mentioned, anhedonia is the main symptom of depression, but not everyone who is depressed experiences anhedonia and not everyone who has it is otherwise depressed. There are many reasons why an individual may have anhedonia, and they all stem from the brain.
When it comes to regulating emotions, there are two major players: the ventral and dorsal system. The ventral system of the brain is involved in identifying the emotional significance of different types of stimuli along with the production of affective states (feelings). The ventral system is shaded green below and includes the amygdala and the ventral regions of the prefrontal cortex.
The dorsal system, on the other hand, includes the hippocampus and the dorsal regions of the prefrontal cortex. It regulates affective states through selective planning and attention. The dorsal system is shaded purple below.
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 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) and the motor and memory regions.
Studies have shown that the amygdala is the most important structure involved in extracting the affective importance from different environmental stimuli and habituating to them. This means that every time you experience a hedonic feeling, the amygdala identifies the stimuli and creates associations for these positive feelings.
Unlike most people, people with anhedonia exhibit significant activity in the anterior insular cortex, a region of the brain that is less involved in hedonic emotions. Anhedonia also increases the activity of other regions (like the insula) that are involved in distressing and negative emotions.
When it comes to maintaining hedonic capacity, a part of the brain called "the pleasure pathway" is important. 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.
Simply put, nerve impulses travel in both directions along the pleasure pathway to maintain reward and motivation. In healthy brains, the "feel good" signal travels back and forth between the prefrontal cortex and the nucleus accumbens. Depressed brains, however, have trouble using the prefrontal cortex to sustain the activities of the nucleus accumbens over time. This is why people who are depressed are less motivated to do the things they love.
Based on the role of the brain, it's clear that genetics can play an important role in determining whether or not someone is likely to have anhedonia. Other risk factors include physical abuse, substance use disorder, traumatic experiences, major illnesses, and eating disorders.
If left untreated, anhedonia can be debilitating, not only in your personal life but also in your relationships. It's crucial to seek treatment if you have it. First, seek help from a medical expert. You may want to start with your primary care provider, who can write you a referral to a specialist if necessary. Usually, you need to have symptoms for at least two weeks before you can begin treatment, but if you contact your doctor after only a few days, it can help to establish when the problem started. It's always wise to get help as soon as possible.
In the meantime, there are a couple of things you can try at home. Anhedonia is similar to burnout, a condition that arises when we work too hard. If you're experiencing anhedonia, try to take some time off of work or school if you can. You may also want to do things that you usually enjoy and see if that makes you feel better.
Ultimately, medication and/or therapy will probably be an important part of your treatment plan.Please consult withyour doctor or primary care physician before considering any medication options.
If you tried both therapy and medication and neither worked for you, another way of treating this symptom of depression is ECT or electroconvulsive therapy. With this treatment, doctors will put you under general anesthesia and place electrodes on your head, so an electric current can flow. Then, the electric current stimulates a brain spasm to change the wiring of the brain. TMS or transcranial magnetic stimulation is a similar process, but no general anesthesia is used because the current applied is so minimal. Both treatments are an option but remember that they're generally used only when all other therapies have failed.
Note that ECT is controversial and has been for decades. If you’re considering this treatment option, educate yourself about the treatment and discuss it with your therapist or doctor or both. Ultimately, the decision to have this treatment is up to you and you only. Although not receiving the same attention, TMS is also controversial. Do your due diligence when it comes to these treatments.
You don't need a referral or a diagnosis to start talking to an in-person or online therapist or a counselor, though you may need one depending on your insurance plan. Ultimately, you'll want to find someone who makes you feel comfortable, so you can work through your anhedonia and find ways to feel pleasure again. In addition to seeing a mental health professional, you may also need to consult a psychiatrist who can prescribe antipsychotic or antidepressant medications to improve your mental health.
If you’re experiencing a lack of motivation to travel to a therapist’s office, consider using online therapy where you can meet with a therapist in your own home. Evidence has shown that online therapy is as effective as face-to-face therapy. A literature review of sixty-five articles found that client satisfaction was positive and clinical outcomes were comparable to traditional therapy for a diverse population receiving different therapeutic treatments. Online therapy could be the right choice for you as you deal with anhedonia issues in your life.
How BetterHelp Can Support You
BetterHelpcan connect you with online therapists and counselors who you can meet via the internet. This affordable, convenient approach may be a great option for you, so you can address your anhedonia and its effect on your life and your relationships. For more information, read the reviews below.
"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."
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The inability to feel pleasure can greatly impact the quality of your life. If you believe you're experiencing depression and anhedonia, talk to your doctor. There is no standard anhedonia cure, but your doctor can help you create a treatment plan that works for you. A truly fulfilling life is possible – all you need are the right tools. Take the first step today.
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