Anhedonia

What is anhedonia?

Anhedonia describes the inability or reduced ability to feel pleasure. When a person suffers from anhedonia, they lose interest in the activities, hobbies, or experiences they used to love. It has been associated with many mental disorders, including depression, bipolar disorder, schizophrenia, and substance use disorder. People who have physical conditions like chronic pain and Parkinson’s disease may also experience anhedonia.

The U.S. National Library of Medicine states that anhedonia refers to the reduced ability to experience pleasure, and has been studied in different neuropsychiatric disorders. This condition is nevertheless considered as a core feature of major depressive disorder, according to DSM-IV criteria for major depression and the definition of melancholic subtype, and regarding its capacity to predict antidepressant response. [1]

anhedonia
When a person suffers from anhedonia, they lose interest in the activities, hobbies, or experiences they used to love.

Some researchers divide anhedonia into two types: social and physical. Social anhedonia revolves around social situations and causes a decreased interest in social interactions as well as a reduction in pleasure from engaging in social situations. On the other hand, physical anhedonia describes a person’s inability to feel pleasure from physical things that are normally pleasurable, such as eating, touching a loved one, or engaging in sexual interactions.

Causes

It’s unclear exactly what causes anhedonia, but it’s linked to several mental disorders. Anhedonia is considered one of the core features of depression. People with schizophrenia often report both physical and social anhedonia. Research has shown that depression in bipolar disorder is also associated with anhedonia, and doctors use the severity of this condition to determine how severe a case of bipolar disorder is. The use of recreational drugs can potentially lead to anhedonia. Research has shown that anhedonia can also lead to drug addiction. [3]

anhedonia
Anhedonia is considered one of the core features of depression.

Risk Factors

The major risk factors associated with the development of anhedonia include a family history of mental disorders such as schizophrenia or depression. A study found that people with schizophrenia, substance use disorder, Parkinson’s disease, and chronic pain experience moderate levels of anhedonia, but those with depression have more severe anhedonia. [3]

Other conditions that have been associated with this condition include Parkinson’s disease, chronic pain, and diabetes. Those with eating disorders, autism, or neurodegenerative diseases can also experience anhedonia.

Symptoms

The symptoms depend on the type. Symptoms of social anhedonia may include:

  • Very few or no relationships at all
  • Complete withdrawal from existing social relationships
  • A diminished capacity to express emotions
  • Fake emotions in social situations
  • Preference for being alone

When a person suffers from physical anhedonia, they may experience:

  • A complete loss of libido or interest in sexual interactions
  • Frequent illness or other physical health issues

A person with anhedonia may miss out on big life events. By not maintaining their social connections, people with this condition may have strained relationships and even a loss of social connections. Experiencing high levels of stress or traumatic events, including abuse or neglect, is also a risk factor for anhedonia.

Complications

Studies have shown that those who have anhedonia are more likely to be at risk of suicidal ideation, suicide attempts, or death by suicide, especially among those with post-traumatic stress disorder. Research has also shown that this may also be a psychopathological risk factor for dementia-related diseases, such as Alzheimer’s disease. Older adults who have this were five times more likely to develop dementia compared with people who don’t have anhedonia. Anhedonia has also been associated with a heightened risk of adverse cardiac events among patients with heart conditions.

Anhedonia
Those who have anhedonia are more likely to be at risk of suicidal ideation and substance use disorder.

Diagnose

Medical professionals will often use anhedonia as a symptom to diagnose a mental health illness. For example, anhedonia may lead your doctor to look into whether you have depression or bipolar disorder.

Anhedonia can be measured using a questionnaire. One of the most popular ones is the Snaith-Hamilton Pleasure Scale (SHAPS). It consists of 14 statements about enjoyable situations typically encountered in daily life, such as food or drinks and interests or pastimes. You will be asked to rate how strongly you agree or disagree with the statements based on your memories of the past few days. Your doctor may also perform a physical exam and blood tests to ensure your anhedonia is not caused by a physical condition.

Treatments

Anhedonia can be challenging to treat. You’ll need treatment for the mental disorder that’s causing the symptom, such as depression. As the first step in your treatment, you should seek the help of a medical professional. Your primary care provider should be your first choice to rule out a medical cause of your symptoms. If they don’t find any medical issues, your primary care provider may recommend you see a psychiatrist, psychologist, or other mental health professional.

Anhedonia
Your primary care provider can refer you to a therapist. You and your therapist must have a good rapport.

Therapy

Your primary care provider can refer you to a therapist, or you can ask your insurance company to help you find someone. You and your therapist must have a good rapport. You may need to have initial consultations with a couple of mental health professionals before finding one you think will be a good fit.

Medications

Your treatment may include prescription medications such as antidepressants. In some cases, other classes of medications may be recommended. You should take the medication as prescribed and let your doctor know if you have any side effects. They may need to adjust your dosage or medication. These medications affect people in different ways. A medication that works for you may not work for someone else with the same symptoms.

Electroconvulsive therapy (ECT)

Another type of treatment that may be used in some cases is electroconvulsive therapy (ECT). ECT is one of the most effective treatments for depression. Some experts feel that it should be used sooner rather than later — especially with people who have uncomplicated depression. [4] During this treatment, a doctor places electrodes on the head and applies an electric current while the person undergoing the procedure is under general anesthesia. This induces a small brain seizure. ECT is usually only used when other treatments don’t work.

Transcranial magnetic stimulation (TMS)

Transcranial magnetic stimulation (TMS) uses a magnetic field to stimulate nerve cells. It uses a smaller electric current than ECT and doesn’t require general anesthesia. TMS can treat major depression in people who have depression that isn’t responding to medication.

Vagus nerve stimulation (VNS)

A final treatment option is vagus nerve stimulation (VNS). Your doctor will implant a medical device similar to a pacemaker in your chest. The wires of this device create regular electrical impulses that stimulate your brain. As with ECT and TMS, VNS can treat depression in people who have depression that hasn’t responded to other treatments.

Reclaim your life from Anhedonia

Anhedonia refers to the reduced ability to experience pleasure and it has been associated with many mental disorders, including depression, bipolar disorder, schizophrenia, and substance use disorder. This should not be taken lightly. We Level Up CA Treatment Center can provide you, or someone you love, the tools to treat mental health disorders or any substance use disorder with professional and safe care. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.

Sources

[1] Gorwood P. (2008). Neurobiological mechanisms of anhedonia. Dialogues in clinical neuroscience, 10(3), 291–299. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181880/

[2] Dimick MK, Hird MA, Fiksenbaum LM, Mitchell RHB, Goldstein BI. Severe anhedonia among adolescents with bipolar disorder is common and associated with increased psychiatric symptom burden. J Psychiatr Res. 2021 Feb;134:200-207. doi:10.1016/j.jpsychires.2020.12.031

[3] Trøstheim M, Eikemo M, Meir R, Hansen I, Paul E, Kroll SL, Garland EL, Leknes S. Assessment of Anhedonia in Adults With and Without Mental Illness: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Aug 3;3(8):e2013233. doi:10.1001/jamanetworkopen.2020.13233

[4] Ross EL, Zivin K, Maixner DF. Cost-effectiveness of Electroconvulsive Therapy vs Pharmacotherapy/Psychotherapy for Treatment-Resistant Depression in the United States. JAMA Psychiatry. 2018 Jul 1;75(7):713-722. doi: 10.1001/jamapsychiatry.2018.0768. PMID: 29800956; PMCID: PMC6145669. (pubmed.ncbi.nlm.nih.gov)