What is Anhedonia
In the simplest of terms, anhedonia is the inability to experience pleasure while participating in pleasurable activities. It is a core symptom of a condition known as major depressive disorder (MDD). Many people view anhedonia as only a symptom of major depressive disorder, but don’t realize that it is also a symptom of other mental disorders. Furthermore, some individuals who experience anhedonia do not have a mental disorder at all.
Conditions, aside from depression, in which anhedonia is commonly seen include:
- Personality disorder
- Parkinson’s disease
- Anorexia nervosa
- Substance abuse disorders
Experts define anhedonia as the inability to feel pleasure. Some doctors will describe hedonic capacity as the total amount of pleasure that someone is able to gain from a single activity. For this reason, many specialists find a strong correlation between anhedonia and depression.
Over the past several years, anhedonia has gained a fair amount of necessary attention in the mental health world. This attention primarily comes from the connection between the symptom and its ability to help predict how the individual with depression will respond to treatment. For example, the antidepressants typically prescribed to depressed patients tend to be less effective in patients with major depression and have anhedonia as a symptom.
The term inability is defined as the state of being unable to do something. Simply put, it is a lack of ability.
Pleasure is the happiness feeling one gets from success or enjoyment. Additionally, pleasure can also be a verb in the sense of a desire to satisfy someone else, often used in a sexual context.
Excitement is feeling great enthusiasm, exhilaration, and eagerness.
There are two types of anhedonia that mental health specialists will diagnose: social anhedonia and physical anhedonia. Specialists will observe these two types of anhedonia or order to make a diagnosis of the underlying cause of the symptom. Many times a psychiatrist diagnoses major depressive disorder.
People who experience social anhedonia will commonly have a disinterest in social situations and lack of pleasure in social contact.
Those who endure physical anhedonia will typically have an inability to experience tactile pleasures such as touching, eating, and even sex.
Anhedonic symptoms include the following:
No Motivation To Do Anything
People who experience anhedonia will often describe themselves as not having the desire or motivation to do anything. Studies suggest that there is a missing link between individuals who experience anhedonia and the concept of reward. Because of the fact that they cannot see the reward at the end of the road, they lack to motivation to get there.
Often without conscious input, our brain is constantly making choices regarding risk, reward, payoff, etc. If the brain does not see the reward or payoff, it will not want to move forward with a risk or participating in goal-directed behavior.
Lack of Interest / Withdrawal
Another commonly present symptom of anhedonia is a lack of interest or social and/or physical withdrawal. This can come in the form of social interest wherein individuals with anhedonia will isolate themselves. The lack of interest can also come in form of sexual anhedonia wherein individuals will lack feeling pleasure from sexual encounters, even sex with the person they love or are in a relationship with and once found enjoyment in physically.
Negative Feelings Towards Yourself and Others
As you may be able to tell, all of the symptoms of anhedonia tie into one another to a degree. It is no different with the symptom of negative feelings towards yourself and others.
Lack of Relationships
Again, this can play into both social anhedonia as well as physical anhedonia in that often individuals with anhedonia have difficulties maintaining relationships.
Reduced Emotional Abilities
With that in mind, the lack of or inability to develop relationships is often linked to an incapability to express emotions. Imagine your friend or lover not knowing how you feel about them. It can be challenging for people to understand the individual experiencing anhedonia.
Difficulty or Inability to Adjust Socially
This symptom further explains the social anhedonia that many individuals experience. People with social anhedonia feel that they are unable to adjust appropriately to new surroundings or new individuals.
Loss of Libido
As briefly aforementioned, sexual anhedonia and a loss of or lack of libido is a common symptom of physical anhedonia. Furthermore, sexual anhedonia can often be a symptom of hypoactive sexual desire disorder (HSDD). Hypoactive sexual desire disorder is a clinical disorder that is characterized by a lack or total absence of any desire for sexual interaction.
Studies show that people with anhedonia also tend to have physical health problems such as getting sick often.
These negative symptoms cause the individual experiencing anhedonia to become incredibly isolated and reclusive. While some people may see anhedonia as merely a symptom of major depression, as you can see, anhedonia can severely affect someone’s day to day life when they lack the ability to feel pleasure in activities which others enjoy. People with anhedonia may also experience immense social anxiety thus leading to the desire to want to be alone.
Before we dive into the causes of anhedonia, it may be beneficial to recognize just how important the brain is when it comes to the anhedonia (and all psychiatric disorders).
A section of the brain known as the nucleus accumbens has been called the “pleasure center” for a number of years. However, the nucleus accumbens is not the only section of the brain involved.
When it comes to anhedonia, there are several other parts of the brain that play important roles.
The Prefrontal Cortex
The prefrontal cortex is responsible for planning as well as personal expression. The prefrontal cortex is linked directly to the ventral striatum which has been tied to motivation and reward, and therefore, tied to anhedonia in individuals with depression.
The amygdala is responsible for processing emotions. This part of the brain also has involvement in decision making.
The striatum is the part of the brain that houses the nucleus accumbens. Therefore, the striatum plays an incredibly important role in the reward versus risk arena.
The part of the brain referred to as the insula is considered to have a great deal of importance when it comes to self-awareness.
The Importance of Neurotransmitters & Dopamine
Neurotransmitters in the brain, specifically neurotransmitter imbalances and dopamine, have recently been gaining attention in regards to their connection to anhedonia. Dopamine, in particular, has the attention of researchers due to the fact that it is expressed in large amounts in the nucleus accumbens and its involvement in reward pathways.
Studies now show that a reduced amount of dopamine in the ventral striatum of individuals with depression has a direct correlation with the severity of anhedonia but not the overall symptoms of depression.
Causes of Anhedonia
While anhedonia is a core symptom of major depression, not all depressed people experience anhedonia. There are several causes that can lead to an individual experiencing anhedonia. Some of these causes are based in a depressed mood disorder while others are brought on by differing factors.
Antidepressants and Antipsychotics
Medications, particularly antidepressants and antipsychotics may cause people to experience anhedonia.
Recreational Drug Use
Additionally, recreational drug use can lead to an experience that can often be diagnosed as anhedonia.
Certain synthetic drugs, including Naltrexone, block opiate receptors in the nervous system. Doctors typically use these synthetic drugs in the treatment of heroin addiction.
Additionally, the following is a list of risk factors that studies suggest can lead to an individual developing anhedonia.
- Recent traumatic events
- Recent incredibly stressful and/or anxiety-provoking events
- A history of substance abuse
- A history of neglect
- An eating disorder (such as anorexia or bulimia)
- A major illness (such as Parkinson’s Disease. Many people do not realize that PD patients are at a higher risk of experiencing anhedonia)
Additionally, studies show that females are at a higher risk of developing anhedonia.
Furthermore, a family history of major depression or schizophrenia also shows an increased risk of developing anhedonia.
Anhedonia in Individuals with Schizophrenia
As we previously mentioned, while anhedonia is a common symptom of major depressive disorder, it is also a symptom of other mental disorders including schizophrenia. While depression and schizophrenia are very different mental disorders, they both share several common depressive symptoms, one of which being anhedonia.
Experts agree that anhedonia can be difficult to treat. An individual experiencing anhedonia will have to first have to receive a diagnosis of the underlying cause of the symptom, such as depression.
The first step in seeking treatment is finding a mental health specialist, or psychiatrist, who you trust and who you can develop a rapport with.
Your psychiatrist may prescribe antidepressant or antipsychotic medications as a part of your treatment program. Patients should take these medications exactly how their doctor prescribes them. Additionally, individuals should let their doctor know of any side effects that arise. All medications can affect people differently.
Because anhedonia can be so difficult to treat and the symptoms can be so severe, including suicidal ideation, it is incredibly important to take seeking treatment seriously.
Anhedonia: A Final Thought
It goes without saying that an inability to experience pleasure can greatly disrupt the well-being and day-to-day life of an individual. If you feel that you may be experiencing anhedonia, we recommend contacting your medical health professional right away. Because anhedonia is a symptom of something else, you will likely not be able to treat it alone, nor should you want to. Specialists all over the world help people like you every single day. Trust us, you are not alone.