Anhedonia

Anhedonia is a Greek term that means literally “without pleasure.” It is characterized by the inability to experience pleasure or satisfaction and is a hallmark of depression. It is also associated with some other mental health conditions.

What Is Anhedonia?

Anhedonia is distinct from apathy in that while apathy refers to a lack of motivation or energy investment on many levels, anhedonia is the lack of a specific feeling: pleasure. It can, however, be a sign of apathy. It’s not uncommon for a person to experience apathy and anhedonia simultaneously.

When a person experiences prolonged anhedonia, they may encounter relationship difficulties, particularly if they no longer gain a sense of pleasure when engaging in emotional or physical intimacy. Anhedonia can also make it more difficult to establish a relationship; a person with social anhedonia who does not get a sense of enjoyment from spending time with others, for instance, may have a harder time establishing social connections.

In addition to depression, anhedonia is connected to a variety of mental health issues, including schizophrenia, posttraumatic stress (PTSD), bipolar, anxiety, and certain types of dementia.

Anhedonia Causes

In some cases, lifestyle choices can influence the presence of anhedonia. Problems with procrastination and motivation can contribute to increased anhedonia, although these contributing factors may also have their origins in brain chemistry.

Depression

Anhedonia is most commonly associated with depression, and for many depressed people, anhedonia is their primary symptom. Anhedonia tends to be self-perpetuating. An avid reader, for example, might suddenly find they get no enjoyment from reading. They may then feel despondent because they cannot enjoy previously-enjoyed activities.

While there are several theories about the causes of depression, anhedonia is associated with a problem in the brain’s reward system. Dopamine, a chemical that contributes to feelings of reward or pleasure, may not be present in appropriate quantities in people experiencing this symptom of depression.

Bipolar disorder

Anhedonia in bipolar depression may stem from dysregulation within their reward processing systems. Someone experiencing anhedonia during a depressive episode, for example, might have a difficult time registering the benefits they once enjoyed from particular activity, making the activity they formerly enjoyed less pleasurable.

Schizophrenia

A well-known diagnostic criterion for schizophrenia, anhedonia can be difficult to treat in those diagnosed with schizophrenia. Up to 80% of people with schizophrenia may experience anhedonia. It is classified as a negative symptom, which means it’s indicative of the absence of something that occurs in most healthy individuals (in this case, pleasure). Some researchers posit that because anhedonia is a negative symptom of schizophrenia, it’s more difficult to treat.

Posttraumatic stress (PTSD)

It’s not uncommon for individuals with PTSD to also experience anhedonia. When it occurs as a symptom of PTSD, anhedonia may often impact how a person experiences relationships, sex, and their own emotions. It may also play a role in the emotional numbness that can take place as a coping mechanism when a person goes through trauma. Some research suggests people with anhedonia as a result of PTSD may react less positively overall to events that would have previously caused them to experience positive emotions.

Anxiety

When people with anxiety experience anhedonia, they may also be more likely to develop depression. In cases of anxiety, anhedonia can often manifest as a lack of pleasure in activities that cause anxiety. One study explains that anxiety can lead to depression through anhedonia because individuals may be prone to depression when they become numb to the anxiety-causing activities.

Knowing what’s causing your anhedonia may be the first step in overcoming it. Losing a sense of enjoyment in something that previously brought you joy can be an unsettling experience, but anhedonia does not have to be permanent. With the help of a trained mental health professional, it’s possible to effectively treat anhedonia.

Anhedonia Treatment

A combination of therapy and psychoactive drugs is usually the most effective treatment for both anhedonia and depression. Medications that alter the way the brain processes rewards are especially helpful with anhedonia. Some people also experience an improvement with lifestyle changes. For example, meditation, dietary changes, and better time management may help some people to experience greater satisfaction in their life.

While selective serotonin reuptake inhibitors are the medications of first choice for depression, other medications are also available. Amphetamines such as Dexadrine act on dopamine and are particularly effective in people who have chronic anhedonia as a result of treatment-resistant depression.

Types of Anhedonia

While anhedonia is most often seen as a symptom rather than a mental health condition, there are several commonly discussed subtypes. These indicate anhedonia in a certain area of life instead of anhedonia that affects all facets of an individual’s life.

• Sexual anhedonia: Also known as orgasmic anhedonia, ejaculatory anhedonia, or pleasure dissociative orgasmic dysfunction (PDOD), this type of anhedonia impacts an individual’s ability to experience pleasure during sexual climax. While sexual anhedonia can be caused by mental health issues such as depression, it may also occur due to chemical and hormonal imbalances in the body.
• Social anhedonia: People who have less interest in social interaction because they don’t associate it with pleasure may experience social anhedonia. Perhaps the type of anhedonia most likely to indicate schizophrenia, some experts suggest social anhedonia could be linked to brain abnormalities that make it more difficult to read emotion in facial expressions.
• Musical anhedonia: Some individuals don’t experience a pleasure response when listening to music. Researchers have found there are more than one pathways in the brain that allow music to effect an emotional response, but it’s thought that disconnection between auditory and reward centers in the brain may cause musical anhedonia.

If you no longer experience pleasure when participating in activities you usually enjoy, a mental health professional can help you determine what’s causing your symptoms. Take the first step toward getting your joy back by contacting a trained, empathic therapist in your area.

References:

1. American Psychological Association. APA concise dictionary of psychology. Washington, DC: American Psychological Association, 2009. Print.
2. Anhedonia: What to do when you’ve lost your joy. (n.d.). Depression Alliance. Retrieved from https://www.depressionalliance.org/anhedonia/#Lack_of_Relationships
3. Frewen, P. A., Dozois, D. J., & Lanius, R. A. (2012, January 11). Assessment of anhedonia in psychological trauma: Psychometric and neuroimaging perspectives. European Journal of Psychotraumatology, 3. doi: 10.3402/ejpt.v3i0.8587
4. Germine, L. T., Garrido, L., Bruce, L., & Hooker, C. (2011, October 1). Social anhedonia is associated with neural abnormalities during face emotion processing. NeuroImage, 58(3), 935-945. doi: 10.1016/j.neuroimage.2011.06.059
5. Horan, W. P., Kring, A. M., & Blanchard, J. J. (2006). Anhedonia in schizophrenia: A review of assessment strategies. Schizophrenia Bulletin, 32(2), 259-273. doi: 10.1093/schbul/sbj009
6. Husain, M., & Roiser, J. P. (2018, June 26). Neuroscience of apathy and anhedonia: A transdiagnostic approach. Nature Reviews Neuroscience, 19, 470-484. doi: 10.1038/s41583-018-0029-9
7. Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M. (2010). Abnormal psychology. Hoboken, NJ: John Wiley & Sons.
8. Leentjens, A. F. G., & Starkstein, S. E. (2012). Rating scales in Parkinson’s disease: Clinical practice and research. Oxford University Press. doi: 10.1093/med/9780199783106.003.0373
9. Loui, P., Patterson, S., Sachs, M. E., Leung, Y., Zeng, T., & Przysinda, E. (2017, September 25). White matter correlates of musical anhedonia: Implications for evolution of music. Frontiers in Psychology, 8(1664). doi: 10.3389/fpsyg.2017.01664
10. Rizvi, S. J., Lambert, C., & Kennedy, S. (2018, March 8). Presentation and neurobiology of anhedonia in mood disorders: Commonalities and distinctions. Current Psychiatry Reports, 20(2), 13. doi: 10.1007/s11920-018-0877-z
11. What is orgasmic anhedonia/pleasure dissociative orgasmic dysfunction? (n.d.). International Society for Sexual Medicine. Retrieved from https://www.issm.info/sexual-health-qa/what-is-orgasmic-anhedonia-pleasure-dissociative-orgasmic-dysfunction
12. Winer, E. S., Bryant, J., Bartoszek, G., Rojas, E., Nadorff, M. R., & Kilgore, J. (2017, October 15). Mapping the relationship between anxiety, anhedonia, and depression. Journal of Affective Disorders, 22(1), 289-296. doi: 10.1016/j.jad.2017.06.006

Last Updated: 05-15-2019