Most of us have certain interests and hobbies that we enjoy, whether it is playing the guitar, reading a book, or hiking a trail. We are motivated to engage in these activities, as they make us feel good and bring us pleasure and happiness. Even when we are having a bad day, planting flowers in the garden, shooting some hoops, or watching a movie can make us feel better. Being with friends, tasting cuisine, and physical intimacy can also derive pleasure. But, what happens when we lose the motivation to participate in these activities? What happens when these activities no longer bring us pleasure or joy?
Anhedonia is characterized by reduced motivation to engage in pleasurable activities and a loss of interest in activities that were once enjoyable. Anhedonia is the diminished capacity to feel pleasure and is always indicative of another underlying condition or disorder. Anhedonia stems from the Greek suffix “an”, meaning without and “hedone”, meaning pleasure. The concept of pleasure and the absence of pleasure were originally studied by Greek philosophers and was later classified as a symptom of psychopathology in the early 1800’s.
Anhedonia is believed to be caused by an impairment of reward mechanisms in the brain, which can impact a person’s level of drive, expectation, and reward. The nucleus accumbens, part of the basal ganglia of the brain, is referred to as the “pleasure center.” Research shows that the nucleus accumbens may be linked with anhedonia. Chemical imbalances in the brain have also been studied to determine possible causation. Research has focused on the neurotransmitter dopamine, which is directly involved in reward pathways.
Anhedonia can make personal relationships extremely challenging. It is difficult for an individual to get motivated to spend time with friends or family members, especially when they fail to perceive potential for enjoyment. People with anhedonia cannot identify positive benefits from engagement in an activity. Some social scientists postulate that anhedonia can either present as a complete lack of pleasure, or can represent a blunting or dulling of positive emotions. Anhedonia can be sub-divided into social and physical types. Social anhedonia is characterized by apathy pertaining to social interaction and socialization opportunities, while physical anhedonia is typified by an incapability to feel physical pleasure and sensation.
Social anhedonia is portrayed by a withdrawal from social pursuits and a lack of interest in others. Social anhedonia can be linked to both depression and schizophrenia. Indications of social anhedonia can include isolative behaviors, withdrawal from social interactions and previous social relationships, trouble adapting and adjusting to social situations, and a reduced need for social engagement. Individuals with social anhedonia may have heightened sensitivity to stress and can become vulnerable and easily overwhelmed.
Social anhedonia differs from an introverted personality type, as an introverted person focuses on inner feelings, while social anhedonia refers to an inability to feel pleasure. Social anhedonia and social anxiety are also related and often co-occurring conditions. Individuals with social anhedonia may develop a heightened level of anxiety in social situations and be at risk for other social phobias.
Physical anhedonia can be described as a lack of interest in physical contact, such as hand holding, hugging, eating, or engaging in sexual intercourse. People with physical anhedonia may have a reduced sex drive and can have ejaculatory anhedonia. Ejaculatory anhedonia is a condition in males where ejaculation occurs without a sensation of pleasure. Although more common in males, women can also experience an absence of pleasurable sensation during orgasm.
Other symptoms of anhedonia can include low self-esteem and self-criticism, reduced verbal and non-verbal communication, artificial emotions, and depressed mood and affect. Anhedonia can be a symptom of underlying mood disorders, psychotic conditions, recreational drug use, or pervasive personality disorders. Anhedonia can also exist independently without being linked to a specific mental health condition.
Anhedonia is a hallmark symptom of major depressive disorder and occurs in the majority of people diagnosed with depressive disorders. However, anhedonia does not always present in individuals with depression and can present either independently, or in other mood disorders, such as bipolar disorder. Some studies have shown that anhedonia in depression can be a potential predictor of suicide. Other studies have shown that depression combined with anhedonia may be less responsive to commonly prescribed antidepressants.
Anhedonia is classified under the negative symptom category of schizophrenia and is an important feature of schizotypy, a range of personality traits that contributes to psychosis and schizophrenia risk. Social anhedonia is not portrayed in all individuals with a schizophrenia diagnosis. In addition, people with social anhedonia may never be diagnosed with schizophrenia, although it can be a potential predictor of a future schizophrenia spectrum diagnosis.
Anhedonia can occur in individuals with substance abuse issues or in recreational drug users. Anhedonia can result from alcohol, opiod, and nicotine use and can be an important forecaster of relapse. Anhedonia can also present in individuals who have health issues such as Parkinson ’s disease, diabetes, or heart disease or in people with other mental health conditions such as anorexia nervosa.
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At present time, there are no specific treatments for anhedonia. Treating anhedonia can be challenging, as anhedonia is always the result of an underlying condition or disorder. Thus, a practitioner must first determine what an individual’s underlying issue is and then treat it in order to address symptoms of anhedonia. Anhedonia is usually treated with psychotherapy, psychotropic medications, or a combination of both.
Antidepressant medications, such as SSRI’s can improve symptoms of depression including anhedonia. However, certain psychotropic medications that treat depression have also been shown to cause or worsen anhedonia by dulling a person’s emotions. Some depression treatments may have a negative impact on anhedonia since serotonin prevents the release of dopamine in several areas of the brain. This blockage may interfere with reward mechanism pathways, worsening anhedonia symptoms.
Ongoing research seeks to fully understand anhedonia and to formulate an effective treatment for the condition. Research has recently been conducted with anesthetic ketamine, which has been shown to successfully reduce symptoms in individuals with major depressive disorder and bipolar disorder.