Anhedonia

Older man sitting alone on park benchAnhedonia 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

  • 7 comments
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  • Pete

    Pete

    April 29th, 2018 at 12:20 AM

    I am pretty sure that any responsible doctor will not script dexadrine. Where I live psych doctors will script bupropion or effexor. When they dont work they say deal with it. I am not kidding.

  • melissa

    melissa

    March 4th, 2021 at 11:38 AM

    Please send notifications of new blog entries.

  • LaurenGT

    LaurenGT

    March 4th, 2021 at 2:11 PM

    Hi Melissa!

    We’re glad you’re enjoying our blog! We don’t have an email notification system for new articles, but we usually post 3-4 per week. Feel free to bookmark our blog homepage (https://www.goodtherapy.org/blog/) and come back often to see what we’ve added!

  • Me

    Me

    March 12th, 2021 at 9:20 AM

    Yah I’m pretty sure my amphetamine abuse caused anhedonia so I’m not about to try and con a doctor for more and make it worse.

  • Art jefferson

    Art jefferson

    May 22nd, 2021 at 6:39 AM

    A novel procedure to reduce anhedonia, quickly refutable with a good swift kick

    Summary
    Endogenous opioids are induced when we eat, drink, have sex, and relax. Opioid activity however is not static, but labile, or changeable. Opioid release is always modulated by concurrently perceived novel act-outcome expectancies which may be negative or positive. If they are negative (e.g. a spate of bad news or bad implications of our behavior), opioid activity is suppressed and our pleasures are reduced (anhedonia), but if they are positive, then opioid activity is enhanced and our pleasures are accentuated as well (peak experience, ‘flow’). This is due to dopamine-opioid interactions, or the fact that act-outcome discrepancy, or positive or negative surprises, induce dopaminergic activity, which in turn can suppress or enhance opioid release. This can be demonstrated procedurally, and if correct, can provide a therapeutic tool to eliminate anhedonia and increase positive wellbeing.

    Explanation and Procedure
    The ideal for any scientist with a great idea is to be able to explain it in a minute, and to confirm or falsify it as quickly. The world record for this arguably goes to the English philosopher Samuel Johnson, who rejected Archbishop Berkeley’s argument that material things only exist in one’s mind by striking his foot against a large stone while proclaiming, “I refute it thusly!”

    Here is a similarly novel and useful idea that can be confirmed or refuted with a proverbial swift kick, and can also be easily explained through affective neuroscience (links below).

    Basic Facts
    Endogenous opioids are induced when we eat, drink, have sex, and relax. Their affective correlate, or how it ‘feels’, is a sense of pleasure.

    Fun Fact
    When we are concurrently perceiving some activity that has a variable and unexpected rate of reward while consuming something pleasurable, opioid activity increases and with it a higher sense of pleasure. In other words, popcorn tastes better when we are watching an exciting movie than when we are watching paint dry. The same effect occurs when we are performing highly variable or meaningful activity (creating art, doing good deeds, doing productive work) while in a pleasurable relaxed state. (Meaning would be defined as behavior that has branching novel positive implications). This is commonly referred to as ‘flow’ or ‘peak’ experience.

    So why does this occur?
    Dopamine-Opioid interactions: or the fact that dopamine activity (elicited by positive novel events, and responsible for a state of arousal, but not pleasure) interacts with our pleasures (as reflected by mid brain opioid systems), and can actually stimulate opioid release, which is reflected in self-reports of greater pleasure.

    Proof (or kicking the stone)
    Just get relaxed using a relaxation protocol such as progressive muscle relaxation, eyes closed rest, or mindfulness, and then follow it by exclusively attending to or performing meaningful activity, and avoiding all meaningless activity or ‘distraction’. Keep it up and you will not only stay relaxed, but continue so with a greater sense of wellbeing or pleasure. In addition, the attribution of affective value to meaningful behavior makes the latter seem ‘autotelic’, or reinforcing in itself, and the resultant persistent attention to meaning crowds out the occasions we might have spent dwelling on other unmeaningful worries and concerns.

    A Likely Explanation, as if you need one!
    A more formal explanation from a neurologically based learning theory of this technique is provided on pp. 44-51 in a little open-source book on the psychology of rest linked below. (The flow experience discussed on pp. 81-86.) The book is based on the work of the distinguished affective neuroscientist Kent Berridge, who was kind to review for accuracy and endorse the work.

    Implications for psychotherapy from the neuroscience of incentives
    Affect in rest is labile, or changeable, and rest is not an inert and non-affective state, but modulates affective systems in the brain. In addition, the degree of the modulation of pleasurable affect induced by rest is ‘schedule dependent’, and correlates with the variability of schedules or contingencies of reward and the discriminative aspects of incentives (i.e. their cognitive implications). In other words, sustained meaningful activity or the anticipation of acting meaningfully during resting states increases the affective ‘tone’ or value of that behavior, thus making productive work ‘autotelic’, or rewarding in itself. This provides an entirely complementary procedure for all psychotherapeutic perspectives that although derived from affective neuroscience does not demand a departure from any research or philosophical commitment.

    References:

    Rauwolf, P., et al. (2021) Reward uncertainty – as a ‘psychological salt’- can alter the sensory experience and consumption of high-value rewards in young healthy adults. Journal of Experimental Psychology: General (prepub)
    doi.apa.org/doiLanding?doi=10.1037%2Fxge0001029

    The Psychology of Rest
    scribd.com/doc/284056765/The-Book-of-Rest-The-Odd-Psychology-of-Doing-Nothing

    The Psychology of Incentive Motivation and Affect
    scribd.com/document/495438436/A-Mouse-s-Tale-a-practical-explanation-and-handbook-of-motivation-from-the-perspective-of-a-humble-creature

    The Psychology of Rest, from International Journal of Stress Management, by this author
    scribd.com/doc/121345732/Relaxation-and-Muscular-Tension-A-bio-behavioristic-explanation

    Berridge Lab, University of Michigan sites.lsa.umich.edu/berridge-lab/

    History and Development of Motivation Theory – Berridge
    lsa.umich.edu/psych/research&labs/berridge/publications/Berridge2001Rewardlearningchapter.pdf

  • Ann

    Ann

    July 28th, 2021 at 6:25 PM

    I’m sure there is good information in your comment but it is way to complexly written for a “sick” brain to comprehend.

  • Art

    Art

    July 29th, 2021 at 8:05 AM

    I understand. And that is why I have included references. ‘The Psychology of Rest’ is non technical explanation of how affect is generated in the brain and can be understood by any layperson. Explanations unfortunately have to have some detail, just pick up any diet book and you get a lot of that However, it is procedure that counts, and here I would assume that the procedure I have outlined is simple enough to understand, just like the procedure for a low carb diet is set apart from a complex explanation of how carbs work that one ultimately can skip!

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