Your Scientific Guide To Anhedonia

For some people, the feeling of pleasure or enjoyment can seem elusive. They may not experience them when listening to music, spending time with loved ones, or eating delicious food. Things that may have once brought them pleasure just don’t have the same effect anymore. This experience is referred to as anhedonia (also sometimes called anadonia and anedonia), and it’s one of the core symptoms of major depressive disorder. However, anhedonia can also be caused by other conditions besides depressive disorders.

Below, we’ll look at anhedonia and its causes, manifestations, and potential treatments.

What is anhedonia?

Anhedonia may occur when the brain's pleasure circuit (e.g., ventral tegmental area, nucleus accumbens, and prefrontal cortex) shuts down or reduces its capacity. In the context of psychology, the term was first coined by French psychologist Theodule Ribot as “l’anhédonie” in 1896. He found that people with social anhedonia can lose interest not only in their hobbies but also in friends, work, and food. They may also experience chronic pain and have difficulty experiencing positive emotions of any kind.

The brain's pleasure circuits seem to have the ability to be modified based on the stimuli they receive. The circuitry in the brain of individuals with anhedonia may change so that it becomes unable to receive impulses related to pleasure. However, anhedonia may not shut down all the brain's pleasure circuits. Some people with depression still experience pleasure; they may simply find it difficult to sustain good feelings over time.

Examples of feelings that may be affected by anhedonia include happiness, joy, gratitude, interest, connection, excitement, love, and positive anticipation.

Anhedonia may also cause a diminished ability to experience extremely negative emotions. For this reason, anhedonia is also sometimes called "emotional flatlining." In any case, it can cause a disruption to one’s social life, daily functioning, and overall quality of life.

Types of anhedonia

There are several types of anhedonia, and it’s possible to exhibit multiple types at once. It’s also possible to experience total anhedonia or a loss of interest in virtually everything. The most common types of anhedonia include:

• Physical: the inability to experience pleasure from the senses
• Social: the loss of interest in social contact and situations
• Sexual: the inability to derive pleasure from sex when you were previously able to
• Musical: the inability to enjoy music
• Motivational: the loss of motivation to do things
• Anticipatory: the inability to feel excited about the future

What are the symptoms of anhedonia?

The symptoms of anhedonia may vary depending on the type of anhedonia an individual experiences. For instance, people with social anhedonia may experience feelings of social isolation and negative feelings toward others. People with anticipatory anhedonia may feel a lack of motivation and fatigue.

In general, however, common anhedonia symptoms include:

• Social withdrawal and isolation
• Problems with personal relationships
• Unexplained physical health problems and fatigue
• Negative feelings toward self and others
• Lack of pleasure in things that were formerly enjoyable
• Irritability and defiance
• Lack of motivation
• Reduced ability to express emotion
• Trouble communicating verbally
• A tendency to show false emotions

Anhedonia isn’t necessarily a condition on its own but rather a symptom of another primary condition. For this reason, psychologists may look for symptoms of anhedonia when diagnosing mental health disorders like major depressive disorder, schizophrenia spectrum disorders, post-traumatic stress disorder, and substance use disorder.

Causes of anhedonia

The exact causes of anhedonia are unclear, but it is associated with physiological brain function. Genetics may also affect whether someone is likely to experience anhedonia. Other risk factors may include early trauma, a brain injury, substance use disorder, major illnesses or diseases that affect brain functioning, eating disorders, and others.

Treatment for anhedonia

Regardless of whether anhedonia accompanies a diagnosable mental illness, treatment is usually the same: psychotherapy, sometimes in combination with medication. In addition to these formal treatments, there are informal treatments or lifestyle changes that may help as well, such as a healthy regimen of self-care and time off work or school if possible, since anhedonia and depression can be associated with burnout.

In more severe cases, a doctor may also prescribe electroconvulsive therapy (ECT) for treating conditions that cause anhedonia, like major depressive disorder—particularly treatment-resistant depression. With this treatment, doctors administer general anesthesia and place electrodes on the scalp to initiate an electric current. The current then stimulates a spasm to change the wiring of the brain. 

Transcranial magnetic stimulation (TMS) is a similar process, but no general anesthesia is required because the current applied is minimal. TMS and ECT can be controversial, and both treatments are generally used only when other therapies have failed.

When left unaddressed, anhedonia and its cause—whether it’s major depression, treatment-resistant depression, or bipolar disorder—can have a significant impact on a person’s relationships, work life, and mental health. Since anhedonia is often cited as a symptom of a primary mental illness, it may help to seek treatment from a doctor. When anhedonia presents as a symptom, doctors typically conduct a physical assessment to determine if there is a physical cause, such as a thyroid problem or a vitamin deficiency. If they don’t find a physical cause, they may refer you to a psychologist, psychiatrist, or other mental health professional to examine your symptoms of anhedonia in the context of your overall mental health. You might be prescribed both medication, such as a selective serotonin reuptake inhibitor (SSRI), and talk therapy as part of your treatment plan.

However, not everyone feels comfortable visiting a therapist in person. Some may have limitations that make it difficult to speak with a therapist during normal office hours or travel to in-person appointments, while others may not feel comfortable interacting with a therapist in person, especially if they are experiencing social anhedonia or other difficult symptoms.

In cases like these, online therapy can be a convenient alternative to in-person therapy. Evidence suggests that virtual therapy can often be as effective as in-office therapy for treating psychiatric conditions that can include anhedonia as a symptom, such as depression. With an online therapy platform like BetterHelp, you can connect with a therapist via phone or video call from the comfort of your own home or anywhere with an internet connection. You can also contact your therapist at any time via in-app messaging and they’ll respond as soon as they can.