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Anhedonia

Dr. Ayush PandeyMBBS,PG Diploma

September 11, 2020

September 12, 2020

Anhedonia
Anhedonia

Anhedonia is a condition in which a person stops being interested in things that used to bring them joy earlier. It is characterised by an inability or reduced ability to feel pleasure or motivation to engage in one’s old hobbies, sex or socialising.

Though people with anhedonia have a diminished ability to experience pleasure, their ability to feel negative emotions or displeasure remains unchanged. People with anhedonia also tend to harbour negative feelings and thoughts about themselves and others.

The word anhedonia derives from an ancient Greek philosophy—hedonism—that prioritised the pursuit of pleasure and the avoidance of suffering in life. Anhedonia is also known as “hedonistic deficit”.

But anhedonia isn't just a general sense of ennui (being uninterested due to boredom), it is linked with some mental health issues:

  • Seven out 10 people with major depressive disorder (depression) have anhedonia.
  • Anhedonia may be associated with health problems such as anxiety or chronic illnesses.
  • Anhedonia is sometimes seen in people with schizophrenia.
  • Experts say anhedonia can make depression harder to treat.
  • Anhedonia can also increase suicide risk in some patients.

Research has shown that in people with anhedonia, there’s generally a problem with the brain’s dopamine reward system. Dopamine is a feel-good neurotransmitter or chemical that the brain releases as a reward whenever we do something good.

Anhedonia can sometimes be difficult to diagnose, as joy and pleasure are subjective. Still, researchers have developed a variety of telltale signs and tests to confirm its presence or absence. For example, research shows that people with anhedonia are likely to experience sweet taste at higher concentrations of sugar in a solution than someone who doesn't have this condition—they are also likely to enjoy the sugary taste less than people who don't have anhedonia. Treatment usually involves talk therapy and may also include drug therapy in some cases.

Read on to know more about the symptoms, causes, risk factors, complications, diagnosis and treatment of anhedonia.

Anhedonia types

Anhedonia can be of different types, depending on which aspect of the patient’s life it affects:

  • Physical anhedonia is the loss of sensual and physical pleasure. People with this condition may not enjoy sex or food as much as they used to.
  • Social or interpersonal anhedonia is marked by a loss of pleasure in or motivation to socialise, go out, connect with people, and form and maintain relationships. Some people with social anhedonia can keep up appearances, like looking happy at a party. But they tend to feel less happy at these gatherings than they used to.

Anhedonia can also be differentiated based on whether the activity that should have brought joy is ongoing or coming up soon:

  • Consummatory anhedonia is the inability or reduced ability to take pleasure in things that are happening now.
  • Anticipatory anhedonia is the impaired ability to enjoy something that is upcoming.

Anhedonia symptoms

People with anhedonia may feel empty or numb or experience a loss of joy in things that used to bring them pleasure before. They are also more likely to feel negative emotions towards themselves and others. Some people with anhedonia are also more likely to diminish or underplay the memory of positive events.

That said, anhedonia isn’t just a feeling of unhappiness or emptiness for a short while, but a “near-complete” loss of joy in response to positive events and stimuli. It is accompanied by changes in the brain chemistry that disrupt the body’s natural rewards system to help you feel good. People with anhedonia have “persistently low motivation”. 

The symptoms of anhedonia can vary, depending on the type:

  • Sexual anhedonia: Reduced or no feeling of pleasure during orgasm. Though sexual anhedonia can occur in females as well as males, it is reported more widely by men.
  • Social anhedonia: Loss of pleasure or motivation to form interpersonal relationships and engage with people. While some people with this form of anhedonia may experience social withdrawal and discomfort in social situations, others may find themselves faking emotions.

Anhedonia causes and risk factors

Anhedonia is a trait or symptom rather than a disease in itself. It can arise in a number of situations, such as:

Risk factors for anhedonia can be genetic or environmental. Some risk factors for anhedonia are:

  • Going through a traumatic event
  • Having a major illness
  • Experience of physical or sexual abuse
  • Mental health disorders
  • Females are more prone to anhedonia than males
  • A family history of mental illness

What happens in the brain in anhedonia?

Scientists at the US National Institutes of Health-affiliated National Institute of Mental Health did functional magnetic resonance imaging (fMRI) in 2,878 children aged 9-10. Of these,

  • 261 children had anhedonia
  • 277 low mood
  • 109 anxiety
  • 459 had attention-deficit hyperactivity disorder

The scientists found some characteristics of anhedonia which were different from the other conditions. Specifically, the children with anhedonia had a poorer association (hypoconnectivity) between the part of the brain responsible for arousal (the cingulo-opercular network) and the part responsible for dispensing rewards (the ventral striatum area) than in children who didn’t have anhedonia. Arousal and reward are obviously linked to motivation and anticipation/experience of joy.

Anhedonia (loss of pleasure and motivation) complications

Researchers have found that in people with depression and anhedonia, medicines such as anti-depressants and anti-psychotics don’t work as well as they typically do in people with depression but no anhedonia.

Anhedonia has also been linked with increased risk-taking behaviour and suicide risk.

Anhedonia (loss of pleasure and motivation) diagnosis and treatment

To diagnose anhedonia, a psychologist or clinical psychiatrist would ask the patient about their symptoms and mood. He or she may also order a blood test to check for nutritional deficiencies and thyroid problems.

Treatment involves using medicines like anti-depressants and therapies such as:

  • Electroconvulsive therapy: In which the doctor passes a small current through the patient's brain.
  • Transcranial magnetic stimulation: This therapy uses a magnet to stimulate the nerves.
  • Vagus nerve stimulation involves placing a small gadget in the body to stimulate the vagus nerve.

While these therapies may help some patients, it is useful to remember what research has shown: anhedonia can be very hard to get rid of. Where it accompanies depression, there have been cases where anhedonia (as a trait) has persisted even after a person's depression is treated. It is important to persist with therapy and support people who have anhedonia.



References

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