What Is Anhedonia?
Anhedonia is the inability to experience joy in activities most people would find pleasurable.1 People with anhedonia often have a lack of interest, feel withdrawn or detached from friends and family, and have little motivation to engage with the world around them.2
Commonly viewed as one of the key symptoms of major depressive disorder (MDD), anhedonia can also be seen in other mental health conditions such as schizophrenia, as well as in people with Parkinson's disease or chronic pain. That said, anhedonia tends to be more common and more pronounced in people with depression.3
In fact, research shows about 70% of people diagnosed with MDD have obvious signs of anhedonia.4 And although anhedonia is a complicated symptom, it may be possible to treat with therapy and medications.
Types of Anhedonia
There are two types of anhedonia: social anhedonia and physical anhedonia. Here is a closer look at each and how it could impact you.
Social Anhedonia
People with social anhedonia have no desire or motivation to interact with their family and friends. They also get little to no enjoyment from spending time with people or participating in social situations.
Social anhedonia is not the same as social anxiety disorder where people avoid social situations for fear of being judged. Instead, people with social anhedonia get no reward from engaging with other people.5
Physical Anhedonia
When someone has physical anhedonia, they don't enjoy or get pleasure from physical or sensory experiences, such as eating, touching, or sex. They also may not notice changes in temperature, movement, smell, and sound.
Most of the research involving physical anhedonia has revolved around schizophrenia, but it is possible for anhedonia to manifest in other mental health conditions, including depression. In fact, an older study found that people with higher levels of physical anhedonia had more significant cases of depression. For this reason, researchers speculate that physical anhedonia could be a predictor for the severity of depression.6
Editor's Note: The word anhedonia has Greek roots and can be translated to mean "without pleasure."4
Anhedonia Symptoms
A key characteristic of anhedonia is a lack of enjoyment and interest in things that would typically bring joy to other people.
Other signs of anhedonia include:4
Lack of desire to engage with the world: People with anhedonia have lost their desire to participate in activities they once found enjoyable of that other people might find enjoyable. They also have difficulty expressing emotions, especially joy, happiness, and contentment.
Loss of interest in people, hobbies, or activities: When someone has anhedonia, they can lose interest in trying new things, spending time with others, or participating in activities or hobbies that once made them happy. As a result, they may prefer to be alone and have fractured relationships.
A display of false feelings or emotions: Because anhedonia can be so significant, some people will try to power through the situation by pretending to be happy to mask their true feelings.
A struggle to find motivation: Even if there is a reward to gain from a task, someone with anhedonia can find it hard to motivate themselves.
Because of behaviors like withdrawal from activities or changes in eating patterns that are associated with anhedonia, weight gain is possible as well.7
What Causes Anhedonia?
Anhedonia is caused by a dysfunction of reward processing in the brain. Reward processing influences desire, effort, motivation, and pleasure. The processing is possible thanks to the brain's reward circuit, which connects brain structures that control your ability to feel pleasure. The reward circuit is responsible for the distribution of dopamine, the main pleasure-providing chemical messenger.84
In people with anhedonia, something prevents the reward circuit from accurately processing desires or pleasures. One theory as to what disrupts the reward circuit is higher levels of inflammatory markers in the blood.4
It's believed that anhedonia has a significant genetic component, with researchers thinking it may be passed down through families.9
Anhedonia is most commonly tied to an underlying mental health condition. It may also be tied to a neurologic condition.3
Risk Factors
Anhedonia most commonly occurs in people with MDD. Aside from depression, there are certain conditions that increase the likelihood of developing anhedonia, including:3101112
Schizophrenia
Bipolar disorder
Substance use disorders
Parkinson's disease
Chronic pain
Post-traumatic stress disorder (PTSD)
Autism
Eating disorders
The severity of your anhedonia might be influenced by the condition you have. For instance, one study found that people with schizophrenia, chronic pain, substance use disorder, and Parkinson's disease usually experience mild-to-moderate levels of anhedonia. People with MDD typically have more pronounced anhedonia.3
How Is Anhedonia Diagnosed?
To diagnose anhedonia, a healthcare provider will likely ask about any prior psychiatric or neurologic conditions with which you may have already been diagnosed. They will also want to discuss your symptoms and ask you to fill out a questionnaire. A questionnaire is how anhedonia is most frequently measured.3
The most commonly used questionnaires are the Snaith-Hamilton Pleasure Scale (SHPS or SHAPS), the Fawcett-Clark Pleasure Scale (FCPS), and the Revised Physical Anhedonia Scale (RPAS). Each of these self-report questionnaires evaluates your reward responsiveness or your ability to feel pleasure.13 Here's what to expect from each diagnostic tool:
SHAPS: This questionnaire is the most frequently used and has 14 prompts that ask you to indicate your level of agreement or disagreement with pleasure-oriented statements. Some examples include, "I enjoy being with family and close friends" and "I would be able to enjoy my favorite meal."3
FCPS: This questionnaire contains 36 questions asking you to imagine how much pleasure you could experience in a variety of situations regardless of whether the situations apply to your life.14
RPAS: This questionnaire has 61 true-or-false questions about your ability to experience pleasure from things like food and sex.15
Treatments for Anhedonia
The goal of anhedonia treatment is to increase your feelings of joy, pleasure, and motivation. Treatment will usually consist of a combination of therapy and medication.
Cognitive behavioral therapy has been shown to be an effective therapy approach for anhedonia. The medication you take can depend on the underlying associated condition. For instance, if your anhedonia is associated with Parkinson's disease, the Parkinson's drug Mirapex (pramipexole) may improve your anhedonia symptoms. If your anhedonia is associated with depression, you might be prescribed an antidepressant.9
Certain antidepressants, like Wellbutrin (bupropion), may be more effective against anhedonia than others. Some common antidepressants, like selective serotonin reuptake inhibitors, are better at reducing negative emotions than increasing your ability to experience pleasure, so it can be hard for them to help with anhedonia symptoms.4
For this reason, healthcare providers have looked into other options for treating anhedonia, including the following:9
Ketamine
Ketamine is an injectable, short-acting anesthetic that can cause people to feel detached from their pain.16 One study found that injecting ketamine into participants with treatment-resistant bipolar disorder rapidly reduced the levels of anhedonia.17 Another study had similar results, also finding that ketamine improved quality-of-life.18 Because research is limited, more studies are needed to gauge safety and efficacy.
Transcranial Magnetic Stimulation (TMS) Therapy
TMS therapy is often reserved for treatment-resistant depression as well as other conditions like obsessive-compulsive disorder (OCD), PTSD, chronic pain, and substance use disorders. It's also been successful in significantly reducing symptoms of anhedonia.1920
Positive Affect Treatment (PAT)
PAT is a type of treatment targeting reward sensitivity by practicing different activities, such as being generous or doing activities that are pleasurable, that may trigger the brain's reward system. In one study, researchers found that PAT helped people feel more positive. It also reduced symptoms of depression, anxiety, and stress.21
Vagus Nerve Stimulation (VNS)
VNS is often used to treat seizure disorders and treatment-resistant depression, so it makes sense that it could be helpful in treating anhedonia.19 Research has found VNS affects many of the same brain areas and neurotransmitters as traditional antidepressants, though one study found VNS may take slightly longer for people to respond.22
How To Prevent Anhedonia
While there is no way to prevent anhedonia, there are lifestyle changes you can implement that could reduce its severity and help improve your mental health. For instance, you can prioritize sleep and make sure you are eating a balanced diet. You also can meditate, exercise, and even make sure you are getting enough sunlight or time in nature.
Keeping a journal of everything for which you are grateful can help mitigate the severity of anhedonia. Gratitude not only changes the neural structures in your brain, but also boosts mood—especially since it has a direct impact on the dopamine your brain produces. Gratitude has also been linked with a lower risk of mental health disorders and can increase life satisfaction.2324
Related Conditions
Research indicates people with anhedonia have a heightened suicide risk. People with anhedonia are more likely to have suicidal thoughts, attempt suicide, and die by suicide. This is especially true for people with PTSD who have anhedonia.25
People with anhedonia also have an increased risk of heart issues or cardiac events. One older study found that people with anhedonia were more likely to experience an adverse cardiac event like a heart attack or stroke than people who did not have anhedonia.26 This is in line with more recent research that has connected depression with a risk of major adverse cardiac events.27
Having anhedonia can increase your risk of developing dementia, too. In fact, one study found that older adults with anhedonia were five times likelier to develop dementia than those without anhedonia.28
Research suggests anhedonia contributes to the risk and maintenance of binge-eating disorder. This may be because people with anhedonia find it easier to get a sense of pleasure from food than something like a social situation and so eat large amounts of food in an attempt to feel positive emotions.7
