Imagine, what you used to enjoy doing… maybe going on a trip with friends, watching a good movie, doing a little gardening, or eating your favorite food. But now you don't feel any joy, no pleasure, no 'satisfaction' from any of those things? What if those things no longer feel 'fun' to you? That's what we medically call anhedonia. Simply put, the loss of the ability to experience pleasure.
What exactly is Anhedonia?
Anhedonia means “lack of pleasure.” It’s
a common symptom of depression and other mental health conditions. In fact, about seven out of ten people with major depressive disorder (MDD) have anhedonia. We usually know what happiness is, and we enjoy certain things. But when this happens, that feeling of pleasure disappears. You used to love eating chocolate or listening to a song. Now you may find that doing those things makes you feel less happy. You may not even know why.
Many people confuse this with apathy, which is the state of 'not wanting to do anything'. But these are two different things. Apathy is the lack of interest or motivation to start something. But anhedonia is the inability to get pleasure from doing that thing.
A person with anhedonia may feel that friendships and family relationships are valuable, but they may not feel the pleasure, or 'reward', that comes from those things, so they may feel like there's no point in working hard for them.
Are there main types of anhedonia?
Yes, we're talking about two main types of anhedonia. There are also a few other specific types. Let's look at these in a table.
| Type of anhedonia | Simply put… |
|---|
| Social Anhedonia | Feeling no connection or joy even with your best friends and family. Not wanting to meet friends or go to parties. Feeling better about staying home alone. |
| Physical Anhedonia | Lack of pleasure from physical sensations. For example, feeling empty even when hugged affectionately, feeling like your favorite food doesn't taste good, not getting pleasure from sex, or having a decreased libido. |
A few more specific types
- Anticipatory Anhedonia: The lack of any expectation of pleasure about something fun (e.g., a trip) that is coming up. The inability to get excited about it even though you know it will be fun.
- Consummatory Anhedonia: The lack of pleasure in an activity at the time. The lack of pleasure in talking to a friend.
- Musical Anhedonia: The inability to enjoy music, melody, or tone . A song sounds like nothing more than a sound, without any emotion.
- Ejaculatory Anhedonia: This is a specific sexual health condition in which you may experience orgasm during sex but not feel any pleasure from it.
Why is this happening? What are the reasons?
Although anhedonia is a core symptom of depression, there are several other factors that can cause it. You may be at increased risk of developing anhedonia if you have the following conditions:
Scientifically, anhedonia is caused by
a disruption in the pleasure and reward circuits in our brain . Many experts believe that the main cause is a decrease in the activity of a chemical in the brain called
dopamine . Dopamine is a “feel-good” hormone that makes us feel happy, satisfied, and motivated. When this dopamine system is disrupted, we experience less pleasure.
Do you also have these characteristics?
Anhedonia feels like a void. Where there used to be happiness, there may now be a feeling of emptiness, a lack of emotion. Even positive things don't feel great. Common symptoms include:
- Numbness
- Losing interest in hobbies you used to enjoy
- Withdrawing from others and avoiding social activities
- Difficulty making decisions
- Being constantly sad, negative, or lethargic
- Apathy (lack of interest or motivation to do anything)
- Sleep problems and decreased sexual desire
These symptoms are not the same for everyone. For some people, they come and go for a while, while for others, they may be constant.
How does a doctor find this?
When you describe these symptoms, your doctor will first check to see if you have depression. They will also look for other physical conditions that could be causing these symptoms. To do this,
- You will be asked a few questions about your mood and symptoms.
- Blood tests can be done to check for low vitamin D or thyroid hormone levels.
- Your physical health will be checked.
- Sometimes you can also use special questionnaires (surveys) designed to measure your level of happiness.
All of this is done to accurately diagnose your condition and choose the most appropriate treatment.
What are the treatments for this?
Because anhedonia is a symptom, the most important thing when treating it is to find the underlying cause. The treatment plan is usually a combination of medication and talk therapy.
Medications
Some antidepressants can help. In particular, drugs that affect dopamine levels in the brain, such as
bupropion (Wellbutrin), have been shown to be helpful for some patients. Some studies have shown that traditional SSRI drugs do not have much effect on this condition, and may even dull emotions. So your doctor will decide which medication is best for you. In some cases that do not respond to other treatments, newer treatments, such as
ketamine therapy, are also being investigated.
Talk Therapy
This is a very important part of the healing process.
- Cognitive Behavioral Therapy (CBT): This helps you identify and change your negative thought patterns. This allows you to challenge thoughts that are preventing you from experiencing happiness.
- Behavioral Activation: The therapist encourages you to gradually start doing things you used to enjoy, even if you don't feel like doing them. As you gradually get used to them, you may start to enjoy them again.
Other treatments include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).
Risks if left untreated
Anhedonia is not just a lack of pleasure. If left untreated, it can have a profound impact on your life.
- Connection failure:Spending time with friends and family can be a burden because you don't feel happy. This can lead to you gradually becoming distant from everyone.
- Social isolation: There may be a fear or reluctance to meet people and participate in social activities.
- Worsening of mental health conditions: Anhedonia can worsen conditions such as depression.
- Suicidal thoughts: This is a very serious issue. There is a strong link between anhedonia and suicidal thoughts.
If you or someone you know is having thoughts of harming or killing themselves, please do not suffer alone. Seek help immediately. You can call Sri Lanka Friends on 011-2692909 or the National Mental Health Helpline on 1926. These services are confidential and free. In an emergency, go to the Emergency Treatment Unit (ETU) of the nearest hospital.
Anhedonia is not a permanent condition. It can be completely cured with the right treatment. Therefore, if you have symptoms, it is very important to seek medical advice as soon as possible.
Take-Home Message
- Anhedonia is the inability to experience pleasure from things that used to bring pleasure. This is a common symptom of illnesses like depression.
- This is not due to laziness, but to changes in the functioning of chemicals like dopamine in the brain.
- This condition can be improved with medication, talk therapy, and lifestyle changes.
- If you have these symptoms, the best thing to do is not to be ashamed or afraid of it, but to talk to a trusted doctor.
Anhedonia, anhedonia, depression, dopamine, mental health
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