Anhedonia: A complete guide to finding no pleasure
Feel like nothing is worth giving it a try? Like everything that you do, provides little to no satisfaction? We all have things that we don’t find pleasurable, but there are a few people out there who find nothing pleasurable. Why? What is anhedonia, and what are the different types, symptoms, and causes? How does it tie in with depression, being sexual, and being social? How does it affect the brain? What are the diagnosis, treatment, and prognosis? What are some tips to deal with it? This article will answer all your questions.
What is anhedonia?
While many people refer to anhedonia as the inability to feel pleasure- a symptom of several psychiatric illnesses such as schizophrenia and depression, it also is used by researchers to mean reduced anticipatory pleasure (wanting), reduced consummatory pleasure (liking), reduced motivation, and a lack in reinforced learning.
While it’s common to lost pleasure in things throughout life, anhedonia takes this lack of pleasure to new limits. It can occur due to major depressive disorder, psychosis, Parkinson’s, schizophrenia, substance abuse disorders, and anorexia nervosa. It’s been studied that it’s the reason for one’s want to go skydiving.
Sigmund Freud, the famous neurologist, and theorist believed that pleasure is the feedback process that we developed as humans to motivate ourselves to create and recreate pleasurable experiences. It also motivates us to do more pleasurable things and steer away from painful experiences. A handful of Greek philosophers also believed that pleasure was the only good to be had in life. Everything derives from pleasure. The concept of “hedonism” stems from the Greek word for pleasure. The word “anhedonia”, with the word “hedon” hidden in the middle, comes from the Greek word meaning “without pleasure”.
Symptoms of anhedonia
The common symptoms are:
- Lack of understanding the happiness and laughter in others.
- No joy or happiness found in life. All days feel the same.
- Offish and not being comfortable while in uncommon places such as a restaurant or crowded place.
- Loss of interest in everyday pleasures such as pictures, music, art, and literature.
Anhedonia and depression
Scientists have found that depression is linked to the less activity in the part of the brain known as the medial prefrontal cortex (mPFC). The same lack of activity they believe is connected to anhedonia.
In 2003, a study took the brains of 14 women- 7 diagnosed with major depression and 7 healthy (not-diagnosed). The researchers showed the women positive or negative images while scanning their brains. The researchers found that women who suffered from depression had lower activity in their mPFC compared to the non-depressive women.
Scientists have begun to treat depression by stimulating the prefrontal cortex of the brain. Essentially, they zap brain cells with a small amount of electricity in order to stimulate it and tell it to produce dopamine, the happy neurotransmitter. One study took six patients treated with mental stimulation for depression in their prefrontal cortex and found that four of the six went into remission.
Roughly 90% of people who are diagnosed with depression will also experience some form of anhedonia, too.
Anhedonia and Schizophrenia
Anhedonia is commonly listed as a symptom of schizophrenia. People who suffer from schizophrenia say that they experience less positive emotions than others who aren’t schizophrenic. With this, it makes sense that the two conditions are tied together. However, the consummatory pleasure (liking) is actually intact and fully functional with schizophrenics. Due to the fact that schizophrenia is associated with a reduced pattern of response to unexpected reward, known as prediction errors, a few studies have been able to correlate schizophrenia and a lessened amount of prediction errors. One study shows that Schizophrenics also demonstrate an impairment in learning tasks when the task is complex and requires explicit learning. When the task requires implicit learning, schizophrenics don’t seem to have any impairment. These deficits and “shortfallings” can be related to a dysfunction in the brain that leads to the brain giving an abnormal and “wrong” representation of goals and rewards. Essentially, a schizophrenic’s brain won’t be rewarded with (as much) dopamine like a non-schizophrenic might be.
Anhedonia and Parkinson’s
Anhedonia and Parkinson’s disease have been reported together with rates between 7-45% of people experiencing both conditions at the same time. That said, there isn’t much evidence that anhedonia is, in fact, related to the high rates of depression that happens with those who suffer from Parkinson’s. It makes sense, though, that Parkinson’s causes depression with its neurodegenerative symptoms such as weakening of motor skills and loss of dopaminergic neurons (deriving from “dopamine”) in the brain.
Anhedonia and PTSD
Ahnedonia isn’t associated with Post-Traumatic Stress Disorder (PTSD) per se. However, considering that PTSD is associated with a reduced motivation, a common symptom of anhedonia, it makes sense that the physiological arousal would lessen. It also makes sense that the “blunted affect” would take place. The blunted affect is an effect that means the pleasure and want is blunted, dull, and unpleasing which is a common side effect of depression, too.
Anhedonia and Addiction
It is common among people who are addicted to things in order to receive “a high”. For instance, alcoholics and drug addicts such as people addicted to nicotine and opioids. Anhedonia has been correlated with substance-related disorders such as cravings, protracted withdrawal, and hedonic capability- especially in opiate-dependent participants in the studies. It’s also been found that clinically, anhedonia can’t be separated from the other behavioral symptoms that come from withdrawal and is actually considered part of the withdrawal process. Although the anhedonia that occurs in addicts can lessen over time, it can also be a strong predictor of relapse.
Types of anhedonia
There are different types of anhedonia that each have different aspects to them. These types include:
- Physical anhedonia
- Social anhedonia
- Sexual anhedonia
- Musical anhedonia
- Motivational anhedonia
- Appetitive anhedonia
- Consummatory anhedonia
- Anticipatory anhedonia
- Total/complete anhedonia
The sexual, social, and musical types mean the person feels no pleasure in those areas. Motivational and appetitive mean having no desire or motivation to do something. Consummatory anhedonia means not enjoying the activity itself. Anticipatory anhedonia means not having the ability to feel excited towards the future. Total/complete anhedonia means that one experiences all of these types together with no positive emotion and no interest in any area of life.
Also known as ejaculatory anhedonia, sexual anhedonia means that a person can ejaculate without feeling pleasure. While it’s a condition mostly found in males, it can occur in women, as well. It’s often treated with the antidepressant bupropion which has been shown to help sexual dysfunction in patients that don’t have depression. It can be caused by conditions such as:
- A spinal cord injury
- Use of antipsychotics (antidopaminergic neuroleptics)
- Multiple sclerosis
- Use of antidepressants (SSRIs)
- Hypoactive sexual desire disorder (HSDD) the opposite of hypersexuality, Inhibited sexual desire
Social anhedonia is trait-related which means that it is stable through one’s life. It typically looks simply like indifference to others. It’s different from social anxiety because social anxiety is classified by a diminished positive effect and exaggerated negative effect while socially, anhedonia is classified by a diminished positive effect.
Social symptoms include:
- Disliking social events including parties and concerts.
- Incapacity to be with others for long periods of time and want to go away from big groups.
- Difficulty with long conversations and sharing thoughts with others.
- Lack of interest in sexual activities
- Incapable of having fun with others and lack of understanding for having fun.
Causes of anhedonia
The amygdala in the brain is actually the key cause for this condition. However, there are other things that cause the amygdala to fall a bit out of wack:
- Inflammation and depression have been linked together. People who suffer from depression have increased levels of inflammatory compounds in their brain. One study showed that increased levels of C-reactive protein (a type of inflammatory) were linked to reduced connectivity between the ventromedial prefrontal cortex (which is essential for motivation) and the ventral striatum. There are many studies that find these types of results, too.
- Lack of dopamine production
- Damage to the brain’s reward system
- Substance abuse
- Depression, major depressive disorder
- Schizophrenia, check out a study about it here
How does anhedonia affect the brain?
When we feel pleasure, dopamine, the neurotransmitter and happy hormone, flood into our brain’s reward system– also known as the striatum. When we feel depressed, our dopamine levels are lower and our prefrontal cortex isn’t as stimulated. It’s believed that anhedonic symptoms come from the medial prefrontal cortex, which controls the brain’s release of dopamine throughout the brain (and thus, body). Essentially, the body’s brain reward system doesn’t reduce the appreciation for chocolate, the actual underlying reward mechanisms in the brain are impaired and unable to appreciate chocolate, for example. This comes from overlapping, yet different, neural circuits that are processed in the brain.
One study proved this by using a functional magnetic resonance imaging machine (fMRI) and stimulating the dopamine neurons in rat’s midbrains (where dopamine takes the biggest effect) and performed optogenetics. Essentially, the researchers shined a light on the light-sensitive nerve cells and used a machine that detects blood flow within the brain. This light causes a boost in activity within our striatum- the brain reward area. After, they stimulated the neurons within the rats’ medial prefrontal cortex and saw that stimulation to the mPFC decreased activity in the brain reward system. Due to this, some of the rats lost interest in drinking sugar water, a water they prefer over plain, non-sugar water.
The part of the basal ganglia, the nucleus accumbens, also known as the pleasure center, is what is theorized to implicate anhedonia. However, other parts of the brain such as the prefrontal cortex (which plans and is in charge of our personality and personal expression), the amygdala (in charge of our decision-making and emotions), the insula (in charge of self-awareness), and the striatum (a part of our nucleus accumbens that plays a role in the brain’s reward system) are also involved.
Diagnosis for anhedonia
There are no anhedonic specific tests, just a simple questionnaire, and tests for other conditions. The questionnaire includes questions like if the person goes to social events, participates in a social activity, how often, and if the person was always this way. Asking whether the person feels pleasure while doing their “favorite” hobby might also be asked. Other tests include:
- Scale for emotional blunting (SEB) which measures apathy and dementia.
- Schedule for the deficit syndrome (SDS) which measures schizophrenic patients who have anhedonia and those who don’t.
- Positive and Negative Syndrome Scale (PANSS) which is used to measure the severity of schizophrenic symptoms.
- Scale for the Assessment of Negative Symptoms (SANS) which is used to determine the extent of negative symptoms in schizophrenia.
Treatment options for anhedonia
As of now, there are no treatments known to work for anhedonia specifically. However, it is commonly treated alongside another condition that it is a part of.
For example, one might take selective serotonin reuptake inhibitors (SSRIs) for their depression with hopes that they help the anhedonic symptoms. That said, there is evidence that antidepressants don’t do much to treat anhedonic symptoms and actually can worsen it by causing sexual anhedonia, emotional blunting, and anorgasmia as a side effect. This could be due to the fact that serotonin (a hormone that comes with SSRIs and is supposed to alleviate depression) actually inhibit the release of dopamine in parts of the brain. Parts that have to do with motivation, reward, and pleasure.
Lately, there has been interest in using anesthetic ketamine as a potential treatment. Ketamine shows promise as a treatment for depression by reducing symptoms in both bipolar disorder and major depressive disorder. The study that looked at ketamine as a treatment for bipolar disorder noted that ketamine rapidly reduces the anhedonic levels in the subjects studied. To the point that it began to work within 40 minutes of beginning treatment and lasted up to 14 days with just one injection. Ketamine might work because it blocks the N-Methyl-D-aspartate receptors that activate and produce glutamate. Glutamate is also thought to be a neurotransmitter that plays a part in anhedonic brain activity.
Prognosis for anhedonia
Because there is no true treatment that is tried and true for anhedonia, there may be cases where someone is cured, cured temporarily, or never cured- it all depends on each individual case. It is important that you visit a doctor or psychologist if you feel anhedonia.
Tips to help someone with anhedonia
- Sleep well. Try to get a good night’s sleep
- Eat well. Eat things that have sources of serotonin such as fresh fruit and chocolate.
- Be positive and focus on happy moments in life.
- Keep an eye out for other symptoms of depression and get help if you have more symptoms.
- Try psychotherapeutic therapy such as Gestalt therapy and different behavioral techniques
Let us know what you think in the comments below!
Anna is a freelance writer who is passionate about translation, psychology, and how the world works.