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WHAT IS ANHEDONIA?
By
Sherri Gordon
Sherri Gordon
Sherri Gordon, CLC is a certified professional life coach, author, and
journalist covering health and wellness, social issues, parenting, and mental
health. She also has a certificate of completion from Ohio State's Patient and
Community Peer Review Academy where she frequently serves as a community
reviewer for grant requests for health research.
health's editorial guidelines
Published on March 6, 2024
Medically reviewed by
Dakari Quimby, PhD
Medically reviewed by Dakari Quimby, PhD
Dakari Quimby, PhD, is a Clinical Assistant Professor of Psychiatry & Behavioral
Sciences at the University of Southern California.
learn more
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In This Article
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In This Article
* Types
* Symptoms
* Causes
* Diagnosis
* Treatment
* Prevention
* Related Conditions
* FAQs
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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withdrawn or detached from friends and family, and have little motivation to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
Looking for Support?
If you are experiencing a crisis, or know someone who is, call or text the
National Suicide Prevention Lifeline at 988 for free and confidential support
24/7. You can also visit SpeakingOfSuicide.com/resources for a list of
additional resources or call the number below to reach the Substance Abuse and
Mental Health Services Administration (SAMHSA) hotline.
(800) 662-4357
LIVING WITH ANHEDONIA
Anhedonia can be challenging to live with. Anhedonia causes a person to
disconnect and disengage from the world around them. Consequently, they can miss
out on big life events; lose their social connections; and have challenging
relationships with friends, family members, and coworkers. This can result in
poorer quality of life both mentally and physically.29
Unfortunately, anhedonia can also be challenging to treat. Thankfully,
researchers are looking into alternative treatment methods that might be more
effective. Particular medications or therapies have already been shown to be
more effective than others.
If you think you have signs of anhedonia, talk with a mental healthcare
provider. Together, you can make a treatment plan that works best for you.
FREQUENTLY ASKED QUESTIONS
* Can people with anhedonia be happy?
One of the hallmarks of anhedonia is the inability to experience joy,
pleasure, or happiness. But with therapy and medications, some people with
anhedonia do experience happiness. Scientists are researching ways that can
help people with anhedonia resistant to treatment can regain joy in life.30
* Does anhedonia ever go away?
For some people, anhedonia will go away when the condition the symptoms is
associated with is treated. But for some people, anhedonia lingers despite
treatment. In these situations, mental health professionals may recommend
other treatment options like TMS therapy, which applies magnetic impulses to
the brain and is often used to treat anhedonia when other options have
failed.31
* What is the fastest way to increase dopamine levels?
Sometimes healthcare providers will prescribe antidepressants that increase
the amount of dopamine neurotransmitters in your brain.32 But there are other
ways to increase dopamine quickly that can be used alongside medication and
therapy. For instance, exercise and meditation can both increase dopamine
levels rather quickly.3334 Even sunlight can raise dopamine levels.35
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35 Sources
Health.com uses only high-quality sources, including peer-reviewed studies, to
support the facts within our articles. Read our editorial process to learn more
about how we fact-check and keep our content accurate, reliable, and
trustworthy.
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