Anhedonia: Does the chronic inability to feel joy affect you too?

What is Anhedonia?

The word anhedonia has been derived from the two Greek words – “an” – meaning “no” or “none” and “hedone” – which refers to pleasure.  The literal meaning of this word is “no pleasure” or “absence of pleasure” which is exactly what this condition refers to.

Anhedonia is now studied as a part of depressive disorder wherein the person turns incapable of feeling any sort of pleasure from activities which were once considered pleasurable. This could include any activity – engaging in your favorite hobby such as gardening or playing the piano, traveling, reading, solving crossword puzzles – and could even stretch to finding your favorite foods bland or tasteless.

An anhedonic person loses all interest in maintaining social contacts as he/she finds negligible pleasure in the company of friends and family members. Intimate activities such as sex also lose its meaning and importance when anhedonia sets in.

While all of these appear very similar to the classic signs of depression, experts content that anhedonia is a part of depressive disorder and then some more. As per the latest research, anhedonia represents a diverse array of diseases.

Anhedonia is not an easy concept to define. Of all the formal studies conducted on patients of anhedonia, a whopping 45% of them were incapable of giving a clear cut definition of the condition. Some define it as the “complete inability to experience pleasure”, while some consider it as a “reduced ability”.

What classifies as anhedonic behavior?

Regardless of this confusion over the exact definition and domain of anhedonia, there are certain factors which are defined for this condition:

• It is at the crux of major depression.
• It is of the melancholic subtype
• Anhedonic display certain neuroanatomical features typical to the condition
• It is also studied as a critical negative symptom of schizophrenia
• It is predictive of antidepressant response

While these definitive elements clear up a number of doubts about anhedonia, there still are many questions regarding the condition that remain unanswered by these. For example, could anyone develop anhedonia? Are there some people who are more likely to develop it? Just like depression, can anhedonia be treated with pills? Let us find the answers to these looming questions in the below-given sections.

Do you think you have anhedonia? Check out these symptoms

As mentioned before, the typical features of an anhedonic individual overlap to a large extent with those of depression and schizophrenia patients. However, the below-mentioned categorization of anhedonic symptoms provides a clearer difference between the former and latter.

Social anhedonia

This type of anhedonia can be best described by the term “social withdrawal” and shouldn’t be confused “introversion”. Social anhedonia describes the condition wherein a person who previously enjoyed social interactions and contact finds himself/herself becoming indifferent to the same.

This is where social anhedonia is different from introversion. In the case of introversion, the individual personally doesn’t prefer social outings and gatherings however in case of social anhedonia, he/she is incapable of deriving any form of pleasure or happiness from such activities. And unlike social anxiety, it is not described by exaggerated negative emotions build-ups such as panic attacks or sudden onset of fear in the face of social gatherings.

Physical anhedonia

Physical anhedonia is where the person becomes incapable of feeling closeness, intimacy, or pleasure through things that previously were associated with sensory pleasure. It could range from a warm hug meaning nothing to sex losing its complete appeal.  As discussed earlier, physical anhedonia can also make a person become indifferent to the taste of foods; foods stop creating the sense of taste to them.

In a nutshell, people with anhedonia can show symptoms that either falls under both categories or just one. With the main motivating force, pleasure, gone from life people find it almost impossible have any desire to perform any work. These are the common tell-tale signs shown by people who are experiencing anhedonia:

• There is a clear cut gap in the mind of an anhedonic between performing a task and the subsequent reward associated with it.
• Since they cannot evaluate that there is a certain pleasure or reward associated with work, they are constantly demotivated to accomplish any task or build on personal relationships.
• Subsequently, they start showing signs of withdrawal – be it from social gatherings, their favorite activities, work, and intimate relationships.
• They also tend to build poor social adjustment as a result of being indifferent to social contacts. They are unable to distinguish between the warmth of a closed one and the emotional distance of a stranger.
• Anhedonics also begin displaying the signs of reduced affection, also known as emotional blunting. This is defined as a reduced emotional response in an individual towards things that previously resulted in either a positive or negative reaction.

Who are at high risk of developing anhedonia?

Anhedonia occurs as an additive result of vulnerable genes and environmental factors. When there is a presence of both these elements, the chances of developing anhedonia is higher in contrast when only one or no factors are present. Vulnerable genes refer to a person with a family history of the following mental health conditions:

• Major depressive disorder
• Schizophrenia
• Social anxiety
• Substance abuse-related disorders
• PTSD or Post Traumatic Stress Disorder
• Parkinson’s disease

Conversely, people diagnosed with these disorders also have a higher probability of developing anhedonia. Studies reveal that anhedonia could be present in as many as 70% of the people with major depressive disorder.

Additionally, anhedonia is also co-morbid with (occurs along with) psychosis and eating disorders such as anorexia nervosa. Environmental factors include any stress-inducing traumatic event that either temporarily or permanently disables the brain’s “reward” or “pleasure-seeking tendencies”. This majorly includes:

• Emotional, physical, or sexual abuse
• Vapid emotional neglect
• A long term illness that is a source of constant pain and/or disability
• Eating disorders

Studies also reveal that given the physiological and environmental situations that are associated with women, they are more likely to develop anhedonia than men.

Anhedonia: What is the exact cause?

As seen above, anhedonia is spawned because of genetic and environmental factors. But what actually happens inside the brain of an anhedonic? What chemical defect(s) actually occurs in the brain that leads to decreased pleasure-sensation? And how different is the brain of an anhedonic from the brain of a normal person?

To understand the answer to these questions, we first need to understand the neurology of pleasure. In the human brain, the elements of desire, motivation, and pleasure are often intertwined and exist in a fluid manner; meaning there are no set boundaries between the chemical responses in the brain in the presence of these events. There are 4 regions in the brain that are associated with the sensation of pleasure.

• The prefrontal cortex – Dictates personality building and planning
• Amygdala – Decision-making center
• Striatum – A part of the reward system
• Insula – Involved with consciousness and self-awareness

All of these regions work in tandem to produce motivation, desire, and pleasure-seeking tendencies.  In the same way, dopamine and serotonin are produced whenever a positive or pleasure-inducing activity is performed.

Anhedonia which literally means the absence of pleasure and motivation in a person, it is clear that there are differences in the excitation of the said neurotransmitters (serotonin and dopamine) and the regions of the brain in an anhedonic when compared to an average individual.

The complete neural circuitry that is involved in the case of anhedonia is extremely complex to evaluate and understand. In brief, it can be summarized as these regions of the brain (especially the prefrontal cortex) might be overactive in many people that disrupt the normal neural pathways that dictate pleasure-seeking and motivation.

This incoherence might refer to an unbalance in the number of neurotransmitters or the particular region where these substances are produced. In a nutshell, anhedonics have a different kind of neurochemistry influencing their behavior. Thus, in the presence of activities that should ideally be creating pleasure-seeking tendencies, the person remains indifferent to the circumstances.

How is anhedonia diagnosed?

The diagnosis of anhedonia is not the same as that of depression or any other mental health condition. This is primarily because anhedonia, in many cases, transcends the set definitions laid out by experts in spite of manifesting several typical characteristics.  There are several self-reported assessment tests that measure several psychological parameters pertaining to anhedonic tendencies.

These are:

• Revised Social Anhedonia Scale
• No Close Friends Subscale
• Introverted Anhedonia Subscale

In most cases, a complete psychiatric evaluation that encompasses a detailed examination of the said individual’s past and current life is conducted.  This also includes an informed inquiry into his/her medical and familial background. Additionally, certain blood-tests are also carried out in order to discern whether the said anhedonic /depressive tendencies are a result of a psychiatric issue or hormonal problems (such as thyroid disorders).

In many cases, nutritional deficiencies can also result in mood disorders. The chances of these resulting in an anhedonic state must be eliminated through careful testing and diagnosis before concluding that the person is actually suffering from anhedonia.

Is anhedonia treatable?

Yes, anhedonia can be treated. However, just as anhedonia is difficult to define and diagnosis, its treatment can be equally tricky. There are varied treatment courses to chose from and it differs from person to person how well the treatment module going to respond.

The first course of treatment is antidepressant medications – SSRIs (Selective Serotonin Reuptake Inhibitor).  On one hand, many patients with anhedonia report positive changes with these medications on the other many might find their “emotional blunting” worsening under the effect of the medications.

ECT or electroconvulsive therapy, which is an effective treatment mechanism for depression, has also shown promise in the domain of anhedonia. In this process, electric impulses are applied to the brain (under the influence of general anesthesia). These electrical impulses tend to correct the incoherent neural pathways that give rise to depressive/anhedonic tendencies.

However, this is usually performed when no other treatment method yields any positive result. Additionally, the most trusted psychiatric therapy module – talk therapy or psychotherapy can also help the anhedonic individual understand his/her condition and the causative agents leading to an improved response to the entire therapy process.

Anhedonia: Prognosis, management, and prevention

Pleasure-seeking tendencies create the fundamental drive in our minds to set goals, accomplish tasks, and be motivated to do things. The complete (or at least partial) disruption of this reward-system in the brain produces long-lasting behavioral abnormalities that borderline with several mental health conditions – depression and schizophrenia primarily.

Thus, it is extremely critical that this condition is evaluated and diagnosed correctly with time in hand. In the majority of cases, people with anhedonia respond positively to the medication and psychotherapy course.

Bottom line is the sooner the depressive/schizophrenia tendencies are dealt with, the faster will be the recovery from anhedonia. People who fall in the risk pool for these should be on a constant check on whether they are developing anhedonic tendencies. The moment they feel that the “emotional bluntness” is dictating their behavior they should immediately go for a complete psychiatric check-up.

There are no exact preventive measures for this condition. However, these following steps can help one reduce the probability of onset of depressive tendencies that could eventually grow into anhedonia:

• De-stress yourself regularly.
• Cut down the consumption of inflammatory foods such as sugar and refined foods
• Exercise
• Get proper sleep every night
• Have a long-term fitness program and maintain a healthy weight
• Indulge in altruistic and volunteering activities.

However, if one still feels the symptoms of anhedonia overpowering in spite of following these measures, he/she shouldn’t delay getting evaluated by a psychiatrist.

TL;DR?

References

 

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