Many of us associate depression with feeling sad or having a low mood. However, there is one symptom which can often be overlooked – anhedonia, the loss of interest or pleasure in activities once enjoyed.
According to Ciara McCabe, Professor of Neuroscience, Psychopharmacology, and Mental Health at the University of Reading, anhedonia affects up to 75 percent of individuals with depression. Despite its prevalence, it remains one of the most challenging symptoms to address.
Anhedonia refers to a reduced interest or pleasure in almost all activities that were previously enjoyable. Even if a person does not feel sad or low, experiencing anhedonia consistently for at least two weeks can lead to a diagnosis of depression.
While commonly associated with depression, anhedonia can also be a symptom of other conditions such as schizophrenia, anxiety disorders, and Parkinson’s disease. Unfortunately, anhedonia often receives less attention in depression treatment strategies.
Mild cases of depression are typically treated with talking therapy, while more moderate or severe cases may involve antidepressant medication. However, over half of individuals with depression do not respond to their initial treatment recommendation, and around 30 percent continue to experience symptoms even after changing treatments.
One possible explanation for these low response rates is that current treatment approaches do not adequately target anhedonia. Traditional therapies primarily focus on addressing depressed mood and the underlying brain processes associated with negative thinking. Similarly, most antidepressant medications mainly target serotonin levels in the brain, which influences how negative information is processed.
Since anhedonia involves a reduced sense of joy in life, treatments such as behavioural activation (a form of talking therapy) may be more effective in addressing this symptom. Behavioural activation aims to help individuals with depression take small steps towards re-engaging in enjoyable activities.
However, some studies suggest that behavioural activation is no more effective than standard treatments for managing anhedonia. This could be due to the lack of motivation inherent in anhedonia, making it challenging for patients to engage in any therapy, even those that may benefit them the most.
Research has also linked anhedonia to dysfunction in the brain’s reward system. Therefore, treatments that focus on improving reward processing may offer greater relief from anhedonia compared to current approaches.
However, the brain’s reward system is complex and involves various subprocesses, including anticipation, motivation, pleasure, and learning about rewards. Understanding how these subprocesses operate in individuals with anhedonia is crucial for developing more targeted treatment strategies.
While anhedonia poses challenges, there is hope for those affected by it. Talk therapies that specifically address reward processing have shown promise in reducing anhedonia. Augmented depression therapy, a new form of talk therapy that targets both negative and positive experiences, may be more effective than cognitive behavioural therapy in treating depression.
Additionally, antidepressant medications that target neurotransmitters involved in the reward system, such as dopamine, could be better suited for individuals with anhedonia. Early studies exploring drugs like ketamine, which can impact dopamine activity, have shown potential in treating anhedonia.
Although finding motivation can be difficult when experiencing anhedonia, incorporating enjoyable activities or hobbies into daily life may help alleviate symptoms. It is crucial not to ignore feelings of anhedonia or other depressive symptoms and seek the necessary help and treatment. Sharing your emotions with a loved one or consulting your GP can be the first steps towards finding support and regaining a sense of pleasure and interest in life.
If you feel like you need someone to talk to you can contact Samaritans – call 116 123 or email jo@samaritans.org. It’s free and anonymous.
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