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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Plenty of things in life can bring a smile to someone’s face, from watching a cute puppy video on social media to sharing a laugh with friends.
However, some people lose the ability to experience pleasure from these things. This is called anhedonia, which is when you no longer feel joy or pleasure from the things you used to enjoy (Trostheim, 2020).
What is anhedonia?
Anhedonia describes an inability (or severely reduced ability) to feel pleasure, particularly from activities or things you once found pleasurable, such as having sex or spending time with friends.
Anhedonia can feel like a big, heavy cloud that casts a shadow over everything in your life. Stunning scenery, the smell of freshly baked bread, or a warm bubble bath may have little to no positive effects on someone with anhedonia. While some individuals with anhedonia feel no happiness at all, others describe their feelings of pleasure as dulled (Cooper, 2018).
Anhedonia is a common symptom of major depressive disorder. However, anhedonia is also associated with other conditions like schizophrenia, bipolar disorder, substance abuse disorder, Parkinson’s disease, and chronic pain (Trostheim, 2020).
Symptoms of anhedonia
Anhedonia is itself a symptom, most commonly of depression. A person with anhedonia may experience or exhibit the following negative symptoms (Cooper, 2018):
- No longer deriving pleasure, happiness, or joy from the big or little things in life
- Being less motivated to engage in social activities or hobbies once found enjoyable
- Withdrawal from social relationships or an overall lack of relationships
- Expressing fake positive emotions when around others
- Loss of libido, meaning a reduced or complete lack of interest in sex
Healthy coping skills for anxiety, depression, and anger
Types of anhedonia
Anhedonia is typically categorized into two main types. While these aren’t officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it can be helpful to understand the different ways anhedonia can manifest in a person (Yang, 2021; Gray, 2018):
- Social anhedonia describes a decreased interest in or lack of pleasure from social situations, activities, and relationships.
- Physical anhedonia is an inability to feel pleasure from physical aspects of life like eating, smelling, and physical touch or intimacy. A person with sexual anhedonia may ejaculate during orgasm but feel no pleasure in the experience.
It’s worth noting that social anhedonia is different from social anxiety disorder. A person with anhedonia feels utterly unmotivated to participate in social situations because they don’t get any pleasure from doing so. On the other hand, people with social anxiety avoid social interactions due to fear of embarrassment or rejection (Rose, 2021).
What causes anhedonia?
Anhedonia is one of the core symptoms of depression, but not everyone who experiences anhedonia has a mental illness. It can also appear in people with Parkinson’s disease, chronic pain, substance abuse, and anorexia nervosa (Trostheim, 2020; Boehm, 2018; Lally, 2014)
Anhedonia can also be a response to trauma and emotional neglect (Cohen, 2019). Childhood trauma is a risk factor for developing major depression, and prior sexual abuse increases the risk of anhedonia––especially in adolescent girls (Sonmez, 2021).
To understand what causes anhedonia, we can turn to neuroscience. Your brain’s reward system controls your ability to recognize pleasurable stimuli and gives you the motivation to seek those gratifying feelings out. Multiple brain regions are involved in this process including the prefrontal cortex, amygdala, and ventral striatum. All of these play a role in emotional regulation and reward-seeking behaviors.
In people with anhedonia, something in the brain circuitry related to reward processing goes awry. There may be any one of multiple possible triggers, many of which are believed to lead to a change in the brain’s response to dopamine (the so-called “pleasure” hormone) (Cooper, 2018; Lally, 2014).
Psilocybin for depression: does it work?
Treatment for anhedonia
Treating anhedonia usually begins by diagnosing and treating the underlying condition, whether that’s depression or something else. As part of the diagnosis process, your healthcare provider will ask a series of questions about your symptoms, medical history, any past drug use, and more.
The first-line treatment for anhedonia is typically a combination of medication and talk therapy. Antidepressants and drugs called selective serotonin reuptake inhibitors (SSRIs) increase the amount of serotonin in your brain, which may relieve symptoms. Therapy focuses on rewiring the brain’s reward processing pathways to savor positive moments and find joy again (Gray, 2018; Trostheim, 2020).
Some people with depression don’t experience significant improvement after treatment with psychotherapy and antidepressants. This is known as treatment-resistant depression. If this is the case, alternative treatments can be recommended including:
- Electroconvulsive therapy (ECT): This method uses an electric current to induce a small seizure in the brain via electrodes that are applied to the head. While that might sound scary, ECT is fairly safe and is effective at quickly relieving depressed moods and suicide risk in people with treatment-resistant depression (Ross, 2018).
- Transcranial magnetic stimulation (TMS): This procedure utilizes an electromagnetic field to stimulate brain cells in your prefrontal cortex. Research has found 4–6 weeks of TMS therapy to be effective for treatment-resistant depression (Rizvi, 2019).
- Vagus nerve stimulation (VNS): This involves placing a medical device (similar to a pacemaker) in your chest, which sends electrical signals to the brain. Based on animal studies, researchers suggest VNS may significantly decrease anhedonia in people who have depression and other conditions like epilepsy (Grimonprez, 2015). Research in humans is needed to confirm this potential.
- Ketamine: Popularly known as a party drug, ketamine is also an option for treating severe depression. In one study, people with bipolar depression felt significant relief lasting for up to two weeks after 40 minutes of a ketamine IV infusion (Lally, 2014). Another study reported that four IV infusions of ketamine reduced depression symptoms and suicidal ideation (Rodrigues, 2020)
Ketamine for depression: how it works, benefits, risks
If you think you have anhedonia, talk to a healthcare professional. They may screen you for a vitamin D deficiency or a thyroid problem, both of which can contribute to depression (Su, 2019; Menon, 2020). They can also refer you to a psychologist or psychiatrist who can guide you on the best course of treatment to get you back to feeling like yourself again.
- Boehm, I., Flohr, L., Steding, J., Holzapfel, L., Seitz, J., Roessner, V., et al. (2018). The trajectory of anhedonic and depressive symptoms in anorexia nervosa: A longitudinal and cross-sectional approach. European Eating Disorders Review, 26(1), 69–74. doi:10.1002/erv.2565. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29168305/
- Bonanni, L., Gualtieri, F., Lester, D., Falcone, G., Nardella, A., Fiorillo, A., et al. (2019). Can Anhedonia Be Considered a Suicide Risk Factor? A review of the literature. Medicina (Kaunas, Lithuania), 55(8), 458. doi:10.3390/medicina55080458. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31405085/
- Cohen, J. R., McNeil, S. L., Shorey, R. C., & Temple, J. R. (2019). Maltreatment subtypes, depressed mood, and anhedonia: A longitudinal study with adolescents. Psychological Trauma, 11(7), 704–712. doi:10.1037/tra0000418. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30589315/
- Cooper, J. A., Arulpragasam, A. R., & Treadway, M. T. (2018). Anhedonia in depression: biological mechanisms and computational models. Current Opinion in Behavioral Sciences, 22, 128–135. doi:10.1016/j.cobeha.2018.01.024. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29503842/
- Gray, M., Zillioux, J., Khourdaji, I., & Smith, R. P. (2018). Contemporary management of ejaculatory dysfunction. Translational Andrology and Urology, 7(4), 686–702. doi:10.21037/tau.2018.06.20. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30211060/
- Grimonprez, A., Raedt, R., Dauwe, I., Mollet, L., Larsen, L. E., Meurs, A., et al. (2015). Vagus nerve stimulation has antidepressant effects in the kainic acid model for temporal lobe epilepsy. Brain Stimulation, 8(1), 13–20. doi:10.1016/j.brs.2014.09.013. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25444592/
- Lally, N., Nugent, A. C., Luckenbaugh, D. A., Ameli, R., Roiser, J. P., & Zarate, C. A. (2014). Anti-anhedonic effect of ketamine and its neural correlates in treatment-resistant bipolar depression. Translational Psychiatry, 4(10), e469. doi:10.1038/tp.2014.105. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25313512/
- Lee, J. R., Suh, S. W., Han, J. W., Byun, S., Kwon, S. J., Lee, K. H., et al. (2019). Anhedonia and dysphoria are differentially associated with the risk of dementia in the cognitively normal elderly individuals: A prospective cohort study. Psychiatry Investigation, 16(8), 575–580. doi:10.30773/pi.2019.06.07. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31446685/
- Menon, V., Kar, S. K., Suthar, N., & Nebhinani, N. (2020). Vitamin D and depression: A critical appraisal of the evidence and future directions. Indian Journal of Psychological Medicine, 42(1), 11–21. doi:10.4103/IJPSYM.IJPSYM_160_19. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31997861/
- Rizvi, S. & Khan, A. M. (2019). Use of transcranial magnetic stimulation for depression. Cureus, 11(5), e4736. doi:10.7759/cureus.4736. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31355095/
- Rodrigues, N. B., McIntyre, R. S., Lipsitz, O., Cha, D. S., Lee, Y., Gill, H., et al. (2020). Changes in symptoms of anhedonia in adults with major depressive or bipolar disorder receiving IV ketamine: Results from the Canadian Rapid Treatment Center of Excellence. Journal of Affective Disorders, 276, 570–575. doi:10.1016/j.jad.2020.07.083. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32871688/
- Rose, G. M. & Tadi, P. (2021). Social Anxiety Disorder. StatPearls. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32310350/
- Ross, E. L., Zivin, K., & Maixner, D. F. (2018). Cost-effectiveness of electroconvulsive therapy vs pharmacotherapy/psychotherapy for treatment-resistant depression in the United States. JAMA Psychiatry, 75(7), 713–722. doi:10.1001/jamapsychiatry.2018.0768. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29800956/
- Sonmez, A. I., Lewis, C. P., Athreya, A. P., Shekunov, J., & Croarkin, P. E. (2021). Preliminary evidence for anhedonia as a marker of sexual trauma in female adolescents. Adolescent Health, Medicine and Therapeutics, 12, 67–75. doi:10.2147/AHMT.S300150. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34163277/
- Su, M., Li, E., Tang, C., Zhao, Y., Liu, R., & Gao, K. (2019). Comparison of blood lipid profile/thyroid function markers between unipolar and bipolar depressed patients and in depressed patients with anhedonia or suicidal thoughts. Molecular Medicine, 25(1), 51. doi:10.1186/s10020-019-0119-9. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31747876/
- Trøstheim, M., Eikemo, M., Meir, R., Hansen, I., Paul, E., Kroll, S. L., et al. (2020). Assessment of anhedonia in adults with and without mental illness: A systematic review and meta-analysis. JAMA Network Open, 3(8), e2013233. doi:10.1001/jamanetworkopen.2020.13233. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32789515/
- Yang, X., Casement, M. D., Keenan, K. E., Hipwell, A. E., Guyer, A. E., & Forbes, E. E. (2021). Physical and social anhedonia in female adolescents: A factor analysis of self-report measures. Emotion. doi:10.1037/emo0000843. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34060862/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.