What is anhedonia? Symptoms, causes, and 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). 

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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). 

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

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). 

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).

Anhedonia is a serious issue that requires treatment. Some research suggests anhedonia increases the risk of suicide and dementia (Lee, 2019; Bonanni, 2019). 

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)

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.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

March 17, 2022

Written by

Amelia Willson

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.