anhedonia

anhedonia, inability to experience pleasure from daily activities and from activities or interactions that normally are considered pleasurable. The word anhedonia is derived from the Greek an-, meaning “without,” and hēdonē, meaning “pleasure.” Persons affected by anhedonia may appear to enjoy an activity but may not actually experience or feel the corresponding emotions. Anhedonia is a common symptom of depression and a primary feature of major depressive disorder. It also is associated with borderline personality disorder, attention-deficit/hyperactivity disorder, autism, eating disorders, substance use disorders, and schizophrenia.

There are multiple ways in which anhedonia is classified. For example, it may be classified as physical or social. In physical anhedonia, affected individuals experience diminished reactions to normally pleasurable bodily sensations, such as touch, eating, and sex. Social anhedonia is characterized by a lack of interest in interpersonal relationships and by a lack of pleasure in social situations. Anhedonia can also be anticipatory or consummatory. Those affected by anticipatory anhedonia do not experience pleasure when looking forward to an activity or in expectation of gratification; in such cases, individuals often suffer from a diminished desire to participate in activities. Consummatory anhedonia is characterized by a lack of pleasure when participating in an activity that others would consider gratifying. Anhedonia may be further classified as motivational or decisional in nature, wherein motivational anhedonia involves a reduced desire to pursue rewarding activities, and decisional anhedonia manifests as an inability to decide which activities are worth pursuing. Some authorities consider the different types of anhedonia to be related; for example, it is possible that consummatory anhedonia leads to anticipatory anhedonia.

Biological mechanisms underlying anhedonia are unclear. When individuals anticipate completing a pleasurable activity or participate in consummatory activities, the brain releases “feel good” neurotransmitters (signaling molecules), most notably dopamine. Dopamine feeds into the brain’s reward circuit, which regulates the ability to perceive pleasure and which reinforces positive emotions. Anhedonia is linked to abnormal function of the reward circuit in patients with substance use disorders and in patients with Parkinson disease.

Treatment for anhedonia is challenged by a lack of understanding of the causes and mechanisms underlying the disorder. Some patients may benefit from selective serotonin reuptake inhibitors (SSRIs), though in others these drugs may further dull emotion and blunt the reward system. The drug ketamine, an anesthetic, has been shown to reduce the effects of anhedonia in patients with bipolar disorder. Other therapeutic approaches include cognitive behavioral therapy and mindfulness exercises; these approaches have helped some patients with major depressive disorder learn to anticipate pleasure when thinking about future events.