What Is Anhedonia?
Anhedonia is losing interest in or not being able to feel pleasure. The word means "without pleasure." It's a common symptom of depression and other mental health conditions. About 7 in 10 people with major depressive disorder (MDD) have anhedonia.
Usually you know what pleasure feels like and are happy about certain things. Maybe you enjoy riding your bike or listening to the ocean. But some people can lose interest or not feel joy.
Things that once made you content aren't fun anymore. You can lose the ability to feel happy --- that's anhedonia.
Some experts think anhedonia can dull your positive emotions. Maybe you still like eating chocolate or listening to jazz; you just don't like them nearly as much. And you probably can't explain why.
Apathy vs. anhedonia
Anhedonia and apathy can look alike. They sometimes happen together, but they aren't the same. Apathy is about motivation, but anhedonia is about your pleasure
Apathy means "without feeling." You don't want to do anything or lack motivation. Apathy can mean you don't want to start an activity. It can also look like you don't express emotion. You may stop caring; not just about doing things, but about how they turn out.
Anhedonia is about liking what you do. It means you’ve lost the joy or pleasure for activities. You no longer enjoy things that used to make you feel good. With anhedonia, you may still value relationships and goals. But you may struggle to feel reward or that it's worth the effort.
Types of Anhedonia
There are two main types of anhedonia, social and physical.
Social anhedonia
Social anhedonia can mean you feel disconnected, even from close friends or family.
With social anhedonia, you may:
- Lose interest in your friends
- Not want to go to family or community activities
- Not want to see your friends
- Feel better staying at home
- Have a harder time expressing emotions
- Feel more stressed about seeing other people
- Socially withdraw more often from your friends, family, or community
Physical anhedonia
You may not enjoy physical sensations. With physical anhedonia, you may
- Not like physical touch, feeling empty rather than nurtured by a hug
- Not enjoy eating or feel like your favorite foods taste bland
- Not find your body senses pleasurable, or have less joy in physical senses like hearing sounds
- Lose your desire for sex, have a lower libido, or not have an interest in sex
Other types of anhedonia
Other anhedonia types can depend on what isn’t pleasurable to you.
Some specific types of anhedonia include:
Anticipatory anhedonia. You don't look forward to your normal activities. That's because you don't expect to feel joy. Although you know it's fun, you may not get excited about a future event.
Consummatory anhedonia. You don't enjoy doing activities. You may lack joy in interaction.
Motivational anhedonia. You can have a lower desire to show up to activities. You may not want to do the things you used to.
Decisional anhedonia. You may not be able to decide which activities are worth attending.
Musical anhedonia. You may not find music, rhythm, or melody enjoyable. Music may not bring you joy or stir up emotion. Non-musical sounds may be nice, but musical patterns aren't pleasing.
Sexual anhedonia. Even sex can lose its appeal. You may lack desire for or pleasure during sex.
Ejaculatory anhedonia. It's also called pleasure dissociative orgasmic dysfunction (PDOD). You may not feel pleasure when you have a sexual climax. But you still want to have sex, get aroused, and orgasm. Something may feel off, like your brain can't sense pleasure. You just may not get joy from orgasm.
Anhedonia Causes
Anhedonia is often a symptom of depression. But many other medical conditions can cause anhedonia, too.
You may have a higher risk for anhedonia if you have:
- Depression
- Schizophrenia, bipolar disorder, posttraumatic stress disorder (PTSD), or another mental health condition
- A neurodegenerative problem like Parkinson's disease or Alzheimer's disease
- Substance abuse issues
- Eating disorders
- Chronic pain or traumatic brain injury
With anhedonia, your brain pathways somehow get stopped. But it's still unclear how because there are very few studies. Most experts think anhedonia is caused by lower dopamine.
Research suggests key brain areas include:
- Ventral tegmental area (VTA), which uses dopamine (the "feel good" hormone) to signal your brain's reward center
- Nucleus accumbens (NAc) and ventral striatum, which help you start activities
- Prefrontal cortex (PFC), which is connected to your VTA, amygdala, NAc, and hippocampus. They control your reward behavior.
- Amygdala, which stores your reward memories
- Hippocampus, which recalls your memories of reward
Anhedonia Symptoms
Anhedonia can feel like something is missing. It can feel like there’s a blank space inside you. You may feel empty where there was once joy or pleasure. You may feel a disconnect or simply feel "off." Even positive moments can feel muted or dull.
With anhedonia, you may feel:
- Numb or lack feelings
- A loss of interest in hobbies or activities you once liked
- Like you can't plan activities
- Withdrawn from others or avoid activities
- Indecisive
- Lower joy or pleasure
- Down, negative, or bored
- Less excited about future activities
- A lack of motivation (apathy)
You can also have trouble sleeping and a lower sex drive. Anhedonia isn’t the same for everyone. And your symptoms can change over time. Your lack of joy can be temporary, often tied to periods of depression. But it can also be a constant challenge.
How Is Anhedonia Diagnosed?
Your doctor will likely check for depression and rule out other problems. To do this, they may order blood tests. The tests check for low vitamin D and thyroid hormone levels. Your doctor may also order imaging scans.
You'll likely get a physical exam. And your doctor will review your medical history. To start, they may ask you a few questions about your mood and symptoms.
Are there tests for anhedonia?
There are a few surveys your doctor uses to test for anhedonia.
Snaith-Hamilton Pleasure Scale (SHAPS)
The standard 14-question test is a more in-depth test for anhedonia. The SHAPS measures your pleasure from things like:
- Socializing with others
- Eating or drinking
- Engaging in hobbies
Temporal Experience of Pleasure Scale (TEPS)
The TEPS has 18 questions. It asks about how much pleasure you get from social and physical activities. You'll take the test to help your doctor tell if you have anticipatory or consummatory anhedonia:
- Anticipatory pleasure: How much do you look forward to an activity?
- Consummatory pleasure: How much enjoyment do you feel when the activity actually happens?
Dimensional Anhedonia Rating Scale (DARS)
The 17-question test asks about your:
- Hobbies
- Social life
- Senses
- Favorite foods and drinks
The tests help your health care provider make a more accurate diagnosis.
Anhedonia Treatment
Because anhedonia is a symptom, treatment often means finding out the cause. Your doctor will look for medical conditions that can cause anhedonia. After you're diagnosed, your doctor will suggest a treatment plan.
Medications for anhedonia
Certain medications may target your brain’s reward center. There's some evidence antidepressants can help with anhedonia.
Antidepressants for anhedonia
It's not clear if selective serotonin reuptake inhibitors (SSRIs) help with anhedonia. Some studies show no benefit from standard SSRI treatments. Some experts think the medications may blunt emotions and make anhedonia worse.
A review suggests using antidepressants like agomelatine (Valdoxan) or vortioxetine (Trintellix).
How dopamine medications help
Dopamine plays a key role in pleasure and impacts anhedonia. Medications that alter your brain's dopamine may help. But some studies also show no benefit.
"We do use dopamine-related medications to improve anhedonia, energy, and concentration," says Keming Gao, MD, a psychiatrist at University Hospitals Cleveland Medical Center in Cleveland.
Some commonly used medications include:
- Armodafinil (Nuvigil)
- Bupropion (Wellbutrin)
- Modafinil (Provigil)
Can stimulants help ease anhedonia?
Stimulants combined with antidepressant medicine may help anhedonia. Methylphenidate usually treats ADHD. But the medicine can raise your brain's dopamine. And higher dopamine may ease your anhedonia symptoms.
Some doctors use stimulants such as:
- Amphetamine and dextroamphetamine (Adderall)
- Lisdexamfetamine dimesylate (Vyvanse)
- Methylphenidate (Ritalin)
Ketamine therapy for anhedonia
If SSRIs and talk therapy don't work, ketamine may help your anhedonia. Ketamine therapy can act like an antidepressant.
More research is needed, but one study showed relief 40 minutes after treatment. People with bipolar depression felt their anhedonia got better, too.
Anhedonia therapy
Therapy is an important part of recovery. Talk therapy can impact how you feel. Treatment plans often include therapy, especially with depression. Talk to your health care provider about the best therapy for you.
Augmented CBT
Cognitive behavioral therapy (CBT) can help you identify negative thoughts. This therapy aims to boost your well-being. Augmented CBT can help lower your depression symptoms long-term. It helps challenge thoughts that keep you from feeling pleasure.
Your therapist can slowly help you get back into activities. You'll focus on things you once enjoyed. This can help you take chances and find solutions.
Amygdala neurofeedback therapy
Also called noninvasive brain stimulation (NIBS), neurofeedback can lower your amygdala activity. That's because your amygdala helps process emotion. And lower brain activity is linked to less joy during positive experiences.
This area of your brain has higher activity during negative experiences. Neurofeedback can retrain your emotions --- shifting your amygdala to more positive responses. The process may help improve anhedonia symptoms.
Talk therapy
Cognitive behavioral and behavioral activation therapy may only help a little. But one study suggests augmented depression therapy can help. This therapy helps you focus on solutions to problems.
Therapy can help you take small steps with purpose. You'll learn to start going to social activities, even if you don’t feel like it. And you'll build momentum. Eventually, you'll start to enjoy and look forward to activities again.
You may start to feel more capable. You'll learn more about your thought patterns, too. You may feel more positive and change the way you think. Other therapies can include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).
Anhedonia Risks and Complications
Anhedonia isn't just about less joy. It can change your life in deeper ways. Anhedonia can impact your overall well-being, too.
Without treatment, your anhedonia can worsen and raise your risk of:
Relationship struggles. Anhedonia can strain your relationships with friends and family. With the reward of enjoyment gone, it may feel harder to interact. You may not spend time with family, skip events, or not go to get-togethers. You may feel like there isn’t a benefit. Meanwhile, loss of libido can also take a toll on your romantic life.
Social isolation. You may get social anxiety or feel like you don't fit in. It may be stressful to meet new people. You may start to avoid family, friends, or community events. You may feel like you have nothing to offer to others, especially feelings of love and appreciation.
Physical effects. You can also feel fatigue or lower energy. You may not feel like going out. You can also get mood changes. Sometimes, you may be too tired to eat or care of yourself. This can cause you to lack vitamins or minerals (malnutrition) and impact self-care.
You may also have unintentional weight changes or trouble sleeping. Without treatment, anhedonia can make it harder to get through your daily routine.
Worsening mental health conditions. Anhedonia is linked to major depressive disorder (MDD). It’s also a common symptom of anxiety, PTSD, schizophrenia, substance use, and eating disorders.
Anhedonia can disrupt how your brain sees rewards. You may lose joy in motivation, anticipation, and learning from positive events. Over time, your mental health can worsen without treatment.
Self-harm or suicidal thoughts. Anhedonia is a symptom linked to self-harm and suicidal thoughts. But experts don't agree about different types of anhedonia linked to self-harm. One meta-analysis showed a higher risk for suicidal behavior with anhedonia.
When to Call Your Doctor
If you don't feel joy the way you used to, talk to your doctor. Untreated anhedonia can have a serious impact on your mental and physical health. Early treatment is key to start feeling better.
If you have suicidal thoughts, don’t wait. Reach out right away. If you or a loved one has thoughts of suicide or self-harming, call the Suicide & Crisis Lifeline at 988. It's always open, and you can speak to a certified counselor. If you need help right away, call 911 or go to your local emergency room.
Is anhedonia permanent?
Anhedonia isn't necessarily permanent. With treatment, it's possible for it to go away (enter remission). But anhedonia may come and go over time. You can lower your risk by sticking with your treatment plan, even after you start feeling better. Follow up with your doctor and tell them about any new symptoms.
Takeaways
Anhedonia means you don’t feel pleasure the way you used to. It can deeply impact your emotional well-being, relationships, and daily life. This common symptom of depression is treatable with medication and therapy. If you notice a loss of joy that isn't going away, talk to your doctor about the best treatment plan for you.
Anhedonia FAQs
How common is anhedonia in generalized anxiety disorder?
It's not common, but you can have anhedonia with generalized anxiety disorder (GAD). Anhedonia and anxiety can show up, especially if you also have depression.
How long does anhedonia last?
Anhedonia can last a few days, weeks, or several months -- it's different for everyone. It doesn’t go away on its own, but it can get better with treatment. There are many options to help with anhedonia, including therapy.
Does Wellbutrin treat anhedonia?
Bupropion (Wellbutrin) may help some people with anhedonia but not others. That's because bupropion can alter your dopamine levels to impact your reward center. But one study showed that Wellbutrin helped with anhedonia.
Can ADHD cause anhedonia?
ADHD doesn't directly cause anhedonia. But anhedonia is a symptom of ADHD. That's because ADHD can lower dopamine. And lower dopamine can cause anhedonia.
