What Is Anhedonia? Exploring Causes, Symptoms, And Treatments

Note: The following article contains topics of substance use disorder, self-harm, and suicide. If you or someone you know is experiencing a substance use disorder, contact the SAMHSA National Helpline at 1-800-662-4357. For concerns about self-harming behavior, contact the Crisis Text Line: Text HOME to 74174. If you or a loved one are experiencing suicidal thoughts, reach out for help immediately at the National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

Does it feel like you've lost your ability to gain satisfaction and reward from activities you once enjoyed? Do you find it extremely difficult to get motivated? Do you frequently feel “empty” or “numb?” You might be experiencing a condition known as anhedonia. If you’re experiencing anhedonia, understand that you’re not alone. The World Health Organization estimates that approximately 300 million people are experiencing anhedonia as a symptom of depression worldwide. 

For people with anhedonia, basic things you once enjoyed, such as good food, your favorite music, or spending time with friends and loved ones, no longer please you. People with anhedonia don’t always feel sad or notice negative thoughts, but it’s often a symptom of mental health disorders such as anxiety and depressive disorders or bipolar disorder. 

People with anhedonia may sometimes feel like they’ll never feel pleasure or joy again. Still, the symptom is highly treatable with the support of a mental health professional and therapeutic intervention.

What is anhedonia?

Anhedonia, Greek for "without pleasure," is the official term for the inability to feel pleasure in activities you may once have. It can range from mild, such as a dampening of pleasurable feelings, to severe, where it becomes impossible to feel pleasure at all. The term was first coined by Theodule Ribot in 1896 to describe people who had lost interest in hobbies, friends, work, and food. He also found that patients with anhedonia often experienced chronic pain and struggled to experience positive emotions. 

Although there are minor subtypes, two primary types of anhedonia have been identified:

• Physical anhedonia: Physical anhedonia involves a dulling or losing the ability to feel sensory pleasures. Food may taste bland and flavorless; physical touch may be difficult to feel. There may be a loss of interest in sex (this may sometimes be referred to as orgasmic anhedonia). 
• Social anhedonia: Social anhedonia is a loss of interest or engagement in social situations. Social anhedonia may lead to isolation from your friends, loved ones, or partner.

Both types of anhedonia may be present at the same time. To determine which kind of anhedonia a person is experiencing, a mental health professional will perform a thorough evaluation and gather information about the symptoms.

Symptoms related to anhedonia

Anhedonia itself is considered a symptom, not an isolated condition. Other symptoms are often present alongside anhedonia. These symptoms may be caused by anhedonia or be part of the overall condition causing it. They may include:

• Abandoning activities or hobbies that were once enjoyed.
• Withdrawal from friends and loved ones.
• Reduced emotional expression.
• Loss of taste and smell.
• Decreased engagement in conversations.
• Discomfort in social situations.
• Weight fluctuations. 
• Loss of interest in sex
• Physical symptoms like headaches, fatigue, weakness, or body aches

Note: Some people with anhedonia may engage in harmful or risky behaviors in an effort to encourage feeling. These may include dangerous sports and activities, speeding, or unprotected sex. People with anhedonia may be at an increased risk for substance use disorders,  self-injury, and suicide. If you or a loved one are experiencing suicidal thoughts, reach out for help immediately by contacting the National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

The lifespan of anhedonia depends on the person experiencing it and/or the therapies they use to treat it. In most cases, adequately treated anhedonia diminishes shortly after the underlying mental or emotional disorder is treated. That generally takes three to twelve months, with intense psychotherapies and SSRIs if necessary. However, there is no concrete guideline, and each person is different. Also, those with anhedonia sometimes experience a confusing ebb and flow in their symptoms, especially as they subside; therefore, adhering to treatment is vital until you consistently feel pleasure again.

Common causes of anhedonia

Anhedonia is a commonly reported symptom of many mental illnesses and is considered a core symptom of major depressive disorder (MDD). It is also sometimes associated with schizophrenia, Parkinson's disease, and substance use disorders. While not everyone with these conditions will develop anhedonia, its presence can indicate greater severity of other symptoms. Anhedonia can complicate treatment and lead to adverse outcomes, largely because it diminishes the motivation to seek therapy and adhere to treatment.  

Research continues to determine the direct mechanism that causes anhedonia, but it is primarily associated with physiological brain functioning. Based on the brain’s relationship with anhedonia, scientists believe that genetics significantly influences if an individual is likely to develop anhedonia. Other risk factors include but aren’t limited to brain injury, early trauma, major illnesses that affect brain functioning, and substance use disorder.

Also, certain medications may dull the senses, alter hormone balances, or cause uncomfortable side effects that may lead to depression, anxiety, and/or anhedonia symptoms. Speak to a mental health professional if you notice a change in your medication’s side effects.

Treatments for anhedonia

Typically, treatment for anhedonia focuses on improving the condition that causes it. Healing requires a personalized therapeutic approach focused on psychotherapies and physiological intervention if needed. Standard methods include, but aren’t limited to:

Cognitive behavioral therapy (CBT)- The most common form of therapy for a wide range of mental health disorders, CBT can ease the symptoms of anxiety, depression, and bipolar disorder—including anhedonia. 

Behavioral activation- Focuses on scheduling enjoyable activities with the aim of “bypassing” motivation to work towards eventually gaining the beneficial emotions associated with those activities.  

Positive Affect Treatment (PAT)-This developing treatment method involves increasing the brain’s sensitivity to reward by asking patients to systematically recall pleasant life events to emphasize, associate, and reinforce pleasurable feelings.  

Medications- Research indicates that most common antidepressants can help relieve anhedonia. As with most pharmacological interventions in treatment, professionals recommend psychotherapy as the primary treatment method, but your therapist may refer you to a Psychiatrist or Psychiatric Nurse Practitioner if they determine medication is appropriate in your case. 

With therapy, people often begin seeing an improvement in their symptoms after a few treatments. In most cases, anhedonia/social anhedonia goes away within three to six months, but more severe cases may require additional time. The nature of the mental health disorder that presents anhedonia as a symptom may also influence how many therapy sessions are needed.

It’s also important to note that this disorder comes in waves. The ebb and flow of anhedonia may be encouraging to some but discouraging to those trying to heal. Therefore, scientists have been working on better treatments to help those who don’t see a change after using psychotherapy and/or SSRI medication.

Work through anhedonia in online therapy

Because of its bi-directional nature as both a symptom and contributor to mental illnesses like anxiety and depression, anhedonia can profoundly affect the person experiencing it. But it is possible to relieve the numbness caused by anhedonia by treating its underlying cause. If you’re concerned that you may have anhedonia as a symptom of a mental health issue, it’s essential to contact a therapist for help. 

One of the trademarks of anhedonia is a lack of motivation; therefore, some people experiencing it have difficulty attending appointments and keeping up with therapy. Online therapy has proven to be an excellent alternative to in-person treatment in cases like these. With the rise in popularity of online counseling, platforms like Regain make it easier to find a mental health professional with a background in treating anxiety and depressive disorders, bipolar disorder, trauma, and more. 

Virtual therapy allows you to attend appointments with your therapist on a schedule convenient for you from the comfort of your home or anywhere with an internet connection. You can speak to your therapist via online messaging, text, phone, and video chat. Therapy through Regain is also often more affordable than traditional therapy without insurance. 

A growing body of evidence suggests that online therapy is as effective as conventional therapy for treating conditions commonly featuring anhedonia as a symptom. For example, a systematic review of sixty-five publications found that patient satisfaction levels were high with their virtual therapy experience. Clinical outcomes were comparable to traditional therapy for a diverse population receiving different treatments. 

Takeaway

Anhedonia doesn’t have to take away your pleasure in everyday experiences. Scheduling an appointment with a licensed Regain therapist is the first step to feeling better.