Anhedonia: Meaning, Symptoms, & Treatment

It seems to me, at times, like he is ritually reminding himself of all the things he is capable of, almost as if he is trying to make himself feel worse. After all, the alternative would be that he goes out and acts on all that awareness—but he just can’t quite seem to find the motivation.

What is causing this lack of motivation? Frankly, my friend has a hard time imagining getting any enjoyment out of the activities he used to regularly engage in. He seems to be experiencing a prolonged period of anhedonia. Let’s take a look at what anhedonia means, so we can better understand what it looks like and how you can help somebody experiencing it.

The most common and simplest definition of anhedonia is a reduction in or absence of experiencing pleasure (Ho & Sommers, 2013). This, however, might be too simple, as most of the time the term is used in reference to specific behaviors not resulting in pleasure. There are few people who are actually experiencing no pleasure at all in their lives; the friend I just mentioned, for example, finds eating cookies as pleasurable as ever. When I say he is experiencing anhedonia, then, I might mean either or both of these things: He may be enjoying all activities, including the consumption of cookies, less than he usually does, and/or he may have lost pleasure in certain activities that are important to him.

So in this sense there is a continuum of anhedonia. Where most people are experiencing just as much pleasure as they usually do, others are experiencing less overall pleasure than usual and/or are not enjoying their preferred activities, and some people are experiencing no pleasure at all (Loas et al., 1994). It is important to note that this lack of pleasure does not mean they are experiencing any less—or any more—of the other emotions they typically experience. In other words, anhedonia is not the absence of all feelings altogether, nor is it something that results from an inability to express one’s emotions (Lee et al., 2011). In fact, many people experiencing anhedonia have plenty of challenging emotions that they are working through.

On that note, we study anhedonia because reductions in or absence of pleasure are a common symptom in several psychiatric disorders. These include major depressive disorder, schizophrenia, substance use disorders, and chronic pain, as a meta-analysis looking at 16,000 individuals who had completed an anhedonia measure found (Trøstheim et al., 2020). This does not mean that every person with any one of these disorders will definitely be experiencing anhedonia, but it does mean that such a diagnosed person is at higher risk of experiencing anhedonia than the typical person without any of those disorders.

Anhedonia & Depression
That said, anhedonia is a core symptom particularly of major depressive disorder (Treadway & Zald, 2011), although it looks different from one person with depression to the next. This may be because the way we usually think about anhedonia does not give enough consideration to the difference between experiencing pleasure and experiencing motivation. We get pleasure not just by having something we want but just as much by envisioning it and trying to pursue it.

In other words, some people may not enjoy things the way they used to, but other people may not anticipate enjoying things the way they used to (Treadway & Zald, 2011). How excited are you to try something you are pretty certain you will find dull or disinteresting? Now imagine that you’re feeling that way about most things, or that a passion of yours has suddenly become boring to even consider. That’s how some people experience anhedonia.

One domain where anhedonia can strike in particularly painful and debilitating ways is in people’s social lives. Social anhedonia is the lack of interest in and enjoyment of social interactions (Barkus & Badcock, 2019). The pattern looks similar for most people with social anhedonia: They get less pleasure from spending time with others, so in time they start to withdraw from their social connections. And with more time, it becomes harder for them to actually ​socialize because they have lost the motivation to stay engaged. Perhaps you can imagine what a vicious cycle this is, as people who get reduced social interaction often end up feeling lonely and depressed in general.

In the people I have watched go through anhedonia, what is most striking is their lack of activity. They have such a hard time getting energized to do much of anything that they end up kind of just hanging around their home or apartment. Often, they lose hours to scrolling through social media or reading random articles on the internet. At the end of these sessions, a lot of time has passed, but they have experienced little pleasure and often feel even worse than they did before.

Anhedonia is not the same as depression, but it is one of two core symptoms of depression. To be diagnosed as being in a depressive episode, a person must have experienced a depressed mood or symptoms of anhedonia most of the day nearly every day for at least two weeks. Anhedonia has been central to our understanding of depression for many years (De Fruyt et al., 2020), as psychologists long ago recognized that some people fit the profile of depression in terms of having every other symptom but a depressed mood. It did not seem right to deny these people a depression diagnosis, especially when their anhedonia was pretty impairing.
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Thus, anhedonia is one of the first symptoms that pops to mind when a clinician gets the sense that their client might be experiencing depression. Clinicians carefully assess whether the client enjoys their life much less than the average person or whether they have recently started to get far less enjoyment from life than they used to.

Finally, people with anhedonia may be experiencing abnormalities in the neurotransmitters in their brains. This may be treated with medication, although it is more effective for some people with anhedonia than for others (Sandman & Craske, 2022). As is often the case with mental health challenges, both medication and another therapeutic intervention may be needed for optimal outcomes.

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• Loas, G., Salinas, E., Pierson, A., Guelfi, J. D., & Samuel-Lajeunesse, B. (1994). Anhedonia and blunted affect in major depressive disorder. Comprehensive Psychiatry, 35(5), 366–372.
  
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• Trøstheim, M., Eikemo, M., Meir, R., Hansen, I., Paul, E., Kroll, S. L., . . . & Leknes, S. (2020). Assessment of anhedonia in adults with and without mental illness: a systematic review and meta-analysis. JAMA Network Open, 3(8), e2013233–e2013233.