Anhedonia: Signs, Symptoms, & Treatments

Signs of Anhedonia: What It Looks Like

Depending on the person, their age, and their situation, anhedonia can look very different. Someone with anhedonia can present as being lazy or depressed, bored,  awkward, detached, disconnected, or anxious, but in reality, they are managing the effects of a serious mental health symptom.^1,2

A person with anhedonia may struggle to show interest in friends, engage in hobbies, complete responsibilities at home, or even leave the house. Their behaviors and actions will be slowed and strained.

When a person has anhedonia, they will display a sharp difference in their thinking patterns and speech. They may frequently complain that there is no point to doing anything, nothing matters, and trying to feel well is pointless.

People with anhedonia will generally appear apathetic and disinterested in what other people are doing. They may look at people who enjoy life with jealousy, or they may think other people are foolish for trying to pursue joy.

Mental health disorders frequently present in unique ways with children.

Signs of anhedonia in children include:^1,2

• Increased defiance and irritability
• Appearing lazy and unmotivated in school work or chores
• Isolating and withdrawing from friends and family
• Shifting away from activities and interests they once enjoyed
• Being more pessimistic and being unable to see good in the future

Likewise, identifying signs of anhedonia in an older adult may be challenging because some aspects of anhedonia may seem like normal signs of aging.

Signs of anhedonia in older adults include:^1,2

• Less energy and activity
• Contracting social networks and spending less time with friends
• Lower energy levels
• Leaving home less often
• Struggling to remember good times

Whether the person is a child, adult, or older adult, these symptoms are troubling and speak to a greater concern. By recognizing and addressing anhedonia, the person can feel better and discover joy again.

Symptoms of Anhedonia

Though it is a symptom of larger mental health conditions, many facets and characteristics make up anhedonia. As anhedonia zaps energy, shrinks motivation, and eliminates feelings of joy, the condition restricts a person’s ability to feel happy and function at expected levels.

Some of the most common and impactful symptoms connected to anhedonia include:^1,2

Lack of Motivation

The low motivation is so powerful that it applies to all activities, not only the challenging or unfun ones. People often do not even have the motivation to complete basic self-care and hygiene.

Relationship Changes

Whether it is fewer relationships, less time spent with friends, or a complete lack of social contact, anhedonia will remove all interest out of relationships.

Undesirable Self-Perception

Referred to as self-esteem, self-worth, self-respect, and confidence, the ability to feel good about oneself decreases with anhedonia.

Reduced Emotional Range

Some people feel high highs and low lows, but people with anhedonia will experience a very narrow emotional range with consistent feelings of apathy and indifference.

Reduced Emotional Identification

People with anhedonia may be feeling something significant, but they will be unable to label the feeling or describe it fully, which can be frustrating for themselves and their loved ones.

Lack of Sexual Interest

Libido and sex drive typically become reduced when depression increases. Anhedonia seems to fuel this reduction.

New or Worsening Physical Symptoms

People displaying signs and symptoms of anhedonia may also note increased physical illness and periods of sickness.

All anhedonia symptoms fit into one of two categories:²

1. Social anhedonia – all symptoms that influence relationships, isolation, and social contacts
2. Physical anhedonia – occurs when people cannot experience the wanted level of pleasure from physical sources like food, sex, and comfort

Some people may have both social and physical anhedonia while others may only exhibit symptoms of one. One type is not necessarily worse or better, but they each offer unique stressors and complications.

Causes & Triggers of Anhedonia

The presence of anhedonia can dictate the degree of depression and its response to treatment, so researchers and clinicians are interested in learning more about the causes and triggers of anhedonia. To this point, experts have discovered consistent links between anhedonia and brain activity in several areas.

Anhedonia seems connected to parts of the brain called the ventral striatum and the prefrontal cortex. In the former, people with anhedonia display lower levels of brain activity when compared to people without anhedonia. In the latter, there is much more activity than the typical person.³

Though these parts of the brain are complex, they are responsible for important daily living aspects like:²

• Motivation
• Reward
• Feeling, identifying, and processing emotions
• Decision making
• Self-awareness

When combined, these aspects influence the person’s perceptions of risks and rewards. When a person sees too many risks and not enough reward, they will not have the motivation to attempt a job interview, a party with friends, or even a phone call because they can only imagine the possible risks and negative outcomes.

Like so many other physiological issues with the brain, it is impossible to say if anhedonia causes these brain changes or if these brain changes cause anhedonia.

Environmental issues commonly linked to depression and other mental health conditions could also factor into anhedonia presenting.

Some situational triggers and causes of anhedonia include:¹

• History of sexual, emotional, or physical abuse
• Trauma
• Family chaos and inconsistency
• Unsafe living conditions
• Parental substance use disorders

Ongoing substance use could also impact the presentation of anhedonia. A person who uses opioids or stimulants will be disrupting the normal functioning of the brain by limiting or overstimulating, depending on the substance, the parts of the brain mentioned earlier. With intoxication or withdrawal, anhedonia can occur and last for months.¹

Anhedonia and Co-Occurring Disorders

Anhedonia may be closely linked to depression and other mood disorders, but these conditions are not the only source. Anhedonia frequently occurs with disorders across the spectrum of mental health from schizophrenia to substance use. Although the disorders are all unique, the anhedonia will present consistently.

Schizophrenia, for example, is a severe mental health disorder that involves the individual being disconnected from the world around them. Someone with schizophrenia will often note symptoms like auditory, visual, or tactile hallucinations, patterns of delusional thinking, and disorganization, but they may  also report anhedonia.¹

With substance use disorders, anhedonia can emerge at various times for various reasons. When a person is using  opioids they may experience symptoms of anhedonia while intoxicated as the drugs influence their body, their thinking, and their motivation. With opioids, people can experience long periods of anhedonia when their substance use ends and withdrawal begins.¹ During this period of extended withdrawal, people might go months without experiencing normal levels of happiness, motivation, and pleasure in life.

Similar experiences may transpire with stimulants like cocaine and methamphetamine. The intoxication with these substances creates such high levels of excitement and energy that when they wear off, the person will feel demotivated, unhappy, and emotionally blunted.¹

Lastly, personality disorders, like avoidant personality disorder, could lead to signs of anhedonia as they detach from friends, family, and society. People with this condition may feel no sense of reward from social interaction, so there is no reason to proceed with the practice.¹

Treatment of Anhedonia

Because of anhedonia’s connection to numerous mental health conditions, a provider cannot only treat the symptom. Instead, professionals must work to understand and address the condition that anhedonia is connected to with a treatment plan that includes psychotherapy and medication management. To supplement the professional options, a person can also explore lifestyle changes to keep anhedonia symptoms low.

Therapy

Psychotherapy involves meeting with a mental health clinician to address and resolve problematic symptoms. Therapy usually involves the practice of sitting and speaking with a trained professional face-to-face, but with changing needs and technologies, there are many ways to receive psychotherapy for anhedonia, including phone, text, and video conferencing options.

A number of mental health professionals, like psychologists, psychiatrists, social workers, and counselors, offer helpful services at schools, community agencies, doctors’ offices, and in the home.

Though it frequently looks different, therapy for anhedonia will work to:

• Identify aspects of the symptom
• Understand the underlying condition
• Reinforce the importance of physical health on mental health issues
• Inform and educate the individual regarding the presence of anhedonia
• Enhance established coping skills like relaxation and communication techniques
• Teach new mental health strategies to diffuse symptoms

Therapy is not a “one-size-fits-all” scenario. The most beneficial forms of therapy are ones tailored to the exact needs and abilities of the individual in treatment.

Common Type of Therapies

Cognitive behavioral therapy (CBT) will be a popular style for many sources of anhedonia. CBT is frequently successful when treating depression, other mood disorders, substance use disorders, and even schizophrenia, so chances are good someone with anhedonia will have a trial of CBT.⁴

CBT works by exploring the connection between thoughts, feelings, and behaviors to recognize the power of negative thinking and defeating behaviors. By learning new self-talk and behavioral strategies, the person can begin moving away from anhedonia.

Some other therapies used with anhedonia include:⁴

• Acceptance and commitment therapy (ACT): ACT works to find the balance between mindfully accepting what cannot change and making commitment to behavioral changes. ACT may encourage people to accept aspects of anhedonia while modifying what they can through action and coping skills.
• Dialectical behavioral therapy (DBT): With focus on mindfulness, communication, distress tolerance, and emotional regulation, DBT helps people identify and manage their feelings.
• Interpersonal therapy (IPT): By investigating and changing a person’s communication styles, IPT helps reduce anhedonia by nurturing their healthy relationships.

Intended Treatment Outcome & Timeline

With sound therapeutic techniques, symptoms linked to anhedonia could shrink in as little as 12 weeks with CBT or IPT, depending on the condition and the person’s adherence to treatment. Progress varies greatly, so people should also practice patience and understanding during the therapy process.⁴ Anhedonia associated with schizophrenia or a personality could take much longer to resolve.

With anhedonia, the goals of treatment will include reversing the impact of the condition and:

• Renewing interest and passion for activities
• Maintaining old and building new relationships
• Finding and exploring simple pleasures
• Feeling optimistic and invested in the future

Medication: What Is Prescribed for Anhedonia?

With anhedonia connected to depression, schizophrenia, substance use disorders, and personality disorders, medications will be an important part of the treatment plan. Fortunately, the same types of medications may be helpful to improve the symptom, no matter the source.

Medications, prescribed by psychiatrists, nurse practitioners, physician assistants, and primary care doctors (PCPs), commonly recommended for anhedonia include, but are not limited, to antidepressants and antipsychotics like:⁵

Selective serotonin reuptake inhibitors (SSRIs) including:

• citalopram (Celexa)
• escitalopram (Lexapro)
• fluoxetine (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)

Serotonin norepinephrine reuptake inhibitors (SNRIs) including:

• desvenlafaxine (Pristiq)
• duloxetine (Cymbalta)
• levomilnacipran (Fetzima)
• venlafaxine (Effexor)

Antipsychotic medications used in schizophrenia and some cases of depression including:⁶

• aripiprazole (Abilify)
• clozapine (Clozaril)
• paliperidone (Invega)

Like with other medications, a person may not see the desired results at the beginning of treatment. The patient should always practice patience and keep the lines of communication clear and open with the prescriber for best outcomes.

Lifestyle Changes

Professional interventions like therapy and medication can provide incomparable assistance to a person with anhedonia, but there are some non-professional lifestyle changes a person can make to drastically improve their health and well-being.

Some of the most helpful lifestyle changes for anhedonia include:⁷

Adjusting Thoughts

A person with anhedonia is bound to have distorted thinking patterns, but they will almost always sound reasonable in the moment. To confront these troublesome thoughts, a person should work to detect the issues, debate their accuracy, and decide on a better thought.

Searching for Meaning

Anhedonia will remove all inspiration, happiness, and motivation from a person, but the search for meaning must continue. A person can fight apathy by seeking out purpose and fulfillment with options like volunteering, community engagement, or religious activities.

Prioritizing Physical Health

With anhedonia in place, a person may find it challenging to eat well, exercise, and get good rest. To reduce this risk, people should try to devote more attention and energy to their physical health. It may not erase anhedonia, but it can make a positive impact.

Avoiding Isolation

A central feature of anhedonia is the desire to pull away from friends and family. Recognizing this tendency is crucial so that the person can make a concerted effort to build and maintain relationships.

How to Get Help for Anhedonia

Getting help for anhedonia starts with a person recognizing that having no joy, no happiness, and no hope for the future is atypical. Once a person makes that realization, they should pursue treatment from every available provider until effective treatment is established.

Some of the best ways to find help for anhedonia include:

• Discussing the concerns with your primary care provider
• Phoning the nearest mental health agency
• Calling the mental health treatment number on the back of your insurance card
• Consulting with a friend who has mental health experience
• Contacting a national or local treatment hotline

How to Get Help for a Loved One

Getting mental health treatment for a loved one is complicated, since you cannot force a person to seek mental health treatment in most situations. Because of this, addressing the situation from a stance of kindness, support, and understanding will be ideal.

Never lash out against your loved one with anger or hostility as these emotions will only create defensiveness. Let them know your concerns in a respectful way and present them with some options for professional treatment.

How to Get Help for a Child

Children with anhedonia will need even more love and compassion as an adult. Even though parents may be able to initiate treatment for their children, caution is essential. Forcing someone into treatment could harm the relationship and harm the process.

You could consider framing treatment as a positive event, rather than a punishment, to encourage participation. Rewarding the child for attendance and openness could increase motivation to continue the services.

Anhedonia Statistics

As a mental health symptom, anhedonia occurs frequently, but it is not often studied individually. With this being the case, there are limited statistics related to the symptom.

The available anhedonia statistics show:⁸

• Nearly 37% of people with depression experience highly significant levels of anhedonia
• About 45% of people with schizophrenia experience highly significant levels of anhedonia

Living with Anhedonia: Coping & Managing Symptoms

No one should have to settle for a life marked by the lack of joy and inability to seek rewards that anhedonia is known to bring. Anyone who is currently experiencing the symptoms, or feels that the symptoms may present in the future, should seek out professional treatment immediately.

One of the best coping skills someone with anhedonia can develop is accurate self-monitoring, which is the practice of attending to one’s own thoughts, feelings, and behaviors. Through self-monitoring, a person can begin to identify anhedonia, and its triggers, sooner.

Another crucial step is to always avoid the allure of negative coping skills. Negative coping skills, like overeating, overspending money, having unsafe  sex, drinking alcohol, and using other substances, may seem like a cure for anhedonia, but they only worsen symptoms with time. Steering away from these and towards healthy lifestyle changes will lead to long-term gains.