Anhedonia: Signs, Symptoms, & Treatments

What Is Anhedonia?

Anhedonia is a complex and multifaceted symptom related to several psychological conditions. Anhedonia has two important parts–the decreased ability to experience pleasure from positive stimuli or situations and an inability to remember past experiences that were pleasurable, exciting, or engaging.¹ Many people may feel withdrawn or detached from relationships and the world.¹

Anhedonia commonly stems from mood disorders like major depressive disorder and bipolar disorder. Someone amid a depressive episode will routinely experience symptoms of low mood, motivation, or interest in activities. All together, these symptoms create the impression of anhedonia.

Anhedonia Vs. Apathy

Anhedonia is a lack of enjoyment or pleasure in usual activities, while apathy is a lack of motivation or emotional energy. The two symptoms can coincide together. However, while someone may have decent energy and motivation to complete tasks, anhedonia makes enjoying these activities challenging.

Types of Anhedonia

Anhedonia can be social, physical, or both. People may experience co-occurring social or physical anhedonia, or symptoms may ebb and flow. In both cases, many feel a sense of emptiness where feelings “should” be. People cannot feel excitement or pleasure, even when they want to.

Social Anhedonia

Social anhedonia refers to feeling numb or empty in relationships. These behaviors may be confused for shyness, introversion, or social anxiety but are entirely different. Someone with social anhedonia may value their relationships and appear talkative or friendly with others, but they cannot experience much pleasure from such interactions.²

Symptoms of social anhedonia include:

• Lack of desire to have relationships
• Limited or no relationships
• Social withdrawal
• Depression
• Dislike of physical affection from others
• Difficulties in social settings
• High levels of autonomy

Physical Anhedonia

Physical anhedonia is a lack of pleasure from physical senses, including touch, sounds, taste, smell, or sight. Every experience may feel “blah,” or the anhedonia might concentrate on one to two senses. A person struggling with physical anhedonia may not enjoy eating or cuddling with their partner.

Symptoms of physical anhedonia include:

• Limited or no desire for physical affection
• Limited reactivity to food
• Dislike or indifference to music
• Feeling bored or disappointed by activities others might consider exciting

What Anhedonia Feels Like

Anhedonia can look very different depending on the person, age, and situation. Someone with anhedonia can present as being lazy or depressed, bored with life, awkward, detached, disconnected, or anxious. However, in reality, they are managing the effects of serious mental health symptoms.^1,3

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. They may display a sharp difference in their thinking patterns and speech. Many frequently complain there is no point to anything, nothing matters, and trying to feel well is pointless.

Other times, individuals with anhedonia may appear apathetic and disinterested in others. They may envy those who enjoy life or view these people as foolish for trying to pursue joy.

Symptoms of Anhedonia

Many facets and characteristics make up anhedonia. Anhedonia restricts the ability to feel happy and function at expected levels as it zaps energy, shrinks motivation, and eliminates feelings of joy.

Common and impactful symptoms connected to anhedonia include:^1,3

• Lack of motivation: The low motivation associated with anhedonia applies to all activities, not only those challenging or unfun. Many people feel unable to maintain basic self-care and hygiene.
• Relationship changes: Anhedonia will remove all interest in relationships. Individuals may spend less time with friends or lose social contact altogether.
• Undesirable self-perception: Those with anhedonia may lose the ability to feel good about themselves.
• Reduced emotional range: Some people experience emotional high highs and low lows. However, people with anhedonia often report very narrow ranges with consistent feelings of apathy and indifference.
• Reduced emotional identification: People with anhedonia may feel something significant but cannot label or describe the emotion, which can be frustrating for themselves and their loved ones.
• Lack of sexual interest: Depression often decreases libido and sex drive. Anhedonia seems to fuel this reduction.

Examples of Anhedonia

Anhedonia affects everyone differently, but many individuals often report feeling numb or absent from their lives. Things may seem “flat,” even if things are going well. Those with anhedonia lack emotions in response to positive events or stimuli.

Living with anhedonia can look like:

• You used to love going on date nights with your spouse but have lost interest.
• You no longer look forward to work, even though you once found your job meaningful and rewarding.
• You want to continue your hobbies but no longer find them enjoyable.
• You remain present for your child but don’t feel connected to their joy or happiness.
• You go on vacation but are not excited once you’re there.

What Causes Anhedonia?

Researchers and clinicians are interested in learning more about the causes and triggers of anhedonia because the underlying issues affect treatment approaches and outcomes. To this point, experts have discovered consistent links between anhedonia and brain activity in several areas.

Changes in Brain Activity

Anhedonia seemingly affects the ventral striatum and prefrontal cortex in the brain. People with anhedonia display higher brain activity in the prefrontal cortex than those without symptoms. Conversely, anhedonia decreases activity in the ventral striatum.⁴

When combined, these aspects influence perceptions of risks and rewards. For example, a person will not be motivated to complete a job interview, attend a party with friends, or make a phone call because they can only imagine the possible risks and unfavorable outcomes.

However, determining if anhedonia causes or results from these brain changes is impossible.

Environmental Factors

Environmental issues commonly linked to depression and other mental health conditions could also influence anhedonia onset. Those with histories of trauma, abuse, or family dysfunction may be at a higher risk for anhedonia.¹

Additionally, parental or personal substance use could also impact the presentation of anhedonia. For instance, opioids or stimulants disrupt normal brain functioning. Furthermore, anhedonia can occur and last for months with intoxication or withdrawal.¹

What Conditions Cause Anhedonia as a Symptom?

While anhedonia often stems from depression and other mood disorders, these conditions are not the only possible sources. Anhedonia also frequently occurs with schizophrenia and substance use.

For example, those with schizophrenia often feel disconnected from the world and others. They may note symptoms like tactile hallucinations, patterns of delusional thinking, and disorganization alongside anhedonia.¹

With substance use disorders, anhedonia can emerge sporadically for various reasons. Someone misusing opioids may experience symptoms of anhedonia while intoxicated because these drugs influence their body, thinking, and motivation. Moreover, prolonged anhedonia may occur when substance use ends and withdrawal begins.¹ Some may go months without experiencing normal happiness, motivation, and pleasure.

Similar experiences may transpire with stimulants like cocaine and methamphetamine. Intoxication creates increased excitement and energy levels, leaving individuals demotivated, unhappy, and emotionally blunted when consumption ends.¹

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

Can Anhedonia Go Away on Its Own?

Anhedonia symptoms can fluctuate, and they may dissipate on their own. However, symptoms can progressively worsen when accompanied by depression, schizophrenia, or other serious mental health conditions.

How Is Anhedonia Diagnosed?

A mental health provider may test for anhedonia with assessments like the Snaith-Hamilton Pleasure Scale. They might also assess for depression with Beck’s Depression Inventory. That said, anhedonia is merely a symptom of depression and is therefore not a diagnosis of its own.

Treatment of Anhedonia

A provider cannot only treat anhedonia. Instead, professionals must work to understand and address the condition resulting in symptoms with a treatment plan that includes psychotherapy and medication management. A person can also explore lifestyle changes to keep anhedonia symptoms low to supplement professional options.

Therapy

Psychotherapy involves meeting with a mental health clinician to address and resolve problematic symptoms. Clients often sit and speak with trained professionals face-to-face. However, receiving treatment for anhedonia can also occur online, including phone, text, and video conferencing options. Various types of mental health professionals offer helpful services at schools, community agencies, doctors’ offices, and in the home.

Therapy for anhedonia aims to identify aspects of the symptom, understand the underlying condition, and establish coping skills to help mitigate negative experiences. Still, therapy is not a “one-size-fits-all” scenario. Beneficial forms of treatment fit the exact needs and abilities of the individual in treatment.

Therapies used to treat anhedonia may include:⁵

• Cognitive behavioral therapy (CBT): CBT explores the connection between thoughts, feelings, and behaviors. Clients can move away from anhedonia by learning new self-talk and behavioral strategies.⁵
• Acceptance and commitment therapy (ACT): ACT works to find the balance between mindfully accepting what cannot change and committing to behavioral changes. ACT may encourage people to modify aspects of anhedonia through action and coping skills.
• Dialectical behavioral therapy (DBT): DBT helps people identify and manage their feelings through mindfulness, communication, distress tolerance, and emotional regulation.
• Interpersonal therapy (IPT): IPT may reduce anhedonia by nurturing healthy relationships.

Anhedonia Medication

Medications will be an important part of the treatment plan because anhedonia often connects to depression, schizophrenia, substance use, and personality disorders. Professionals may prescribe selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or antipsychotic medications.⁶

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 the best outcomes.

Alternative Anhedonia Treatments

In addition to therapy and medication, new treatment advances may help people struggling with anhedonia. Professionals may combine these methods with other approaches, as with treatment-resistant depression.

• Electroconvulsive therapy (ECT): ECT uses electrical stimulation to create a brief brain seizure intended to reduce mental health symptoms
• Transcranial magnetic stimulation (TMS): TMS uses magnetic fields for nerve cell stimulation, possibly positively affecting brain activity.
• Vagus nerve stimulation (VNS): VNS electrically stimulates the brain and may be recommended for depression.
• Ketamine: Ketamine may help reduce depressive symptoms and improve overall quality of life.

How to Cope With Anhedonia

Therapy and medication can greatly benefit a person with anhedonia, but lifestyle changes can also help drastically improve their health and well-being. No one should have to settle for a life marked by the lack of joy and inability to seek rewards. Anyone currently experiencing symptoms should seek professional treatment immediately.

Below are healthy ways to cope with anhedonia:⁷

Adjust Your Thoughts

Anhedonia can create distorted thinking patterns that almost always sound reasonable in the moment. To confront these troublesome thoughts, work to detect the issues, debate their accuracy, and decide on a better approach.

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

Search for Meaning

Anhedonia will remove all inspiration, happiness, and motivation, but the search for meaning must continue. Individuals can fight apathy by seeking purpose and fulfillment through volunteering, community engagement, or religious activities.

Prioritize Physical Health

A person with anhedonia may find eating well, exercising, and resting challenging. Devote more attention and energy to your physical health to combat symptoms. These behaviors may not erase anhedonia but can positively impact how you feel.

Avoid Isolation

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

Avoid Negative Coping Mechanisms

Another crucial step is avoiding the allure of negative coping skills. Negative coping skills, like overeating, having unsafe sex, or drinking alcohol, may seem like a cure for anhedonia. However, they only worsen symptoms. Steering away from these and opting for healthy lifestyle changes will lead to long-term gains.

Final Thoughts

Getting help for anhedonia starts with recognizing that having no joy, happiness, and hope for the future is atypical. Individuals should pursue treatment from every available provider until they find an effective treatment.