Anhedonia

"You feel like you're alive, but you aren't living."


What is anhedonia?

Anhedonia is described as a reduced ability to experience pleasure. It is often a key symptom of depression and other mental health diagnoses, but can also present on its own. It is often noted as a marked change in things that used to bring pleasure that no longer spark a response. People have indicated feeling numb, empty, or detached. This can lead to a loss of belonging and questioning one's purpose. Everything may feel like a huge laborious task, from brushing your teeth to taking part in something that used to bring you joy.

It is incredibly painful to live life gray rather than in colour. People aptly stated that anhedonia being akin to living life as a human zombie; being lifeless and no feelings of enjoyment. Anhedonia can vary greatly person to person, but there is oftentimes a generalized numbness to the world around you.


Causes of anhedonia

Anhedonia is often an important symptom of depression. It can also be apart of mental health disorders such as schizophrenia, psychosis, substance use disorders, grief, post-trauma stress disorder, and eating disorders. Those with chronic health diagnoses have also found to experience anhedonia. Though we do not have a clear cut answer of the physiology, research suggests that the decrease in dopamine is the cause of anhedonia.


Types of anhedonia

There are 2 main categories of anhedonia:

Physical anhedonia is described as the decrease in experiencing joy from physical sensations. This can include daily activities such as eating and physical touch/intimacy.

Social anhedonia is the reduced ability in experiencing joy from others. This results in less socialization and can lead to isolation.


What are the signs to look out for?

- Decreased interest engaging with others

- Isolation

- flat emotions

- Lack of energy and motivation

- inability to feel excitement

- Decreased libido

- fatigue

- Withdrawal from emotional/physical intimacy

- Suicidal ideation, fixation with death

- lack of motivation

- Difficulties getting help

- Frequently feeling unwell

- Feelings of hopelessness

- Suicidal thoughts


Can anhedonia be dangerous?

Anhedonia is known to be very exhausting but can be a danger should the emotional detachment reach a certain level. This can result in dissociation, where you may feel disconnected from your environment. This can lead to maladaptive coping strategies where you may take part in risky activities to "feel alive." When this is self-harm or there is an increase of risk, we become concerned about safety, as anhedonia can also impair one's decision-making ability. If you are experiencing any suicidal ideations or self-harming thoughts, please contact your local crisis line or present to your local emergency department.


What is the treatment for anhedonia?

Speaking to your primary care provider is going to be the best next step. They will likely rule out any organic possibilities through bloodwork. Your PCP will also investigate with you underlying conditions that are causing this lack of pleasure. Should it be mental health related, they will be able to refer you to a mental health professional that may be able to do a complete assessment and may diagnose (often a psychiatrist or psychologist). They will then help you find the correct path to treatment to reactivate you; whether that be therapy, lifestyle changes, medication, mindfulness or a combination.


How can I cope with anhedonia?

It is important to remember that anhedonia is a serious symptom that can be extremely draining. It can be incredibly difficult to motivate yourself and get help. Trying to maintain a schedule to your best ability may help in developing a routine. Your schedule does not have to be chock-full, nor do you need to have many laborious tasks; it simply must have attainable goals for yourself. If you have a large task to do, do not be scared to break it down into bite-seized pieces. Whether it be attending to your self-care or working slowly towards your goals, make sure your daily to-do list is achievable.


Resources:

Grillo L. Might the inability to feel pleasure (anhedonia) explain the symptoms of major depression and schizophrenia, including unmotivated anxiety, delusions and hallucinations? Med Hypotheses. 2012 Jan;78(1):98-101. doi: 10.1016/j.mehy.2011.10.002. Epub 2011 Oct 27. PMID: 22036091.

Anhedonia: What to do when you’ve lost your joy. (n.d.). Depression Alliance. Retrieved from https://www.depressionalliance.org/anhedonia/#Lack_of_Relationships

Watson, R., Harvey, K., McCabe, C. et al. Understanding anhedonia: a qualitative study exploring loss of interest and pleasure in adolescent depression. Eur Child Adolesc Psychiatry 29, 489–499 (2020). https://doi.org/10.1007/s00787-019-01364-y



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