Anhedonia may not be a term you’ve heard before, but there’s a high probability that you’ve experienced it. Periods of acute inability to derive pleasure from taking part in “pleasurable” activities are common. Chronic (prolonged) anhedonia is less common. In this piece, we’ll discuss what anhedonia is, its causes, its treatments and how to proceed if you think you may be experiencing it.
What Is Anhedonia?
Anhedonia is an interesting name for a symptom that most people are familiar with. It describes a particular feeling when a person is no longer able to feel pleasure or fulfillment, typically during a time or an activity when they would be expected to.
There are two types of anhedonia:
Physical anhedonia, when physical sensations that previously brought pleasure — sex, exercise or eating a food that you enjoy — no longer spark happiness.
Social anhedonia, in which you no longer feel rewarded from being part of a community or spending time with a group of friends.
What Causes Anhedonia?
Anhedonia can be caused by or linked to a wide variety of different factors, but there are two that are most commonly credited. One is long-term substance abuse. Many people who struggle with addiction find that the condition causes them to keep using their drug of choice out of compulsion, rather than desire. Over time, this causes the pleasure — the euphoria that initially helped form dependence — to be stripped away from the practice of using drugs.
Another companion to anhedonia is severe clinical depression. People who suffer from depression typically can no longer find the motivation to perform their daily routines. Part of the reason for this is that the rewarding feeling of accomplishment is removed from the most basic practices of living, which can act cyclically to worsen depression and contribute to suicidal thoughts and urges.
Interestingly, some research suggests that anhedonia bridges the gap between certain behaviors and the development of major depressive disorder. Anhedonia can also be a side effect of a variety of different medications, prescribed to treat a range of conditions.
The Neurological Pathways of Anhedonia
Anhedonia is common in patients being treated for substance abuse and other behavioral health conditions. The main reason for this is the set of processes that the brain undergoes when it’s controlled by a substance or behavior.
Addiction can form from many different circumstances, but the initial process looks very similar in the majority of cases. It’s about why, exactly, a person continues to use a specific substance or perform an activity until they’re dependent on it. In this sense, it doesn’t make a difference what that behavior — sex or gambling, for example — or the substance actually is.
The reason can be traced back to the source of pleasurable feelings in the brain: dopamine.
What Is Dopamine?
Dopamine is a chemical that’s naturally produced by the brain, and it’s linked to the neurological pathways of risk and reward. People are motivated to take certain actions based on the way their brain is going to make them feel. Even something seemingly unpleasant — a chore like taking out the trash, for example — is done to experience the dopamine release of living in a clean, pleasant-smelling environment.
The problem with addiction is that it rewires the brain’s decision-making pathways. Addictive substances and behaviors prompt the release of a larger-than-normal amount of dopamine, which causes feelings of euphoria. Those feelings make people want to keep doing the action in question. Over time, the influence of the drugs takes precedent over the brain’s natural risk-reward process. As the user becomes physically and mentally dependent on a substance to function, they experience more severe and regular anhedonia because when the brain is constantly flooded with dopamine, it’s desensitized to it.
Mental Health and Anhedonia
The causes of anhedonia when it’s linked to depression are less clear, but research suggests that it’s similarly related to a dysfunction in the brain’s dopamine pathways. Rather than some influence causing dopamine to be released in amounts that are too large to be sustainable, depression and several other mental health conditions involve the relative inability to create dopamine at all.
Other mental health conditions that can prompt or result in anhedonia include:
- Post-Traumatic Stress Disorder: In PTSD, the brain releases high levels of cortisol — the chemical associated with stress — which is linked with dysfunction in the neural pathways responsible for pleasure.
- Bipolar Disorder: This condition is marked by manic episodes in which the brain is overactive and creates an elevated level of dopamine in response to stimuli and depressive episodes in which anhedonia is a primary symptom.
Anhedonia is also a sign of schizophrenia and social anxiety, as well as some seemingly unrelated diseases such as Parkinson’s and diabetes.
Is Anhedonia Reversible?
The good news is that, in most cases, anhedonia will go away with treatment. For cases in which addiction is the leading cause, anhedonia may go away with sobriety. As a general rule, treating the accompanying condition will generally lessen anhedonia because it doesn’t typically happen on its own.
What If I Have Anhedonia?
If you’re experiencing the inability to feel pleasure, it may be a sign that you’re experiencing a mental or behavioral health condition. If you use drugs or alcohol heavily, anhedonia may be a sign that it’s time to seek professional help. A productive first step is to meet with a professional who can help you identify the source of the issue.
If your anhedonia is caused by something underlying, it may take more exploration and treatment to solve. One way to identify anhedonia is with a brain scan — typically, a brain that is able to experience pleasure will exhibit more electromagnetic activity than one that isn’t. Standard psychotherapy may be able to help you understand the source of your issue. Some studies also show that it may be a part of an effective treatment for anhedonia.
Treatment using antidepressants (or even ketamine, an experimental but promising treatment for depression) can also treat some underlying factors of anhedonia.
For obvious reasons, anhedonia can cause you to feel hopeless about your life, which can worsen feelings of depression or the experience of substance abuse issues. The condition is likely being caused by another condition, and while this may seem more complicated, what it actually means is that it’s treatable.
The addiction and mental health treatment specialists at FHE Health can help. Contact us today to learn about your options.