Anhedonia: When Nothing Feels Good Anymore

Even as the general public has gained a better understanding of mental health issues like depression and anxiety over recent years, some psychological symptoms remain a mystery to many. Case in point: anhedonia.

Defined as "a psychological condition characterized by inability to experience pleasure in normally pleasurable acts," anhedonia refers to the absence of good feelings someone might expect from things and activities they once enjoyed, like friendship, food, sex or music.

"Anhedonia is the lack of experiencing joy or pleasure," Los Angeles-based psychotherapist, Alyssa Mass, MFT, writes via email. "It's typically thought of as a symptom of depression or dysthymia, though it can also exist separately from either."

In addition to depression, anhedonia can accompany other mental health issues like schizophrenia, anorexia nervosa and substance abuse disorders. It can also signal issues like Parkinson's disease. For some people, anhedonia can be social (meaning they no longer feel joy being around people) or physical (meaning sensations like touch can feel empty or food can taste bland).

"It means lack of experiencing joy and can range from emotional joy — like the feeling from a hug or some kind of human connection — to even just senses, like taste, hearing etc.," Mass says.

What Causes Anhedonia?

The causes of anhedonia can vary, and while it's associated with depression, a person doesn't necessarily have to have depression to have anhedonia. Experts believe anhedonia may be linked to changes in brain activity and an inability to produce or respond to a "feel-good" hormone, dopamine.

Some research (performed on rats) indicates that anhedonia may be tied to an overactive prefrontal cortex, impacting the dopamine neurons and interfering with the pathways that control how and why we seek out and experience desire and rewards. Other research indicates that other brain areas and structures like the amygdala (which processes emotion), striatum (associated with the reward system), and the insula (connected to self-awareness and consciousness), could also be involved in anhedonia.

While there's no single way to treat anhedonia, many mental health experts often lean on strategies prescribed for depression, including talk therapy and in some cases, medications like selective serotonin reuptake inhibitors (SSRIs). There is, however, evidence to suggest that SSRIs "do not adequately address motivational and reward-processing deficits in depression." One 2014 study found that ketamine "rapidly reduced the levels of anhedonia" in people with treatment-resistant bipolar disorder, but more research is needed to understand the positive and negative implications of medications on the issue.

For now, mental health experts are continuing to incorporate anhedonia assessment into their work with clients and working with them to find coping strategies.

"In cases of depression — long or short term — I always screen for anhedonia," Mass says. "If a client screens positive for it, then it's really about looking at everything that's going on and treating the depression as a whole. Until there is relief from that, it's impossible to tell if the anhedonia is part of the depression or something that exists on its own. If someone's case history tells me they never had anhedonia until the depression hit, in that case, it's likely more treatable than if it had always existed and is more of a baseline."