On Wednesday, Michela turned 49. She considered forcing herself to celebrate, but when two friends offered to take her out, she said no.
“All that takes so much effort,” she said. “I just don’t have the energy.”
Michela, who asked to be identified only by her first name, wasn’t simply having a bad day. For years, she has had difficulty enjoying the things in life that would normally bring her joy and has felt little drive to pursue them — an experience called anhedonia.
Anhedonia is not a diagnosis but rather a common symptom of mental illness. It is a quiet symptom, not a blaring sign that something is wrong. And, for some people, that can mean it goes undetected, said Dr Judith F. Joseph, a clinical assistant professor of child and adolescent psychiatry at NYU Grossman School of Medicine in the US.
“It is not seen as a crisis,” Dr Joseph said. But in a way it is, she added. “It’s an existential crisis.”
And although most people aren’t familiar with the word “anhedonia”, they should be, she said. It is one of the core markers of major depressive disorder, which Michela lives with, and it is also tied to other illnesses, including schizophrenia, substance use disorder and post-traumatic stress disorder or PTSD.
We asked Dr Joseph and other experts what we should know about anhedonia and why it can be so distressing.
Anhedonia has long been defined as a reduced ability to experience pleasure but in more recent years, mental health clinicians also associate it with a lack of motivation to seek joy.
The foods that once tasted great might now seem boring and tasteless. The museum that used to elicit feelings of awe no longer holds any appeal. Even getting out of bed might feel like a chore for someone with anhedonia — and they may start to withdraw from important people in their lives.
“I feel off” or “I don’t feel like myself” are common refrains, Dr Joseph said. Someone with anhedonia might also describe feeling numb or empty.
“I had a patient that loved to go to dance concerts — she would attempt to go and she’d get no pleasure out of going,” said Dr Mark Rapaport, president-elect of the American Psychiatric Association. “She was just sitting there.”
This might sound like depression, but it is possible to have anhedonia without being diagnosed with major depressive disorder, which requires patients to have at least five different symptoms that cause distress or make it very difficult to function.
And if it’s not addressed, the ripple effects are many: anhedonia can hurt mood, sleep and nutrition. And it has been associated with difficulty managing one’s life and relationships, a worse response to mental health treatments and an increased risk of suicide.
Scientists are still working to discover what the root causes of anhedonia are.
Research suggests that it may be partly attributed to changes in the activity of certain neurotransmitters, the chemical messengers in the brain. Dopamine, for example, is the neurotransmitter that has been associated with the wanting of something and the motivation to go and get it.
Michael Treadway, a clinical psychologist and cognitive neuroscientist at Emory University, US, is investigating to what extent inflammation might play a role by disrupting the amount of dopamine that the human body produces.
“The main question is: can we figure out just how to identify who has that sort of vulnerability?” he said. If so, “we could do a lot of really effective preventative and intervention strategies.”
Other research is examining whether it runs in families — some evidence points to a genetic component. There is also evidence that chronic, uncontrollable stressors like living in poverty or enduring discrimination can produce anhedonia as well.
In addition, selective serotonin reuptake inhibitors, which are often used to treat depression and other psychiatric illnesses, are known to produce emotional blunting or numbness — a feeling that may mimic aspects of anhedonia.
There is no medicine that has been approved to treat anhedonia specifically. But if you have an underlying disorder, like depression, getting treatment for it may help anhedonia symptoms improve. Getting enough sleep and regular exercise is also important.
A type of therapy called behavioural activation can also be effective for people living with anhedonia. “It’s sometimes referred to jokingly as ‘the Nike therapy’ because the motto is: ‘Just do it,’ ” Treadway said.
The guiding principle of behavioural activation is that behaviour can affect your mood and well-being.
If you gently push yourself to do things that are important to you, you’ll help your brain remember how good it feels, which can then motivate you to do those things again.
Joseph urges anyone who thinks they may have anhedonia to talk to a mental health professional. “Joy is not something that’s a luxury,” she said. “It’s essential.”
NYTNS