Emotional Flatlining: What is Anhedonia?

One of the core symptoms of major depressive disorder is anhedonia; the inability to experience pleasure from activities that are usually found enjoyable. People who experience anhedonia have either lost interest in activities they used to enjoy, or they have an overall decreased ability to feel pleasure in general, as if their pleasure circuits have completely shut down. While it is one of the classic symptoms of depression, some people who experience anhedonia don’t have a mental health disorder and experience this symptom as a standalone.

There are two main types of anhedonia—social and physical anhedonia. With the social type, a person loses interest in all or most social contact and experiences displeasure in social situations. With physical anhedonia, a person is unable to feel tactile pleasures such as eating, touching or sex. Some major symptoms of the condition include social withdrawal, a lack of relationships or withdrawal from previous relationships, negative feelings toward oneself and others, reduced emotional abilities (such as having less verbal and/or nonverbal expressions), difficulty adjusting to social situations, a tendency toward showing fake emotions, a loss of libido or lack of interest in physical intimacy and  persistent physical symptoms (such as being sick often).

As stated previously, anhedonia can be a symptom of depression, but it can also be experienced without having clinical depression. An alternative theory poses that anhedonia comes not from an inability to experience pleasure, but rather from a reduced ability to sustain good feelings over a period of time.  Pleasure may be experienced, but only briefly, and then disappears. This can be explained by the different ways that nerve impulses travel in the brain to maintain reward and motivation. “Feel good” signals travel upward to the prefrontal cortex (PFC) and nerve fibers from the PFC also send signals downward to the nucleus accumbens (NA, deep inside the “primitive brain”). In a normal brain, the nerve impulses travel along this pleasure pathway from the PFC downward to the NA to sustain interest in a pleasurable activity, whereas the depressed brain experiences some difficulty.

Not everyone who’s depressed will experience anhedonia. In fact, some medications used to treat depression, such as antidepressants and antipsychotics, can actually cause anhedonia. Other chief causes are schizophrenia and recreational drug use. After that, risk factors include a recent traumatic or stressful event, a history of abuse or neglect, an illness that impacts your quality of life, or an eating disorder. Overall, females are more likely to experience anhedonia. Medically speaking, anhedonia can be difficult to treat because, to treat anhedonia, you will most likely need to treat the underlying disorder that’s causing the symptom, such as depression.

One group of doctors, however, has produced a report with multiple significant insights into this area. Aaron Heller and his colleagues at the University of Wisconsin and the University of Reading (UK) have developed a new functional magnetic resonance imaging (fMRI) procedure to study brain activation patterns in depressed and non-depressed people. In this study, the volunteers look at pleasant, unpleasant, and neutral pictures over a 37-minute period. The volunteers were instructed to actively try to enhance the mood the picture produced, whether happy, sad, or indifferent. The insights delivered were as follows:

  • The depressed brain didn’t sustain NA activation to positive images as the normal brains did
  • The difficulty in sustaining activity in the NA was caused by lower activity in the PFC
  • The depressed people who couldn’t sustain NA activity reported less positive emotional responses to the pleasurable pictures
  • The depressed people who were better able to sustain activity in the NA also reported more pleasure in their everyday lives
  • The difference in sustaining NA activity between depressed and normal brains was specific to positive emotions.

If you believe you are experiencing symptoms of anhedonia, it is best to seek the help of a mental health professional. They will best be able to help you cope with your symptoms and perhaps seek medical treatment.

References

Brynie, Faith. “Depression and Anhedonia.” Psychology Today. Sussex Publishers, 21 Dec. 2009. Web. 21 Apr. 2017.

Heller, A. S., T. Johnstone, A. J. Shackman, S. N. Light, M. J. Peterson, G. G. Kolden, N. H. Kalin, and R. J. Davidson. “Reduced Capacity to Sustain Positive Emotion in Major Depression Reflects Diminished Maintenance of Fronto-striatal Brain Activation.” Proceedings of the National Academy of Sciences 106.52 (2009): 22445-2450. Web.

Purdie, Jennifer. “What Is Anhedonia?” Healthline. Healthline Media, 05 July 2016. Web. 21 Apr. 2017.

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