Anhedonia: Meaning, Symptoms, & Treatment

Anhedonia is the reduced ability to experience reward and pleasure across multiple aspects of daily life. It is a key symptom in several psychiatric disorders.

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There is one friend of mine with whom I chat several times a month, and for a long time now he has been stuck in a rut. His being stuck in a rut means that our conversations often sound very much the same: He shares about all the things he knows he should be doing, but that he can’t quite find the motivation to get started on or to pick back up.

It seems to me, at times, like he is ritually reminding himself of all the things he is capable of, almost as if he is trying to make himself feel worse. After all, the alternative would be that he goes out and acts on all that awareness—but he just can’t quite seem to find the motivation.

What is causing this lack of motivation? Frankly, my friend has a hard time imagining getting any enjoyment out of the activities he used to regularly engage in. He seems to be experiencing a prolonged period of anhedonia. Let’s take a look at what anhedonia means, so we can better understand what it looks like and how you can help somebody experiencing it.

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What Is Anhedonia? (A Definition)

The most common and simplest definition of anhedonia is a reduction in or absence of experiencing pleasure (Ho & Sommers, 2013). This, however, might be too simple, as most of the time the term is used in reference to specific behaviors not resulting in pleasure. There are few people who are actually experiencing no pleasure at all in their lives; the friend I just mentioned, for example, finds eating cookies as pleasurable as ever. When I say he is experiencing anhedonia, then, I might mean either or both of these things: He may be enjoying all activities, including the consumption of cookies, less than he usually does, and/or he may have lost pleasure in certain activities that are important to him.

So in this sense there is a continuum of anhedonia. Where most people are experiencing just as much pleasure as they usually do, others are experiencing less overall pleasure than usual and/or are not enjoying their preferred activities, and some people are experiencing no pleasure at all (Loas et al., 1994). It is important to note that this lack of pleasure does not mean they are experiencing any less—or any more—of the other emotions they typically experience. In other words, anhedonia is not the absence of all feelings altogether, nor is it something that results from an inability to express one’s emotions (Lee et al., 2011). In fact, many people experiencing anhedonia have plenty of challenging emotions that they are working through.

On that note, we study anhedonia because reductions in or absence of pleasure are a common symptom in several psychiatric disorders. These include major depressive disorder, schizophrenia, substance use disorders, and chronic pain, as a meta-analysis looking at 16,000 individuals who had completed an anhedonia measure found (Trøstheim et al., 2020). This does not mean that every person with any one of these disorders will definitely be experiencing anhedonia, but it does mean that such a diagnosed person is at higher risk of experiencing anhedonia than the typical person without any of those disorders.

Anhedonia & Depression
That said, anhedonia is a core symptom particularly of major depressive disorder (Treadway & Zald, 2011), although it looks different from one person with depression to the next. This may be because the way we usually think about anhedonia does not give enough consideration to the difference between experiencing pleasure and experiencing motivation. We get pleasure not just by having something we want but just as much by envisioning it and trying to pursue it.

In other words, some people may not enjoy things the way they used to, but other people may not anticipate enjoying things the way they used to (Treadway & Zald, 2011). How excited are you to try something you are pretty certain you will find dull or disinteresting? Now imagine that you’re feeling that way about most things, or that a passion of yours has suddenly become boring to even consider. That’s how some people experience anhedonia.

Opposite of Anhedonia

The opposite of anhedonia could be considered finding the world way more pleasurable than usual. I’m not aware of a clinical term for this experience, but it may occur in people whose overall moods are particularly positive. It may also be induced by the consumption of drugs that activate our reward systems—they make everything around us seem that much more interesting and worth engaging with.

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Causes of Anhedonia

In the broadest of terms, modern neuroscience research suggests that anhedonia comes from some kind of malfunctioning or atypical firing in the reward pathways of the brain (Thomsen, 2015). Our reward system focuses on wanting, liking, and learning—each of these components contributes to our motivation to pursue something we might enjoy. In other words, we can want or not want something, find it pleasurable or not, and learn to enjoy something or learn that it is not enjoyable.

This also helps us see anhedonia as involving emotions, thoughts, and behaviors. The causes of anhedonia could be reductions in how much positive emotion we feel, a persistent pattern of thoughts that discourage pursuing pleasurable activities, and/or the inability to build an awareness over time of how pleasurable something is. This is what has been found in studies of people with psychiatric disorders that include anhedonia as a possible symptom: They learn about and experience reward differently than people without those disorders do (Thomsen, 2015).

And why would people’s reward pathways in their brains be functioning irregularly? As most models of mental illness would suggest, it is from a combination of genetic risk and life experiences that shape how our brains function (Thomsen, 2015).

Symptoms of Anhedonia

To understand the symptoms of anhedonia, researchers have used both laboratory-based and self-report measures (Leventhal et al., 2006). One way that it has been measured in the laboratory is through showing people pictures of things that are meant to elicit a pleasurable response, such as a tasty food, a sunny beach, or a person they might find attractive. People with anhedonia report finding these pictures less appealing, and they also show a more subtle heart rate reaction and fewer changes in their facial expressions in response to the images. Interestingly, some people with anhedonia even need more sugar in a tasty treat to report that they are experiencing pleasure from it.

When it comes to self-reported symptoms of anhedonia, we turn to questionnaires. These questionnaires typically ask people about how much they think they would enjoy a range of activities: their preferred hobbies, socializing with friends and family, eating and drinking, and having desirable sensory experiences, such as taking a warm bath. From examples like this, we can get a sense of what symptoms a person with anhedonia might show. They might turn down opportunities to do things they enjoy, disengage from activities more quickly, or have a harder time enjoying things once they start doing them.

Examples of Anhedonia

One domain where anhedonia can strike in particularly painful and debilitating ways is in people’s social lives. Social anhedonia is the lack of interest in and enjoyment of social interactions (Barkus & Badcock, 2019). The pattern looks similar for most people with social anhedonia: They get less pleasure from spending time with others, so in time they start to withdraw from their social connections. And with more time, it becomes harder for them to actually socialize because they have lost the motivation to stay engaged. Perhaps you can imagine what a vicious cycle this is, as people who get reduced social interaction often end up feeling lonely and depressed in general.

In the people I have watched go through anhedonia, what is most striking is their lack of activity. They have such a hard time getting energized to do much of anything that they end up kind of just hanging around their home or apartment. Often, they lose hours to scrolling through social media or reading random articles on the internet. At the end of these sessions, a lot of time has passed, but they have experienced little pleasure and often feel even worse than they did before.

Treatment for Anhedonia

One effective approach to treating anhedonia is cognitive behavioral therapy (Ho & Sommers, 2013). This is because, particularly in the case of people who are not anticipating that activities will be pleasurable but do experience them as pleasurable once they get started, it is their unhelpful thoughts that are getting in the way. These people need help in critically assessing the validity of these impairing thoughts that tell them their potential actions will not be rewarding. This may help them correct the unhelpful pattern of gradually disengaging more and more from their preferred activities.

For people who have already disengaged from those activities, cognitive behavioral therapy and other therapies focus on getting back into those activities by giving their lives more structure. This is often called behavioral activation, and it involves the therapist and client spending as much time as needed in session to create a game plan for making sure enjoyable activities happen during the week. For example, they might go so far as to text some friends to set up a dinner together, then set reminders with positive affirmations on the client’s phone for the day of the dinner.

Engaging in more exercise has also been shown to be effective in reducing anhedonia. For example, one study found that as people walked more, their scores on an anhedonia measure were lower (Leventhal, 2012).

Overall, effective treatments for anhedonia focus on generating more sensitivity to reward in people through a variety of means (Sandman & Craske, 2022). Some treatments may actually accomplish this by reducing the intensity of people’s negative emotions: With their stress systems less overloaded, they may have greater capacity to focus on the positives around them.

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Anhedonia vs. Depression

Anhedonia is not the same as depression, but it is one of two core symptoms of depression. To be diagnosed as being in a depressive episode, a person must have experienced a depressed mood or symptoms of anhedonia most of the day nearly every day for at least two weeks. Anhedonia has been central to our understanding of depression for many years (De Fruyt et al., 2020), as psychologists long ago recognized that some people fit the profile of depression in terms of having every other symptom but a depressed mood. It did not seem right to deny these people a depression diagnosis, especially when their anhedonia was pretty impairing.

Thus, anhedonia is one of the first symptoms that pops to mind when a clinician gets the sense that their client might be experiencing depression. Clinicians carefully assess whether the client enjoys their life much less than the average person or whether they have recently started to get far less enjoyment from life than they used to.

Anhedonia and Dopamine

Since the brain’s reward systems seem to be malfunctioning in people with anhedonia, it should come as no surprise that these people have unusual dopamine patterns in their brains as well (Huys et al., 2013). Usually, this takes the form of a dopamine deficit in a certain system.

Recovery From Anhedonia

Recovery from anhedonia often hinges on good social support, because experiencing little pleasure tends to isolate us, just as having a lust for life gets people out in the world (Barkus, 2021). It also hinges on developing a sense of gratitude, as gratitude both increases positive feelings in us and reminds us of our connections with others (Craske et al., 2016). For people with addictions, anhedonia may be a result of having focused their brains’ reward systems on just one substance or behavior. To get a sense of what it looks like to recover from anhedonia in addiction, I recommend watching this video:

Video: Anhedonia After Addiction

Anhedonia and Medication

Finally, people with anhedonia may be experiencing abnormalities in the neurotransmitters in their brains. This may be treated with medication, although it is more effective for some people with anhedonia than for others (Sandman & Craske, 2022). As is often the case with mental health challenges, both medication and another therapeutic intervention may be needed for optimal outcomes.

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Articles Related to Anhedonia

Want to learn more? Check out these articles:

Books Related to Anhedonia

If you’d like to keep learning more, here are a few books that you might be interested in.

Final Thoughts on Anhedonia

Anhedonia is best understood as part of a bigger picture of mental health challenges, as it is usually the symptom of a larger psychiatric disorder. However, that does not diminish how painful an experience it can be. I hope this article makes it clear that this is a treatable and common element of certain psychiatric diagnoses.

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References

Barkus, E. (2021). The effects of anhedonia in social context. Current Behavioral Neuroscience Reports, 8, 77–89.
Barkus, E., & Badcock, J. C. (2019). A transdiagnostic perspective on social anhedonia. Frontiers in Psychiatry, 10, 216.
Craske, M. G., Meuret, A. E., Ritz, T., Treanor, M., & Dour, H. J. (2016). Treatment for anhedonia: a neuroscience driven approach. Depression and Anxiety, 33(10), 927–938.
De Fruyt, J., Sabbe, B., & Demyttenaere, K. (2020). Anhedonia in depressive disorder: a narrative review. Psychopathology, 53(5–6), 274–281.
Ho, N., & Sommers, M. (2013). Anhedonia: a concept analysis. Archives of Psychiatric Nursing, 27(3), 121–129.
Huys, Q. J., Pizzagalli, D. A., Bogdan, R., & Dayan, P. (2013). Mapping anhedonia onto reinforcement learning: a behavioural meta-analysis. Biology of Mood & Anxiety Disorders, 3, 1–16.
Lee, J. S., Park, H. J., Chun, J. W., Seok, J. H., Park, I. H., Park, B., & Kim, J. J. (2011). Neuroanatomical correlates of trait anhedonia in patients with schizophrenia: a voxel-based morphometric study. Neuroscience Letters, 489(2), 110–114.
Leventhal, A. M. (2012). Relations between anhedonia and physical activity. American Journal of Health Behavior, 36(6), 860–872.
Leventhal, A. M., Chasson, G. S., Tapia, E., Miller, E. K., & Pettit, J. W. (2006). Measuring hedonic capacity in depression: a psychometric analysis of three anhedonia scales. Journal of Clinical Psychology, 62(12), 1545–1558.
Loas, G., Salinas, E., Pierson, A., Guelfi, J. D., & Samuel-Lajeunesse, B. (1994). Anhedonia and blunted affect in major depressive disorder. Comprehensive Psychiatry, 35(5), 366–372.
Sandman, C. F., & Craske, M. G. (2022). Psychological treatments for anhedonia. Current Topics in Behavioral Neuroscience, 58, 491–513.
Thomsen, K. R. (2015). Measuring anhedonia: impaired ability to pursue, experience, and learn about reward. Frontiers in Psychology, 6, 1409.
Treadway, M. T., & Zald, D. H. (2011). Reconsidering anhedonia in depression: lessons from translational neuroscience. Neuroscience and Biobehavioral Review, 35(3), 537–555.
Trøstheim, M., Eikemo, M., Meir, R., Hansen, I., Paul, E., Kroll, S. L., . . . & Leknes, S. (2020). Assessment of anhedonia in adults with and without mental illness: a systematic review and meta-analysis. JAMA Network Open, 3(8), e2013233–e2013233.

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