Most people understand what pleasure feels like. They expect certain things in life to make them happy. Maybe you enjoy riding your bike, listening to the sounds of the ocean, or holding someone's hand. But some people lose the ability to feel joy. The things that once made them content are no longer fun or enjoyable. That's anhedonia.
There are two main types of anhedonia:
- Social anhedonia. You don’t want to spend time with other people.
- Physical anhedonia. You don’t enjoy physical sensations. A hug leaves you feeling empty rather than nurtured. Your favorite foods taste bland. Even sex can lose its appeal.
Anhedonia makes relationships, including those with friends and family members, a struggle. With the reward of enjoyment gone, it's hard to get motivated to spend time with others. You might turn down invitations and skip events like concerts, parties, and even one-on-one get-togethers because you no longer believe there's any benefit in taking part.
Or you could have social anxiety. You feel like you don't fit in, especially when meeting new people.
Relationships also thrive on positive feedback, and without it they can wither: Imagine not being able to tell someone you love them or that you had a great time spending the day with them. But if you have anhedonia, you can't, because you don't have those feelings. Meanwhile, loss of libido can take a toll on a romantic relationship.
It's also worth noting that some scientists believe anhedonia isn't always a black-and-white issue. You might feel no joy at all, or you could find that your positive emotions are dulled. In other words, it's possible to still like eating chocolate ice cream or listening to jazz; you just don't like those things nearly as much as you used to for reasons you can't explain.
What Causes It
Anhedonia is closely linked to depression, but you don't have to be depressed or feel sad to have it. It also affects people with other mental illnesses, like schizophrenia and bipolar disorder. And it can show up in people with seemingly unrelated health concerns like Parkinson's disease, diabetes, coronary artery disease, and substance abuse issues.
Scientists think anhedonia may be tied to changes in brain activity. You might have a problem with the way your brain produces or responds to dopamine, a "feel-good" mood chemical. Some early research (on rats) suggests that the dopamine neurons in an area of the brain called the prefrontal cortex might be overactive in people with anhedonia. This somehow interferes with pathways that control how we seek out rewards and experience them.
How It's Treated
Anhedonia can be tricky to treat. There’s no clear way to do it. The first step is generally to find any unknown cause, focus on treating that issue, and hope the anhedonia gets better as a result.
That's often true, especially when it comes to depression. People who take antidepressant medications (selective serotonin reuptake inhibitors, or SSRIs) may find that anhedonia improves along with the rest of their depression symptoms, but that's not always the case. Sometimes these medications blunt emotions and make this problem worse.
Scientists are working on new treatments for people with anhedonia who don't get better with treatments like SSRIs and talk therapy. One that shows promise is ketamine, a medication best known for being a party drug that also has an antidepressant effect. More research is needed, but at least one study found that people with bipolar depression who had anhedonia got relief from this symptom within 40 minutes of a ketamine shot.