There is often an assumption that if someone is depressed they will always feel sad or sad. But many do not realize that this is not the only symptom of depression. Another common symptom of depression that is sometimes overlooked is the feeling that you no longer find the things you used to enjoy to be interesting or enjoyable.
Known as anhedonia, this symptom occurs in 75 percent of adults and adolescents who experience depression. But even though this symptom is common, it remains one of the most difficult to treat and manage.
Loss of fun
Anhedonia is defined as reduced interest or pleasure in all – or almost all – activities that a person previously enjoyed. If a person has had anhedonia for a long period of time (at least two weeks in a row), they may be diagnosed with depression — even though they may not feel sad or sad.
Although primarily associated with depression, anhedonia can also be a symptom of other disorders – such as schizophrenia, anxiety and Parkinson’s disease.
In in-depth interviews my colleagues and I conducted with young people about depression, anhedonia was described by many as not only a loss of joy but also a reduced motivation to do something. For some people, this lack of drive is only related to certain things – like going to school or seeing friends. But for others, it’s worse, and they don’t feel like doing anything—not even wanting to live.
But while anhedonia can be troubling, it is often not a primary target for treatment for depression.
Mild depression cases are recommended to be treated with talk therapy. People with more moderate or severe cases of depression may be prescribed antidepressants. Although all of these treatments aim to help patients cope and manage their symptoms, more than half of people with depression do not respond to the first treatment they recommend. Even after changing medications, about 30 percent of patients still experience symptoms.
It has been suggested that one of the reasons for this low response rate may be that current treatment techniques do not adequately target anhedonia. Research has also shown that suffering from anhedonia predicts a recurrence of chronic depression. It’s even possible that some antidepressant medications can make anhedonia worse.
How could this happen? One possibility is that today’s standard medicine focuses primarily on treating depressed mood and the brain processes that underlie bad moods — but not anhedonia. For example, the main goal of talk therapy, like cognitive behavioral therapy, is to reduce negative thoughts in patients. The most common antidepressant drugs also target serotonin, which is thought to support the way the brain processes negative information.
But because anhedonia reduces joy in life, treatment such as behavioral activation (a form of talk therapy) may be better for anhedonia. This is because behavioral activation aims to help people with depression take simple and practical steps to enjoy life again. However, several studies have found that behavioral activation is no better than standard medication in treating anhedonia. This may be because the nature of anhedonia includes a lack of motivation that makes it difficult for patients to undertake any therapy, even the form of therapy that might benefit them the most.
Anhedonia has also been linked to dysfunction of reward mechanisms in the brain. Therefore, treatment that focuses more on improving how the brain works and processes can help relieve anhedonia more effectively than current medications.
But the brain’s reward system is not straightforward and actually involves a variety of subprocesses – including anticipation, motivation, pleasure, and learning about rewards. Problems with any of these subprocesses can cause anhedonia. Therefore, it is important for research to uncover how this subprocess works in people with anhedonia in order to develop better treatment targets.
Treatment options
While anhedonia may be complicated, it doesn’t mean there’s no hope for those affected by it.
For example, research shows that talk therapy that focuses on processing rewards can help reduce anhedonia. A recent pilot study also found that a new type of talk therapy called adjunctive depression therapy may work better than cognitive behavioral therapy in treating depression. This is because augmented depression therapy specifically targets anhedonia by making patients focus on their negative and positive experiences.
Furthermore, antidepressants that target neurotransmitters involved in the reward system (such as dopamine) may be more suitable for patients with anhedonia. Early research examining drugs such as ketamine, which can affect dopamine activity, suggests they may hold promise for treating anhedonia.
While it can be hard to find motivation if you have anhedonia, trying to find time for fun, enjoyable activities or experiences such as a hobby you used to love — or even a new one — can help relieve anhedonia.
If you think you may have anhedonia – or other symptoms of depression – it’s important not to ignore how you’re feeling so you can get the help and treatment you deserve. If you’re not sure where to start, you can try sharing your feelings with a loved one or a general practitioner.
This article was originally published on Conversation by Ciara McCabe at the University of Reading. Read the original article here.
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