Depression and Anhedonia

Anhedonia: Science, Definition, and Treatment Options

Feelings of pain and pleasure are some of the most quintessential experiences of human life. While pain is never a pleasant thing to deal with, it is useful. Pain, both physical and emotional, tells people when something is wrong and that they need to change things to keep themselves safe and happy. On the other hand, feelings of pleasure and enjoyment enrich a person’s life. Without the ability to feel joy, life becomes a chore, and it’s easy for someone to view it as something not worth doing anymore. Anhedonia, or the inability to feel pleasure, is a severe condition that drastically impairs a person’s quality of life. Many things are going on in the human brain that impact feelings of anhedonia. Fortunately, it is a treatable issue.

What is Anhedonia?

Anhedonia isn’t necessarily a condition in and of itself. Generally, anhedonia is a symptom of depression or other mood disorders. Most people know what pleasure is, and they expect certain things and situations to bring them enjoyment. Spending time with friends, engaging in a hobby, or playing games are all pleasurable experiences. But anhedonia robs a person of these joys. People with anhedonia are unable to feel content or have fun. Anhedonia comes in two distinct flavors:

  • Social anhedonia is when someone does not want to engage with other people and becomes withdrawn.
  • Physical anhedonia occurs when someone does not derive physical joy from physical actions. For example, a hug can leave them feeling cold or empty. Foods they once enjoyed taste bland when they are suffering from physical anhedonia.

Anhedonia generally involves a lack of pleasure and a disinterest in social interaction. Anhedonia may look a little different for everyone, so consider the following findings from the research:

  • Anhedonia may present as a “flat affect” or lack of emotion. This emotional numbing may be especially likely among people who are diagnosed with post-traumatic stress disorder (PTSD). 
  • People living with depression may not describe a lack of pleasure with anhedonia but may instead become less interested in daily activities.
  • Those who experience anhedonia may find pleasure in some activities but show reduced pleasure in response to other positive activities. 
  • Social anhedonia involves feeling no enjoyment when conversing with others, sharing feelings with other people, or spending time with friends.
  • Some people may experience physical anhedonia, in which they get no pleasure out of physically stimulating activities like sex or good-tasting food. 

Suppose you do not get pleasure out of interacting with others or are not interested in normal activities, show limited emotions, or do not enjoy physical pleasures like sex, you are likely experiencing anhedonia symptoms.

What are the Consequences of Anhedonia?

Human beings are social creatures. Still, anhedonia makes relationships a struggle and a chore, no matter how close the people were before anhedonia manifested. When once enjoyable things no longer have the same reward, it is difficult for people with anhedonia to get motivated. Some consequences of anhedonia include skipping out on social events like parties or concerts and turning down invitations.

Unfortunately, the consequences of anhedonia can sometimes be severe. Without experiencing joy from pleasurable events or activities, people may begin to feel hopeless and have no purpose in life, which increases the risk of suicide. An analysis of 15 different studies found that individuals who suffer from thoughts of suicide have a significantly higher level of anhedonia. 

Anhedonia is even related to worsened physical health, perhaps because those who do not derive pleasure from exercise or other daily activities may be more likely to be sedentary or lack the drive to practice self-care. In fact, a study in Psychiatry Research found that people who had depression with anhedonia had higher blood sugar levels and increased levels of artery-clogging LDL cholesterol and triglycerides. 

Research has also found that people who suffer from anhedonia are more likely to engage in binge eating and emotional eating. This suggests that anhedonia may drive people to turn to food to find some source of pleasure in life. Sometimes, this can lead to health problems if eating becomes out of control or if a person’s diet contains solely pleasurable foods, such as sweets or fatty fried foods. 

Another risk associated with anhedonia is the development of addictions. Research suggests that anhedonia seems to come before drug abuse. People who live with anhedonia may experience stronger highs when using drugs, placing them at elevated risk of a substance use disorder or addiction.

Social anxiety is also closely related to anhedonia. Personal relationships grow and strengthen from positive feedback. When someone with anhedonia can’t tell another person they care about them or enjoy spending time with them the relationship can be harmed. For romantic relationships, the loss of libido common in physical anhedonia will take a significant toll on the couple.

What is Happening in the Brain During Anhedonia?

The brain is the seat of both human reasoning and human emotion. Feelings of pain and pleasure derive from the brain’s complex neurochemistry and neuronal pathways. When someone is experiencing mood disorder symptoms such as anhedonia, the signs have their roots in complex brain chemistry and structure. 

Studies between anhedonic patients with both mood disorders and no mood disorders present concluded several things. In general, the severity of a person’s anhedonia was based on a lack of activity within the ventral striatum portion of the brain, along with increased activity in the ventral area of the prefrontal cortex. Also found was that dopamine, a powerful neurotransmitter, played a crucial role in both the manifestation and severity of anhedonia.

Anhedonia is most often linked to depression, a common mood disorder. But people do not necessarily have to have depression to experience anhedonia. Those with other mental health conditions like schizophrenia or bipolar disorder can develop anhedonia, and even physical ailments can cause it. Parkinson’s, heart disease, and even substance abuse can cause anhedonia. 

While complex issues within the human brain like anhedonia are not fully understood, brain chemistry does play a role in this symptom. The brain may have difficulty either producing or responding to dopamine, which is a chemical that is responsible for feelings of pleasure, among other things. People with anhedonia may have dopamine neurons in the prefrontal cortex of the brain that is overactive. This issue with brain chemistry and structure may influence the way people experience pleasure, or in anhedonia, don’t experience it.

Is TMS a Viable Treatment Option for Anhedonia and Depression?

TMS is a non-invasive treatment option for people with treatment-resistant depression, who are struggling with stubborn depression symptoms. More than half of all people who try an antidepressant drug for depression will not find adequate relief from their symptoms. For these cases of stubborn depression where anhedonia is a factor, TMS may be worth considering. 

Suitable candidates for TS treatments will enjoy the fact that TMS does not require anesthesia, IV lines, or other invasive procedures to undergo treatment. Patients can go to work or school before and after treatment sessions. During a TMS procedure, a strong magnetic coil is placed over the patient’s skull and used to target areas of the brain that are thought to play a role in symptoms of depression and anhedonia. The coil delivers a powerful burst of magnetic activity to the brain. The magnetic energy used in TMS is the same type and strength of magnetic energy used in MRI machines. 

Fortunately, TMS for anhedonia and depression is backed by science. A 2019 study in the Journal of Clinical Psychology found that when patients with depression received TMS treatment, their anhedonia levels dropped significantly. TMS is so beneficial that a review of 23 different animal studies that assessed the effects of TMS indicated that depression improved after TMS treatment, and symptoms of anhedonia were significantly reduced. For those experiencing treatment-resistant depression along with lack of pleasure, TMS is a suitable treatment option.

Most TMS treatment sessions will involve placing the magnetic coil over the prefrontal cortex of the brain. It is this region of the brain that has been found to play a role in anhedonic feelings. But readers must understand that TMS coils do not directly impact the entire brain, but only penetrate about two to three centimeters below the treatment coil. This allows TMS treatment to be highly targeted, unlike other deep brain stimulation techniques that can affect the entire brain, causing a range of side effects. The magnetic energy used in TMS activates cells in the brain that release neurotransmitters, alleviating depression symptoms, and anhedonia.

Are you struggling with persistent symptoms of anhedonia and medication hasn’t helped? Contact Pulse TMS today. Representatives are standing by to answer your questions and see if you’re a candidate for TMS treatment.

Update 5/30/21