Why Anhedonia Might Be the Worst Symptom of Depression

It might not seem like a big deal at first. You just don’t feel like opening up your favorite coloring book right now, that’s all. But as the days and weeks go on, it becomes more noticeable your energy dipped and you’re not interested in any of your favorite hobbies. All you feel like doing is watching TV, and eventually not even that is appealing. Nothing seems to matter anymore.

Depression is difficult for a lot of reasons, whether you’re feeling down all the time, have no energy or motivation or struggle to fall and stay asleep. What’s perhaps the worst symptom though is how depression can sneakily steal away everything you feel good about, including activities, hobbies and pleasurable moments. There’s a name for this — anhedonia.

What Is Anhedonia?

Anhedonia is the technical term for experiencing a loss of interest or pleasure in things you usually love, even within your relationships. 

“Anhedonia is the inability to take pleasure in activities that you would normally enjoy,” Thomas Franklin, MD, medical director of The Retreat at Sheppard Pratt, told The Mighty. “Also included in this notion is the inability to enjoy sex and intimacy during depression.”

Mighty contributor Heidi Fischer explained in her article about anhedonia, “The Frustrating Symptom of Depression We Need to Talk About,” how a loss of enjoyment can start small before spreading to other areas of your life. Fischer explained what anhedonia felt like to her:

At the worst I’ve found myself laying on the floor staring up at the ceiling, bored out of my mind but not wanting to do anything about it. A friend of mine who experiences something similar has described herself sitting in a chair and staring at a spot on the wall for hours on end. It’s painful, exhausting and leaves me with a sensation of wanting to pull my skin off. I know that sounds weird, but it’s the best way I can describe it.

What Causes Anhedonia?

Losing interest in your favorite things stems from a series of complex systems and processes in your brain. However, Dr. Franklin said the common threads that lead to anhedonia “are likely associated with the pleasure centers of the brain being less responsive during depression.”

The brain’s reward center (centered around the ventral tegmental area of your brain) governs how you respond to a pleasurable and rewarding stimulus, like tasty food, a warm hug or your favorite game. In simple terms, when your reward center lights up, it triggers the neurotransmitter dopamine to head out (along your mesolimbic dopamine pathway) to signal what you just did was great and motivate you to do it again and again. This is why breaking an addiction can be so difficult.

Depression throws a wet blanket over the reward process in your brain. Some research shows this disruption prevents you from registering positive events or cause difficulty determining why an activity should be enjoyable in the first place. When your reward system doesn’t work properly, it’s difficult to feel interested in anything.

Who Can Have Anhedonia?

Anhedonia can affect people with a variety of mental health and neurological conditions, including depression, schizophrenia and other psychotic conditions, substance use disorders and disordered eating. It can be a symptom of Parkinson’s disease as well, a neurodegenerative condition that causes motor and movement symptoms.

Depression remains the most common illness associated with anhedonia’s loss of pleasure. According to the DSM, anhedonia (“markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day”) is one of two symptoms you must have to be diagnosed with major depressive disorder or depression.

Studies also show anhedonia, along with other symptoms like panic attacks, poor concentration and insomnia, puts you at higher risk for suicidal thoughts. If you’re struggling, know you’re not alone. If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or reach the Crisis Text Line by texting “START” to 741741. 

What Helps for Anhedonia?

If you’re struggling with anhedonia, know help is available. You don’t have to do it alone — and feeling this way won’t last forever, even if it feels like it will right now.

One option is medication. Studies show if you experience anhedonia, there’s often a good chance you will respond to antidepressant medication and feel some relief. You can reach out to your family doctor or a psychiatrist if you want to discuss how you’re feeling and if medication might help.

Psychotherapy, specifically cognitive behavioral therapy (CBT), is another treatment option you might want to try. During CBT, your therapist focuses on changing your thoughts, emotions or behaviors to get you moving through anhedonia, depression or other mental health challenges. This doesn’t mean, however, the answer is invalidating advice like “just go for a walk” or “choose happiness.”

Psychologist Sarah Allen, Ph.D., LCPC, said the key to getting out of the negative loop with anhedonia is to focus on your values first as opposed to a more typical list of activities you might enjoy, which might just make you feel worse.

“When someone is depressed or anxious, they typically get stuck in a negative feedback loop where they have negative thoughts that lead to avoiding activities and social interactions,” Dr. Allen told The Mighty, adding:

I avoid just suggesting typical favorites like exercising, phone your friend etc or even just random activities they remember doing before depressed. If we don’t choose activities carefully it can leave people feeling frustrated and sometimes even more hopeless that they will ever feel better. I find it much more effective to help my clients in the session to access a memory where they felt a positive emotion that was linked to an activity that is part of something they value. We can all remember our emotions changing but typically our values remain the same.

Allen works with clients to identify positive memories in valued areas such as relationships, work, fun, health and religion. After identifying meaningful activities among each of these categories, she’ll ask you to start trying those activities, even when it feels like the last thing you want to do. By getting to your core values, Allen said you’re usually more empowered to start participating again, one step at a time. 

“It is also important to start in small manageable goals and have realistic expectations that it is unlikely to feel pleasure the first time you are pushing yourself to do the agreed activity,” Allen said. “But doing something each day does help.”