Depression: the little talked about symptom that defies treatment – 08/12/2023 – Health

It is often thought that someone who is depressed will feel sad or down most of the time. But what many people don’t realize is that these aren’t the only symptoms of depression.

Another common symptom that is sometimes overlooked is the feeling that the things you used to enjoy are no longer interesting or pleasurable.

This symptom is known as anhedonia and is present in up to 75% of adults and young people with depression. But even though it is a common symptom, anhedonia is still difficult to treat and manage.

loss of pleasure

Anhedonia is defined as the reduction of interest or pleasure in all or almost all activities previously enjoyed by a person.

A person who suffers from anhedonia for an extended period of time (consistently for at least two weeks) may be diagnosed with depression even if they do not feel sad or downhearted.

And while it’s mostly associated with depression, anhedonia can also be a symptom of other disorders, such as schizophrenia, anxiety and Parkinson’s disease.

My colleagues and I conducted in-depth interviews with young people about depression. Many of them described anhedonia not only as a loss of joy, but also as having less motivation to do things.

For some, this lack of motivation was only related to specific actions, such as going to school or meeting friends. But for others, it was something more serious. They felt they didn’t want to do anything at all—not even live.

But as disturbing as anhedonia can be, it is often not the main goal of treating depression.

It is recommended that mild cases of depression be treated with psychotherapy. And for people with moderate or severe cases, antidepressants may be prescribed.

All of these treatments are intended to help patients deal with their symptoms and overcome them, but more than half of people with depression do not respond to the first recommended treatment. And, even after changing treatment, about 30% of patients still experience their symptoms.

It is argued that one reason for these low reaction rates may be the fact that current treatment techniques do not adequately address anhedonia.

Research also shows that suffering from anhedonia is a harbinger of chronic recurrence of depression. And it’s even possible that some antidepressant treatments may worsen anhedonia.

Why does it happen? One possibility is that current standard treatments focus primarily on treating depressive mood and the brain processes underlying despondency, but not anhedonia.

The main goal of psychotherapy —like cognitive behavioral therapy, for example—is to reduce patients’ negative thoughts. The most common antidepressant medications also primarily affect serotonin, which is believed to be one of the factors responsible for the way the brain processes negative information.

But since anhedonia is the loss of joy in life, treatments such as behavioral activation (a form of psychotherapy) might work better for anhedonia. That’s because behavioral activation aims to help people with depression take simple, practical steps to enjoy life again.

Still, other studies have concluded that behavioral activation is no better than standard treatments for combating anhedonia. This can occur, since the very nature of anhedonia involves a lack of motivation, which makes it difficult for patients to dedicate themselves to any therapy —even those that may offer greater benefits.

Anhedonia has also been linked to disorders of the brain’s reward mechanisms. Therefore, treatments dedicated to improving the way brain processes deliver rewards may help reduce anhedonia more effectively than current treatments.

But the brain’s reward mechanisms are anything but simple. In fact, they involve several subprocesses, which include anticipation, motivation, pleasure, and reward learning.

And the existence of difficulties in any of these subprocesses can collaborate with the development of anhedonia. Therefore, it is important to research how these subprocesses work in people with anhedonia, in order to develop better treatments.

treatment options

Anhedonia can be complex, but that doesn’t mean there’s no hope for those affected.

Research shows, for example, that psychotherapy directed at reward processing can help reduce anhedonia.

A recent pilot study also concluded that a new type of psychotherapy, called augmented depression therapy, may work better than cognitive-behavioral therapy in treating depression. One reason is that therapy for heightened depression has anhedonia as its specific goal, making patients focus on both their negative and positive experiences.

Furthermore, antidepressants targeting neurotransmitters involved in reward mechanisms (such as dopamine) may be more suitable for patients with anhedonia. Early studies have looked at drugs such as ketamine, which can affect dopamine activity, and indicate that it may hold promise for treating anhedonia.

Even though it can be difficult to find motivation in the case of anhedonia, trying to find time for fun and enjoyable experiences or activities, such as a hobby you once loved—or even a new hobby—can help to reduce it.

If you think you suffer from anhedonia or have other symptoms of depression, it’s important not to ignore your feelings so that you can get the help and treatment you deserve. And if you’re not sure where to start, you can try describing how you feel to a loved one or your GP.

If you need to talk to someone in the UK you can also contact Samaritans (phone 116 123 or email [email protected]). In Brazil, you can look for the CVV (phone 188, website Both are anonymous and free.

This article was originally published on the academic news site The Conversation and republished under a Creative Commons license. Read the original English version here.

Where to get help?

• Psychosocial Care Centers (CAPS) and Basic Health Units (UBS) – family clinics, health posts and centers;

• Emergency Care Unit (UPA 24h);

• Mobile Emergency Care Service (SAMU 192);

• Hospitals;

• First Aid.

Emotional support and suicide prevention:

• Centro de Valorização da Vida (CVV) – operates 24 hours a day by calling 188 (free call from any landline or cell phone) and also provides assistance by email, chat and in person (check it out on the website