Anhedonia refers to a condition in which sufferers are unable to feel pleasure or joy. It may occur in the context of mental disorders, for example, depression, schizoid personality disorder, or as part of the negative symptomatology of psychosis, or it may be a symptom of a physical illness. For this reason, treatment is based on the corresponding underlying disease.
What is anhedonia?
Anhedonia is a psychological symptom that describes the inability to feel pleasure or joy. It can occur as a normal condition in healthy individuals who experience temporary listlessness and lack of interest in most things. However, severely pronounced or prolonged anhedonia in most cases indicates a psychological or organic clinical picture. This is especially the case when other symptoms accompany the listlessness or when anhedonia results in limitations in daily living. The opposite of anhedonia is hedonia, which is characterized, among other things, by an increased sense of pleasure, exuberant joy and heightened interests. It, too, may appear as a temporary, normal state or manifest as signs of psychosis, mania, intoxication, neurological and other diseases. For this reason, medical evaluation may also be advisable for hedonistic abnormalities.
Causes
Anhedonia can occur in the context of various physical diseases and mental disorders. For example, it represents a cardinal symptom of clinical depression, where it may also manifest as a complete loss of interest: The patient loses interest in activities that previously gave him pleasure. In addition, a depressive mood appears. Other typical symptoms of depression are changes in weight and appetite, insomnia or increased need for sleep, psychomotor abnormalities, fatigue, loss of energy, feelings of worthlessness and guilt, concentration problems, difficulty making decisions, thoughts of death or suicidal tendencies. Similar but weaker and longer-lasting symptoms may be seen in dysthymia. Another mental disorder that can lead to anhedonia is schizoid personality disorder. This is a mental abnormality that lasts at least two years and is characterized by flattened affect. Schizoid personality disorder should not be confused with schizophrenia, which is one of the psychotic disorders and may be characterized by hallucinations and delusions, for example.
Symptoms, complaints, and signs
However, in schizophrenia, negative symptomatology occurs, which includes anhedonia. In many cases, negative symptomatology occurs before positive symptoms such as hallucinations. In addition, anhedonia may also be due to physical causes, for example, iron deficiency or hypothyroidism. Some neurological and other diseases also manifest themselves in states characterized by joylessness and listlessness. Only a medical and/or psychiatric or psychological evaluation can determine the cause in each individual case.
Diagnosis and course
Persistent anhedonia may indicate a serious physical illness or psychological disorder and requires specialist clarification. The chances of successful treatment depend, among other things, on the cause of the illness as well as the individual severity. In order to obtain the most reliable psychological diagnosis possible, those affected should seek the help of a psychiatrist or psychological psychotherapist. These specialists are especially trained in the diagnosis and treatment of corresponding clinical pictures. For example, in order to be diagnosed with depression, a patient must exhibit certain characteristics. While a variety of disorders can be responsible for the development of a symptom such as anhedonia, the characteristic pattern of different symptoms is crucial for the diagnosis. Therefore, anhedonic individuals cannot automatically assume that they are suffering from depression, as other medical conditions can also be considered as explanations. For a more precise differentiation, specialists can make use of special questionnaires such as “Beck’s Depression Inventory (BDI)” as well as structured or standardized interviews.To rule out a physical cause or to diagnose one, a blood test is usually necessary. The results may show deficiencies in certain nutrients that can also lead to anhedonia. Examples include iron deficiency or an undersupply of thyroid hormones.
Complications
The types of complications that are possible with anhedonia depend on its cause. If anhedonia is due to a temporary deficiency such as iron or vitamin deficiency, complications often do not develop with appropriate treatment. However, without treatment, overall health may worsen. For example, iron deficiency can cause anemia, which in severe cases can lead to circulatory and cardiac problems, and often causes concentration and memory problems, fatigue, and lassitude. Anhedonia can be a temporary condition triggered by certain life events. Grief immediately following the death of a loved one is not an illness in the strict sense. However, grief can also lead to psychological distress, especially in the absence of coping skills. Chronic grief, depression, anxiety and obsessive-compulsive disorders are possible complications that can occur in the course. In addition, such critical life events can trigger other mental illnesses for which the affected person already has a predisposition. Anhedonia may also precede schizophrenia or psychosis. However, it is often impossible to tell in advance whether anhedonia and other mental symptoms are precipitating a psychotic disorder. However, if other people in the family already suffer from schizophrenia or a similar disorder, appropriate warning signs should be observed. In this case, it is advisable to seek medical advice as soon as prolonged anhedonia (even without hallucinations or delusions) occurs.
When should you see a doctor?
Anhedonia should be discussed with the appropriate therapist or primary care physician. Patients who suffer from listlessness or a general lack of interest in the context of depression do not necessarily need to clarify this medically. However, if the anhedonia leads to problems in everyday life and at work (e.g., neglect of professional duties or loss of earnings), treatment should be considered. Without the help of a psychiatrist and appropriate medication, anhedonia can develop into full-blown depression and result in severe mental and physical problems. It is therefore advisable to seek help if there are signs of anhedonia. As an alternative to seeing a doctor, sometimes just talking to friends or family members can help identify the symptoms of mental illness. People suffering from schizoid personality disorder should talk to a doctor or therapist immediately if they suspect anhedonia. Patients with hypothyroidism, iron deficiency, or neurological disorders should discuss a lack of joy or drive with the appropriate physician, as there may be a physical cause.
Treatment and therapy
Treatment of anhedonia depends on the disease in the context of which it occurs and on personal factors. If the cause is physical, medical therapy is the primary treatment and is aimed at treating the underlying condition in question. If the anhedonia is due to a mental illness, psychiatric and/or psychotherapeutic treatment can bring improvement. Currently, there are three psychotherapeutic guideline procedures in Germany, which differ both in the length of therapy and in the methods used: They include cognitive behavioral therapy, psychoanalysis, and depth psychology-based methods. In the case of depression, dysthymia or schizoid personality disorder, all three approaches are generally considered. Under certain circumstances, medication may be necessary to support treatment, even if a patient is already undergoing psychotherapy. In cases of acute danger to self or others or severe overload in daily life, an inpatient stay may also be necessary, focusing on acute support and stabilization.
Outlook and prognosis
Anhedonia generally has a rather unfavorable prognosis.Without therapeutic support or medical care, patients very rarely succeed in curing or at least alleviating their symptoms by their own efforts. The prospects are particularly unfavorable for people with a severe personality disorder. Since in these disorders the patient usually lacks insight into the disease, there is no way to help the affected person without his or her consent. The state of joylessness remains permanent in these cases. In the case of other mental disorders such as depression, there are various approaches to therapy that help to improve the symptoms. Mild depression can last for several weeks and then lead to complete freedom from symptoms through spontaneous healing. The administration of medication is also possible. In this case, it is not the anhedonia that is treated with medication, but the underlying disease. With a change in the mental state, a reduction in the symptoms of anhedonia occurs at the same time. In the case of moderately severe or recurring depressive states, there is also a prospect of relief. Accompanied by psychotherapy, a better quality of life can be achieved in the long term in the case of joylessness. Necessary for this is a change in the experience of one’s own feelings and a rethinking of developments in the patient’s life.
Prevention
Organically caused anhedonia can be prevented by patients in some cases through a balanced diet and healthy lifestyle. However, for some conditions, specific prevention is not possible. Learning appropriate coping strategies can help prevent depressive illness. With their help, those affected can cope more easily with critical life events and stressors and thus tend to reduce the risk of developing one. However, complete, guaranteed prevention of mental disorders is not possible. In addition to psychological and social factors, genetic and other biological conditions also play a role.
Follow-up
The loss of zest for life and pleasure is difficult to treat in many patients. The disease must therefore be accepted. Aftercare becomes an ongoing issue. Patients have to see their doctor several times a year. The doctor discusses their intersubjective experience with them and uses this information to draw conclusions about the progress of the disease. Psychotherapy is one of the aftercare measures that are regularly prescribed. Weekly outpatient sessions are not uncommon. In addition, physicians also order the use of mood-lifting medications. Since anhedonia usually occurs in combination with depression and schizophrenia, therapy is extended accordingly. If the patient perceives his life as extremely stressful, hospitalization may be indicated. If a cure is successful, patients are by no means immune from relapse. In the preceding psychotherapy, they have learned coping strategies that prevent a renewed outbreak of the symptoms. They have to implement these independently in everyday life. In general, activity can prevent a new outbreak of the mental illness. Sports, club activities and social contacts provide a sense of well-being. Physical deficiencies can be remedied by a varied diet. Certain people have hereditary predispositions. In them, only a temporary improvement can be assumed.
What you can do yourself
Persistent joylessness may indicate a serious physical illness or a serious mental disorder and must definitely be clarified by a specialist. If the cause is psychological, not only a doctor but also a psychotherapist should be consulted, since an improvement in the condition cannot usually be achieved by drug treatment alone, but psychotherapy is required. However, occasional mood swings can also be treated by those affected through behavioral adjustments or naturopathic methods. Anhedonia is often a first sign of a beginning burn-out due to permanent overwork. Affected people who no longer enjoy their lives due to excessive workloads should first analyze the causes of the overload. Insofar as the workload is simply too great, the supervisor must be made aware of the situation.Frequently, however, the causes are rooted in a lack of ability to organize oneself or to delegate tasks. In these cases, those affected should consider attending a seminar that teaches the missing skills. For mild, non-specific depressive moods, St. John’s wort-based preparations are used in naturopathy, which are said to have a mood-lifting, anxiety-relieving and antidepressant effect. Anyone considering therapy with St. John’s wort should know that this remedy increases photosensitivity. Extensive sunbathing and visits to solariums should be avoided during use. In addition, St. John’s wort is suspected of interfering with the effectiveness of hormonal contraceptives. Women who use birth control pills should therefore consult their gynecologist.
