Anhedonia: causes, symptoms and treatment

According to the Spanish Mental Health Confederation, 1 in 4 people will have a mental disorder in their lifetime. 12.5% ​​of all global health problems are divided into psychological imbalances but, even so, from 30 to 50% of patients do not seek help due to fear, feelings of vulnerability, social constraints and many other things more.

The figures provided by this entity go further, since it is estimated that 450 million people in the world are affected by a mental health problem, which seriously hinders their lives. At the symptomatic rate we are going as a society, it is estimated that mental disorders will be the leading cause of disability worldwide by the year 2030.

With these data, we do not intend to scare anyone or paint a disastrous future, but to show the importance of mental disorders globally and to emphasize that, in any case, an emotional symptom should be treated with the same seriousness as a physical one. Once we have established this essential idea, we present the characteristics of anhedonia, a vital component in understanding depressive disorders. Do not miss it.

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What is anhedonia?

The medical journal Dialogues in Clinical Neuroscience defines anhedonia as the reduced ability to feel pleasure. In addition to the lack of pleasure, it also occurs in the form of reduced motivation, loss of pleasant anticipation (wanting to something), reduction of the search for activities that generate pleasure and problems when developing learning circuits reinforced.

Anhedonia is one of the key pillars of depression, occurring in approximately 70% of people with Major Depressive Disorder (MDD) Disorder). In addition, it is also part of the negative symptoms of schizophrenia, along with the lack of energy and interest (apathy-apathy), impoverishment of thought and cognition (alogia) and a marked flattening affective.

This pillar of depression is a multifaceted symptom that includes deficits when it comes to perceiving pleasure, reduction of motivated behavior related to focus and / or impairment of learning about rewards in the environment. From a clinical point of view, anhedonia can be explained by failures at the neuronal level. Let's see why.

The neurological bases of anhedonia

There is ample scientific evidence that link the relationship of dopamine to the reward circuit, a set of interrelated mechanisms in the brain region that allow us to associate certain sensations with a situation of pleasure. In laboratory animals (and humans), dopamine is released in activities such as eating and foraging for food, sex, and the administration and use of drugs.

Dopamine is released by neurons in the nucleus accumbens (brain), but these are in turn stimulated by dopamine hormones from the ventral tegmental area (VTA). The more the dopamine circuitry is exposed to a substance, the more difficult it is for these neuronal groups to be stimulated and release dopamine, hence the mechanisms of substance addiction. It is estimated, to some extent, that a dose of heroin increases circulating dopamine levels in this circuit by 200 in experimental models.

As dopamine plays an essential role in immediate well-being, it has been postulated that anhedonia could be due to alterations in the mesolimbic dopaminergic pathways and their terminal fields, such as the amygdala and the prefrontal cortex, among others structures. Dopamine receptors, glutamate receptors and serotonin (a very important neurotransmitter) also can modulate the reward response and thus explain (in part) the neurological mechanisms of anhedonia.

Anhedonia and depression

As we said, up to 7 out of 10 people with major depressive disorder have anhedoniaAlthough a person can also present this symptom without suffering from depression, whether they are schizophrenic or not. However, as it is one of the bases of depression, a patient can be diagnosed with a depressive disorder based on anhedonia and a few other clinical signs.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published and updated by the Association American Psychologist in 2013, shows us the clinical signs of a depressive disorder higher. For this entity to be such, the individual must present 5 or more symptoms of those mentioned, with one of the two cores included:

• Core I: depressed mood throughout the day, almost every day.
• Core II: a marked decrease in the experience of pleasure in all (or almost all) activities, for most of the day and almost every day. This is anhedonia.
• Significant weight loss when not sought or atypical weight gain. Increased or decreased appetite almost every day, for most of the day.
• A slowdown in thinking and a reduction in physical movement. This clinical sign must be observable by third parties, not only by the patient.
• Fatigue and loss of energy present almost every day.
• Feeling of no use or practically constant feelings of guilt.
• Recurring thoughts of death, recurring suicidal concoctions without a specific plan, and even a suicide attempt or the development of a specific plan to commit suicide.

As you can see, anhedonia is very important to detect major depressive disorder. If a patient has this core symptom and 4 others, they can be diagnosed with depression, despite not presenting a depressed mood for much of the day and repeatedly (depressive mood). Of course, it is paradoxical and interesting to know these criteria. In addition, it should be noted that there are two branches that are split from the main anhedonia complex, with quite different themes. We tell you in a simple way.

1. Sexual anhedonia

Interestingly, anhedonia can also be perceived in the sexual sphere, but it does not have to be related to other emotional fronts. Sexual anhedonia is experienced when the person is aware that she is having an orgasm (that is, she climaxes in the sexual act, unlike other sexual disorders), but is not able to perceive the feeling of euphoria and well-being that this act usually report.

This condition, beyond depression, may be due to low testosterone levels, spinal cord damage, multiple sclerosis, use of antidepressants (SSRIs), use of antipsychotics, fatigue, or physical illness. Sexual anhedonia is much more common in men, but women can get it too.

2. Social anhedonia

Social anhedonia is defined as a clear disinterest when seeking contact with other people, but also as a lack of pleasure in developing activities that involve others individuals. Do not confuse this condition with introversion, because unlike her, in this pathological picture the person is incapable of receiving pleasure from social exchange (not that it costs him more than the rest).

Some of the symptoms of social anhedonia are as follows:

• Reduced abilities in the area of ​​feeling interpersonal pleasure.
• Social withdrawal and isolation.
• Reduced capacity for social interaction and contact.
• Lack of friends and close contacts. The strength of established relationships is very weak.
• Depressive moods, among others.

Social anhedonia is another of the basic pillars of depression and schizophrenia. It also usually occurs together with social anxiety: although they are not the same, in some patients both go hand in hand.

Resume

As you may have seen, anhedonia is a clinical symptom of an underlying pathology, be it a major depressive disorder, schizophrenia or another related condition. On the other hand, sexual anhedonia does not have to be linked to a psychological disorder and, failing that, it arises due to the consumption of certain drugs or physical injuries.

In summary, all types of anhedonia converge on a common point: the inability to feel pleasure in one way or another. If you feel that the activities that you liked before are now innocuous and that you are not able to show anxiety and joy in any of its facets, it is best that you go to a psychologist promptly. Depression manifests itself in many forms, and anhedonia is one of them.