“I don’t want to do anything because nothing feels good, ever.”
Defining Anhedonia in Patients with Depression
Anhedonia is one of several neurovegetative symptoms of Major Depressive Disorder. It is characterized by a strong sense of finding no pleasure in activities that once brought joy to the individual. Anhedonia is a hallmark of clinical depression seen in approximately 70% of presentations (Shankman, et al., 2014).
Anhedonia tends to fall into two primary subtypes. You may experience one or both:
- Physical Anhedonia: Decreased pleasure in tactile and motor activities.
- Social Anhedonia: Decreased pleasure in being around friends and loved ones.
Anhedonia and Prognosis
Anhedonia in patients is a negative prognostic indicator and should be monitored as a benchmark in future care planning. It is not as responsive to medical treatments (SSRI/SNRI) and tends to persist for several weeks while other symptom abate.
During an initial assessment with your physician, psychiatrist, or counsellor, it is important to discuss the challenges you experience when engaging with others and in physical activities. This will help you design an effective treatment plan. With attention, anhedonia will decrease over time.
Effective Treatment of Anhedonia – The Long Game
Traditional pharmacology shows mixed results in the treatment of anhedonia in patients. Some medications leave individuals feeling increasingly detached from others, thus reinforcing the presence of anhedonia, especially in social matters.
There is preliminary evidence that the administration of Ketamine in micro doses, improves both physical and social challenges associated with anhedonia. The effect was shown to be particularly effective in individuals with Bipolar Depression. In fact, in one study, symptom reduction occurred within 40 minutes of a single Ketamine infusion, lasting up to 14 days.
Effective Prevention of Anhedonia
Prevention of anhedonia in patients with clinical depression must consider comprehensive care planing that places significant emphasis on self-care and promotion of an adaptive lifestyle. This means that individuals with a history of anhedonia should seek ongoing one-to-one psychotherapy, group counselling, while engaging in a supportive social network. Patients should evaluate and plan using a biopsychosocial model of care, such as the CHANGES model.