On Wednesday, Michela reached 49 years old. Though she contemplated forcing a celebration, she declined her friends’ offer to take her out.
The idea of preparing, engaging in conversation, and pretending to be joyful seemed exhausting.
“It requires too much effort,” she explained. “I just lack the energy.”
Michela, who preferred to be referred to by her first name, wasn’t merely having a bad day. She has long struggled to find joy in activities that once pleased her, lacking motivation to pursue them — a condition known as anhedonia.
Anhedonia isn’t a standalone diagnosis but a common symptom of mental health disorders. It’s a subtle indicator, not an obvious alarm. This subtlety often allows it to go unnoticed, according to Dr. Judith F. Joseph, a clinical assistant professor of child and adolescent psychiatry at NYU Grossman School of Medicine.
“It’s not seen as a crisis,” Dr. Joseph noted. However, she added, “It’s an existential crisis.”
Despite its unfamiliarity, understanding anhedonia is crucial, as it is a core symptom of major depressive disorder, which affects Michela, and is linked to conditions like schizophrenia, substance use disorder, and PTSD.
Experts, including Dr. Joseph, shed light on anhedonia and its distressing nature.
What defines anhedonia?
Traditionally, anhedonia is seen as a reduced ability to feel pleasure. Recently, it’s also linked to a lack of motivation to seek joy.
Foods that once delighted may now seem dull. Museums that inspired awe might lose their charm. Even rising from bed can feel burdensome, leading to withdrawal from loved ones.
Expressions like “I feel off” or “I don’t feel like myself” are common, Dr. Joseph said. Those with anhedonia may feel numb or empty.
“I had a patient who loved dance concerts — she’d go but felt no joy,” said Dr. Mark Rapaport, president-elect of the American Psychiatric Association. “She was just there.”
While it resembles depression, one can experience anhedonia without a major depressive disorder diagnosis, which requires at least five distressing symptoms.
Anhedonia varies: some feel diminished joy, others none at all.
Brief spells are normal, but prolonged episodes may signal serious issues.
If untreated, anhedonia affects mood, sleep, nutrition, complicates life and relationships, worsens treatment response, and raises suicide risk.
Why does anhedonia occur?
Scientists continue to explore anhedonia’s root causes.
Research indicates changes in neurotransmitter activity, like dopamine, influence motivation and desire, might contribute.
Michael Treadway, a clinical psychologist and cognitive neuroscientist at Emory University, investigates inflammation’s role in disrupting dopamine production.
“The key question is identifying who is vulnerable,” he said. Success could lead to effective prevention and intervention.
Genetic factors may play a role, and chronic stressors like poverty or discrimination can trigger anhedonia.
Moreover, selective serotonin reuptake inhibitors, often used for depression, might cause emotional numbness, mimicking anhedonia.
How is anhedonia treated?
No FDA-approved medication targets anhedonia specifically. Treating underlying conditions like depression might alleviate symptoms. Adequate sleep and exercise are crucial.
Behavioral activation therapy can aid those with anhedonia. “It’s humorously called ‘Nike therapy’ for its motto: ‘Just do it,’” Dr. Treadway said.
This therapy suggests that behavior influences mood. By gently pushing oneself to engage in valued activities, the brain relearns the pleasure, potentially motivating repeat actions.
Dr. Joseph urges anyone suspecting anhedonia to consult a mental health professional.
“Joy isn’t a luxury,” she emphasized. “It’s essential.”
The article originally appeared in The New York Times.
