Anhedonia-Why no feelings of pleasure?

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Anhedonia is a mental condition where a person is unable to feel pleasure at all in the otherwise pleasurable activities. A person finds out that he is no more interested in his previous hobbies and activities. Anhedonia could be a symptom of other mental illnesses like:

  • Major Depressive Disorder
  •  Anxiety disorder
  • Schizophrenia
  • Psychosis
  • Substance abuse disorder
  • Parkinson’s disease
  • Anorexia nervosa

It can also happen that a person experiencing anhedonia has no mental illness at all.

We all somewhere in our lives abandon our hobbies as we feel no more pleasure in them. So, is that anhedonia? The answer is simply a no! Anhedonia is not simply the loss of pleasure but a person cuts-off himself from social activities as well and it affects his daily life routine. Normally, a person changes his/her hobbies and activities and finds those interesting. But, anhedonia makes a person so indifferent and ‘emotion-less’ that he cannot find happiness in anything whatsoever.

Anhedonia compels a person to take risks and harm himself just to feel something. Over the years, anhedonia has got much attention because its presence suggests that how much intense an illness is. If a person in depression has anhedonia also, then he is given medications other than anti-depressants. It is seen that anti-depressants do not work much in the case of anhedonia.

There are two types of anhedonia; physical anhedonia and social anhedonia. In physical anhedonia there is a loss of pleasure in tactile, eating and other physical activities. Social anhedonia is the loss of pleasure in social activities and a person might corner himself from his friends and family. These symptoms should not be ignored and one should take notice if he or his loved ones are undergoing something like this.

Causes:

Besides the mental illnesses in which anhedonia might happen, it’s the brain’s structure and chemicals that alter and result in anhedonia.

Our brain is habitual of computing the reward of everything we do. If a chocolate that we love is free of cost for some days, we will buy lots of it even if it’s some miles away. But it that chocolate is way too expensive then probably we will desire for it much. Similarly, if that chocolate is placed on the table beside us, we will have a piece of it even if we are already done with eating. But if that chocolate is in a different city then we will not go and have it even if we are hungry. So, can you figure out something from this very example? Our brain calculates the rewards, risks, and payoffs promptly and we are not even conscious of it! Certain parts of the brain are responsible for reward, pleasure, and motivation. These are:

  •  The pleasure center is the part of the basal ganglia called nucleus accumbens.
  •  The amygdala is responsible for emotions and decision making.
  •  The insula, which controls consciousness and self-awareness.

Neurotransmitters also play an important role to trigger anhedonia. It is thought that decreased amount of dopamine in the nucleus accumbens can account for decreased feelings of reward and pleasure and thus play a role in anhedonia. Although the whole process is unknown because dopamine plays different roles in different parts of the brain. Other than this serotonin, GABA, glutamate, and opioids also play their part. These neurotransmitters are responsible for excitement and some have the inhibitory role. Again, the whole mechanism is unknown yet.

Symptoms:

  • The symptoms which are observed in anhedonia patients are:
  • Absence of emotions in otherwise emotional situations.
  • Loss of interest in hobbies.
  • Disturbed eating habits.
  • No interest in social gatherings. The patient does not like to talk to friends and family anymore.
  • Lack of emotions can compel a person to develop fake emotions. Like faking smile at a wedding etc. which is very much observable by others.
  • Feeling sick all the time. Feeling of fatigue and decreased physical abilities.
  • Decreased body language and verbal and non-verbal expressions.

Treatment:

There is no specific treatment yet which can literally stop anhedonia. This is unfortunate and there is a long way to go. However, we do have some evidence that ketamine reduces anhedonia rapidly and it is reported that it stopped the symptoms within 40 minutes for 14 days! Ketamine can have some effects which inhibit N-methyl-D-aspartate so glutamate cannot activate them and the pleasure and reward can be felt.

Serotonin uptake can also reduce anhedonia as it reduces Major Depressive Disorder symptoms. But, it should be noted that the medications for depression can actually increase anhedonia. So, before starting medications for depression, the symptoms of anhedonia must be ruled out. The reason is that anti-depressants can make anhedonia patient more indifferent and calm. Serotonin uptake should also be selective in order to treat anhedonia properly.

As for other mental illnesses, exercise can significantly help to reduce anhedonia symptoms. Exercising releases happy hormone ‘serotonin’. A balanced diet and exercise should be incorporated in the anhedonia patient’s routine. It will not only reduce its symptoms but will also help to overcome the underlying causes.

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