Anhedonia – Inability to Experience Pleasure

Symptoms of Anhedonia

Simply put, anhedonia is the inability to experience pleasure from any activities which would typically be found enjoyable. A sufferer cannot feel joy, happiness or any other positive emotions normally found through hobbies, physical exercise, social gatherings and sexual activity. Those with anhedonia have unchanging moods and will feel emotionally empty regardless of what is happening around them.

Anhedonia has commonly been linked to depression and is, in fact, one of the core symptoms associated with the disorder. It occurs in a wide number of mental illnesses, such as schizophrenia and mood disorders, and also exhibits itself within alcohol and drug-dependent patients. This is especially the case during the drug or alcohol withdrawal process, where both body and mind are under significant stress.

Causes of Anhedonia

There are several trains of thought as to what causes anhedonia, involving both mental and physical aspects of the individual. Social learning is one method that has been suggested as a probable trigger. A typical child develops themselves by watching those around them and learning from others how to behave. Through positive and negative feedback, they learn what to do and what not to do. A child with a mental disorder may be deprived of experiencing new things because their development is impaired. This may then lead to anhedonia as they have limited experience in both positive and negative feedback and the emotions that accompany these situations.

The Institute of Psychiatry in London completed a study in 2005 that looked at the brain activity of those diagnosed with anhedonia and compared the results to those gained from healthy subjects. They discovered that the brain actually works differently in those suffering from the disorder. These differences were found in three key areas:

* Ventromedial prefrontal cortex: Deals with empathy and negative emotions
* Ventral striatum: Signals reward
* Amygdale: Handles mood changes and helps to forget recent negative events

In those with anhedonia, the prefrontal cortex had difficulty in processing happiness and had to work harder than normal. As well as this, there was less activity in the ventral striatum and the amygdale. These changes disrupt the brain’s reward system, making it less likely that any positive emotions are felt regardless of what the patient is doing. This breakdown then becomes a key component of depression as the patient cannot gain any pleasure out of activities that would otherwise have been enjoyable.

Assessing Anhedonia

The most common method of assessing the severity of this disorder is through interview-based techniques. Via careful questioning, the clinician examines the subject’s regular activities and the emotions that they experience. Some of the more popular interview methods are listed below:

* Scale for the Assessment of Negative Symptoms (SANS)
* Schedule for the Deficit Syndrome (SDS)
* Positive and Negative Syndrome Scale (PANSS)
* Scale for Emotional Blunting (SEB)

SANS contains the Anhedonia-Asociality Subscale which is by far the most comprehensive analysis tool currently used for the assessment of this disorder. It covers four areas, including personal hobbies, sexual activities, feelings of intimacy and social interaction. These are then rated on a scale of 0 to 5 and a final score is calculated to determine the severity of anhedonia found within an individual.

There are also various self-report trait measures such as the Revised Social Anhedonia Scale (RSAS) and the Physical Anhedonia Scale (PAS) which are currently being used. They are simple questionnaires which an individual completes on their own in which they answer how they react to certain positive and negative stimuli. They should be used instead of interview-based techniques in cases where a patient may have difficulties with social interactions.

Anhedonia and Alcohol

Studies have found that those who abruptly abstain from drinking will have a high chance of experiencing protracted periods of withdrawal in which they can suffer from anhedonia. This disorder is directly linked to the withdrawal process and should be treated, along with any other physical or mental symptoms, in order to successfully free a patient from their addiction.

Anhedonia also has a direct connection with alcohol use as it has been shown that those who have the disorder are more likely to drink heavily than those who do not. However, the causation of this is still unknown and further studies have to be completed to determine whether anhedonia triggers heavy alcohol consumption or if the reverse is true instead.

Interestingly, studies have shown that anhedonia does not typically cause relapses in recovering alcoholics. Rather, it is the drive for thrill-seeking and adventure which is the more important factor in individuals who revert back to their old drinking habits. This is not to say that anhedonia is a minor concern though. On the contrary, it is still a major mental condition which should be treated along with any other symptoms experienced after alcohol abuse.

Along these lines, there have been a number of medications which have been tested for use on alcoholics suffering from anhedonia. The drug, acetyl-l-carnitine, has been shown to assist those with this disorder, decreasing the feelings of craving and increasing the likelihood that they will resist having another drink.

Anhedonia and Drug Use

Like alcohol, drugs can also induce anhedonia. It has been suggested that lengthy periods of taking amphetamine-based drugs, such as cocaine, can trigger this disorder, especially once the abuser crashes. This can then be a factor which spurs on repeated use as positive emotions are limited unless the drug is administered again.

One theory is that the brain’s chemistry is changed through drug use so that the threshold for feeling pleasure is then increased. Thus, everyday activities which most people enjoy are then spurned by the drug user who sees no emotional benefit in them. Rather, the drugs are the main source of happiness and overall well-being, which drives them to use again and again.

When it comes to extended drug use, the changes in an individual’s brain may become permanent, so that it is impossible to get rid of symptoms, such as anhedonia, once they begin. This is most prominent in methamphetamines and amphetamines, where dopamine levels in the brain are altered so drastically that there is no chance of recovery later on. In these cases, prescription drugs may be the only answer, though there is the question of whether this is simply trading one addiction for another.

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