What is anhedonia? |

Causes

Anhedonia is associated with substance abuse, depression, schizophrenia, and some neuroses. It is thought that anhedonia reflects a problem in the dopamine pathways of the brain. Research has used functional magnetic resonance imaging to examine the brains of persons with depression and anhedonia. This research showed less activity in the ventromedial prefrontal cortex, ventral striatum, and amygdala of the brain. These areas of the brain are involved in reactions to pleasant and unpleasant occurrences.

Clinical depression is often associated with anhedonia. However, not all persons with depression have anhedonia, although it is common. Persons with anhedonia often have a flat affect; have a loss of interest in eating, sexual activity, and other normal daily activities; avoid eye contact; and withdraw or isolate themselves. With schizophrenia, it is thought that the chemical imbalance that causes this condition also causes anhedonia.

Anhedonia is fairly common in drug addicts after withdrawal
, particularly from cocaine and amphetamines. Withdrawal appears to deplete dopamine, serotonin, and other neurotransmitters involved with feeling pleasure. Also, chronic substance abuse causes changes in the functioning of the brain. These changes affect emotions and are more likely to occur in persons whose substance withdrawal, called protracted withdrawal, has taken longer than usual. A person with long-term addictions appears to have permanent damage to the pleasure pathways in his or her brain, damage that is characterized by apathy.

Serious losses that cause depression also can trigger anhedonia. These losses include the loss of a loved one; physical trauma; serious illness; extreme stress, such as living through a disaster; and other life-altering happenings. In these instances, the anhedonia will pass eventually, as will the depression.

Treatment

The most common treatments of anhedonia are antidepressant medications, cognitive-behavioral psychotherapy, and group milieu therapy. Other treatments for anhedonia include regularly scheduled exercise, setting goals, spending time with other people, yoga, art and music therapy, and sunlight and fresh air. The antidepressants most commonly used are the selective serotonin reuptake inhibitors and the selective serotonin and norepinephrine reuptake inhibitors.

The therapist working with a withdrawing substance abuser should inform the patient that he or she may continue to have withdrawal symptoms after the acute withdrawal period or detoxification. If necessary, the patient’s doctor should prescribe medications to counter these symptoms.

Ideally, the therapist should encourage his or her patient to be active both physically and mentally, and should suggest that the patient join an appropriate support group. Many recovering addicts need to relearn good sleep habits. The therapist should assist them with this as well.

Bibliography

Brynie, Faith. “Depression and Anhedonia.” Psychology Today, 21 Dec. 2009.

Hatzigiakoumis, D. S., et al. “Anhedonia and Substance Dependence: Clinical Correlates and Treatment Options.” Frontiers in Psychiatry 2 (2011). Web. http://www.frontiersin.org/addictive_disorders/10.3389/fpsyt.2011.00010/full

Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. “Substance Abuse Treatment Advisory: Protracted Withdrawal.” Web. http://hap.samhsa.gov/products/manuals/advisory/pdfs/SATA_Protracted_Withdrawal.pdf.

Website of Interest

Substance Abuse and Mental Health Services Administration

http://www.samhsa.gov