What anhedonia is
You go to the concert you were excited about months ago and feel nothing. Your favorite meal tastes like cardboard. A friend calls with good news and you say the right things, but inside it barely registers. That flatness has a name.
Cleveland Clinic defines anhedonia as a lack of interest, enjoyment or pleasure from life's experiences. Everyone's interests change over a lifetime; with anhedonia, you get much less pleasure from the things you like to do. The NHS describes the same experience in plain terms as "not getting any enjoyment out of life."
Why it matters so much in depression
The National Institute of Mental Health (NIMH) explains that a depression diagnosis requires symptoms most of the day, nearly every day, for at least two weeks, and that one of them must be either a depressed mood or a loss of interest or pleasure in most activities. In other words, a person can be depressed without feeling especially sad, if the main change is that nothing feels good anymore.
That is one reason depression gets missed. People expect sadness, and when they feel blank instead, they assume they are just tired, bored or getting older. The American Psychiatric Association describes depressive episodes in bipolar disorder in similar terms, as times when the ability to experience joy or pleasure disappears.
What it can feel like
Cleveland Clinic describes anhedonia as feeling like there is an emptiness where you expect your feelings to be. It can take the form of numbness, boredom, apathy or negativity. Cleveland Clinic also describes two broad types:
- Social anhedonia: not enjoying time with people, and feeling you have nothing to give in the way of love, affection or appreciation
- Physical anhedonia: touch, smells, sounds and tastes no longer bring pleasure, such as music, food or sex
People often describe it in everyday ways. "I don't look forward to anything." "I do my hobbies out of habit." "I'd rather stay home, but staying home isn't enjoyable either." Cleveland Clinic notes that it can lead to social isolation, sleep problems and lower sex drive.
Anhedonia is not the same as apathy
Cleveland Clinic distinguishes the two. Anhedonia is a lack of enjoyment or pleasure. Apathy is a lack of energy or motivation to do things. They often occur together, but the difference can be useful. Some people still want to enjoy things and push themselves to go out, but the pleasure does not come. Others cannot get started at all. Telling a clinician which describes you best helps them understand what is going on.
What can cause it
Cleveland Clinic lists anhedonia as a possible symptom of several conditions, including depression, bipolar disorder, schizophrenia, substance use disorder, post-traumatic stress disorder, Parkinson's disease and traumatic brain injury. Research into the cause is ongoing. Studies suggest it may involve reduced activity in the ventral striatum, a part of the brain involved in processing reward and dopamine, which can affect how a person experiences rewards such as time with others.
Physical health can play a part as well. Cleveland Clinic notes that a provider may recommend blood tests to look for underlying conditions such as low vitamin D or an underactive thyroid. A checkup with your physician is a sensible step, especially if the change came on along with fatigue or other physical symptoms. If you started or changed a medication around the time things went flat, mention that too, and talk with your prescriber before changing anything.
For a wider look at how biology and life events combine, see What Causes Depression? Biology, Stress and Life Events.
How it is treated
Cleveland Clinic notes that there is no specific treatment for anhedonia itself. Instead, a provider diagnoses and treats the underlying condition, which may involve psychotherapy, medication or both. For depression, NIMH describes psychotherapy, medication or a combination as the usual treatments, and notes that finding the best treatment may take some trial and error.
In therapy, anhedonia can be approached from more than one angle. One is practical: noticing which activities still bring even a flicker of interest, and protecting those. Another is exploring what else is happening, such as grief, burnout, a relationship that has gone quiet, or a long habit of putting your own wants last, any of which can dull pleasure over time. Dr. Lehmann offers depression therapy for adults in Franklin and by telehealth for clients in Michigan.
Small steps while you wait
These are not a substitute for treatment, but they can make the days a little less flat:
- Move your body. Cleveland Clinic notes that a provider may suggest regular exercise, such as walking or yoga.
- Keep a few small plans, even if you do not expect to enjoy them. For some people, a little pleasure shows up partway through rather than in anticipation.
- Lower the bar. Ten minutes of music or a short walk with a friend counts.
- Notice faint positives and write them down. With anhedonia, a 2 out of 10 is information.
- Watch your drinking. NIMH lists increased use of alcohol or drugs among the behavior changes that can come with depression.
Small Daily Steps When You Are Depressed has more ideas along these lines.
When to get help
Cleveland Clinic advises contacting a healthcare provider if you no longer feel joy or pleasure as you once did, and lists suicidal thoughts among the risks of leaving anhedonia and its cause untreated. If the flatness has started to include thoughts that life is not worth living, reach out now.