Apathy is a symptom of depression, a cause for self-harm, yet treatable with therapy and a neuroscience driven approach.
Suffering from mood disorders, including unbearable lightness of being due to chronic stress and inflammation in the past, physical and social anhedonia is a topic close to my heart. Thus, I want to create awareness leveraging scientific development in the field.
We all feel ups and downs in life. It is part of the natural process. However, life becomes meaningless when we experience anhedonia — a lack of pleasure from things that we usually enjoyed in the past.
The closest public term anhedonia is apathy. This experience depicts a lack of interest, enthusiasm, ad concern in enjoyable activities. In addition, apathy is associated with self-harming behaviour such as suicide.
When we experience physical anhedonia, we don’t enjoy natural activities concerning our physical sensations. For example, a touch or a hug by a loved one leaves us empty. Those who were addicted to sex once does not want it anymore when experiencing anhedonia. Some might cry with no stimulus.
There is also social anhedonia associated with reduced social functioning and diminished reward from social interactions. “Individuals expressing social anhedonia are likely to experience reduced social connectedness and feel lonely. Loneliness is associated with reduced social functioning. Thus, loneliness could account for the relationship between social anhedonia and social functioning.”
This study points out that “both physical and social anhedonia is associated with suicidality in major depression. It is a cross-sectional study investigating the association of physical and social anhedonia with suicidality in patients with major depressive disorder.”
What can we do?
The sensible approach is being aware of the symptoms and communicating them to a qualified healthcare professional who can diagnose the conditions and provide valuable tools to address the underlying issues and mitigate risks.
Partnership with qualified practitioners is critical. Awareness of our situations is important because if we don’t know and communicate our symptoms, professionals won’t know about them. No professional is a mind-reader.
In this post, I introduce common symptoms of anhedonia, root causes, and coping mechanisms based on my scientific literature review.
An Overview of Anhedonia
Are you constantly feeling down, and the things you used to enjoy immensely do not give you any pleasure anymore? Are you declining invitations to festive parties once you enthusiastically participate and have lots of fun and get joy?
If you don’t enjoy your previous hobbies or social gatherings that gave you pleasure once, you might be experiencing anhedonia. Awareness of this common condition is critical for our mental health and well-being.
One in one hundred people have major depression symptoms. Some are severely affected and end up self-harming themselves.
Anhedonia is felt in both polar and non-polar depression. In polar depression, people feel excessive joy for a while, then they get fully crashed and feel depressive for some time.
In non-polar depression, also known as major depression, show a flat state of non-enjoyment from things that we used to have lots of pleasure before. Thus, anhedonia is one of the symptoms of major depression.
Anhedonia is a complex phenomenon linked to several pathways in our neurobiology. It has biological, neural, and psychological connections.
Vegetative symptoms depict the existence of anhedonia. These symptoms might reflect not feeling good to do something, especially for things we used to get much pleasure.
Anhedonia is closely associated with hormones and neurotransmitters. For example, the ghrelin hormone, which makes us hungry, does not function anymore. Thus, a person experiencing anhedonia might not enjoy their favourite food. More precisely, it does not give any meaning to their life.
Another example is the deficiency of sex hormones such as testosterone, estrogen, oxytocin. People experiencing a lack of these hormones might not enjoy intimacy and lovemaking as they do not give them pleasure.
According to this paper, “anhedonia is characteristic of depression, some types of anxiety, and substance abuse and schizophrenia. Anhedonia is a predictor of poor long-term outcomes, including suicide and poor treatment response. Because extant psychological and pharmacological treatments are relatively ineffective for anhedonia, there is an unmet therapeutic need for this high-risk symptom.”
The paper points that “current psychological and drug treatments for anxiety and depression focus largely on reducing excesses in negative affect rather than improving deficits in positive affect. Recent advances in affective neuroscience posit that anhedonia is associated with deficits in the appetitive reward system, specifically the anticipation, consumption, and learning of reward. The study describes the therapeutic approach for Positive Affect Treatment (PAT), an intervention designed specifically to target deficits in reward sensitivity.”
Causes of Anhedonia
Even though anhedonia is mainly associated with major depression, other conditions such as dysthymia, schizophrenia, diabetes, Parkinson’s disease, Huntington’s disease, Alzheimer’s disease, bipolar disorders, progressive supranuclear palsy, stroke, and even coronary artery disease can trigger this condition.
These health conditions cause changes in neural activities in the brain. Based on preliminary research in neuroscience and psychiatry, especially in animal studies, it depicts the mechanism associated with dopamine. It is our feel-good neurotransmitter for seeking rewards.
Other neurotransmitters and hormones, such as lack of serotonin and elevated stress hormone (cortisol), is also associated with anhedonia. For example, when we have serotonin deficiency, we can experience grief, guilt, and exhaustion symptoms.
Some recent animal studies provide glimpses of causes. For example, this paper indicates that “during 30-day experimental neurosis and eight-week depression-like behavior cause the development of anhedonia. Therapeutic use of amide 2-hydroxy-N-naftalen-1-il-2-(2-oxo-1,2-dihidro-indole-3-iliden) and ethyl ether 4-[2-hydroxy-2-(2-oxo-1,2-dihidro-indole-3-iliden)-acetamin]-butyric acid effectively corrected anhedonia after experimental neurosis and chronic mild stress in rats.”
Anhedonia specialists mainly use SSRIs (Selective Serotonin Reuptake Inhibitors), therapeutic molecules and talk therapy to apathy symptoms. SSRIs are prescribed as antidepressants and are also used for the treatment of anxiety disorders.
Talk therapy has several benefits, such as reducing stress, identifying early signs of conditions, and giving a broader perspective on a problem. Talk therapy can include individual, family, and group therapies. Talk therapy is usually supplemented with appropriate medications.
Interestingly, some recent studies indicate that ketamine might work for relief from anhedonia. This paper mentions that “ketamine, administered in subanesthetic doses, is an effective off-label treatment for severe and even treatment-refractory depression; however, despite dozens of studies across nearly two decades of research, there is no definitive guidance on matters related to core practice issues.”
While psychiatrists and neurologists work on treatments, the research is active in the area. Many studies are conducted. Some studies refer to transdiagnostic approaches. This paper indicates “a transdiagnostic approach that cuts across traditional disease boundaries provides a potentially useful means for understanding apathy and anhedonia conditions.”
Impact of Chronic Stress on Depressive Conditions
Excessive inflammation caused by chronic stress is associated with major depression. Depression relates to excessive inflammation. When we are chronically stressed, the brain gets inflamed. The cells in the brain get disrupted. This is a complex and comprehensive topic, but I want to give a simple example of leveraging scientific papers.
Without going into detail, I want to point out that even though we consume enough nutrition, inflammation affects the utilization of nutrition. For example, tryptophan, the precursor to serotonin, unfortunately, converts to neurotoxins when too much inflammation occurs in the brain. So even though we nutritionally feed ourselves, the inflammation disrupts the conversion process and use the neuro-toxic pathway.
A pointed out in this paper, “chronic stress and infections can shunt available tryptophan toward the kynurenic pathway and thereby lower 5-HT (serotonin receptors) synthesis.”
In accordance with this, dietary fatty acids affecting the pro-inflammatory cytokines have been suggested to affect the metabolic fate of tryptophan. In addition, exercise is known to help with the conversion of tryptophan to serotonin naturally and effectively. Serotonin is an essential neurotransmitter for a good mood.
Essential fatty acids can reduce inflammation. One of the known tools to minimize inflammation is EPA (Eicosapentaenoic acid). Nutritionists recommend at least a gram of EPA for managing inflammation. It is also used for cardiovascular health. We can get EPA from fish or supplements such as fish oil and krill oil. However, reading the label for EPA in supplements matters as the amount of fish oil might not cover a sufficient amount of EPA.
Another promising supplement for depressive symptoms mentioned in the literature is creatine. For example, this paper notes “growing evidence from human neuroimaging, genetics, epidemiology, and animal studies that disruptions in brain energy production, storage, and utilization are implicated in the development and maintenance of depression. Creatine, a widely available nutritional supplement, has the potential to improve these disruptions in some patients, and early clinical trials indicate that it may have efficacy as an antidepressant agent.”
Compelling Thoughts & Ideas on Anhedonia
There are many ideas offered by thought leaders.
Addictive behaviour is commonly discussed in health communities. For example, addiction to porn leads to disinterest in intimacy at a later stage and cause hormonal and neurotransmitter imbalance. For example, excessive pleasures exceed the dopamine threshold; hence body had to regulate the pain and pleasure pathways.
Other topics in the health forums relate to addictive behaviours such as recreational drugs, alcohol, nicotine, caffeine, online gaming, social media and other hedonistic activities.
Excessive hedonistic behaviours are believed to cause emotional detachment and numbness after overconsumption. This type of behaviour is mainly observed in teenagers obsessed with hedonistic activities disrupting the natural flow of neurochemicals and hormones.
Some of us experience mild and major depression due to various reasons. However, living with apathy can be unbearable.
We need to control our physical and emotional stress by preventing them from reaching a chronic state as a preventative measure.
Smart lifestyle changes can help us avoid a depressive state. Lifestyle considerations such as quality nutrition, moderate exercise, adequate sleep, sunlight exposure, relaxation, and meditation are a few commonly recommended preventative measures.
Physical interventions such as exercise and cold showers can release neurotransmitters to relieve depression symptoms. For example, we know that exercise is protective by stimulating the release of dopamine, norepinephrine, and serotonin.
The problem is depressed people don’t feel like taking exercise or cold showers as they cannot access the circuits like normal people. Thus, they may need medication to fix problems in those circuits. So, prescribed medication might be required to increase the interest of patients in participating in these activities.
My point is despite our efforts to use preventative measures, if we experience symptoms of anhedonia, we need to accept it and seek professional advice with confidence. We might self-diagnose our conditions; however, it is always essential to work with a professional who can methodically diagnose them.
Observing and identifying symptoms are essential but getting advice for proper diagnostics is critical too. We need to partner with our healthcare professionals.
Thank you for reading my perspectives.
I’d be delighted to obtain your feedback.
Please note that this story is not health advice. I shared my research and perspectives for information and awareness only. If you have symptoms of anhedonia please consult your health care professionals such as a psychiatrist or psychologist referred by your primary healthcare practitioner.
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Cited Scientific Reference
Physical and social anhedonia are associated with suicidality in major depression, but not in schizophrenia.
From stress to inflammation and major depressive disorder: a social signal transduction theory of depression.
Effects of physical exercise on depressive symptoms and biomarkers in depression.
A novel construct of anhedonia revealed in a Chinese sample via the Revised Physical and Social Anhedonia Scales.
Social anhedonia, social networks, and psychotic-like experiences: A test of social deafferentation.
Physical and social anhedonia in female adolescents: A factor analysis of self-report measures.
Social and physical anhedonia and valence and arousal aspects of emotional experience.
Body and Social Anhedonia of Depression: A Bifactor Model Analysis.
Schizotypy, depression, and anxiety in physical and social anhedonia.
Link Between Anhedonia and Depression During Early Alcohol Abstinence: Gender Matters.
Association of physical and social anhedonia with depression in the acute phase of schizophrenia.
Mood and metabolism: Anhedonia as a clinical target in Type 2 diabetes.
Anhedonia and functional dyspepsia in obese patients: Relationship with binge eating behaviour.
Psychometric properties of the Revised Physical and Social Anhedonia Scales in non-clinical young adults.
A comparison of psychometric and convergent validity for social anhedonia and social closeness.