{"id":28040,"date":"2023-08-21T08:55:58","date_gmt":"2023-08-21T07:55:58","guid":{"rendered":"https:\/\/research.reading.ac.uk\/research-blog\/?p=28040"},"modified":"2023-08-21T14:26:53","modified_gmt":"2023-08-21T13:26:53","slug":"depression-isnt-just-sadness-its-often-a-loss-of-pleasure","status":"publish","type":"post","link":"https:\/\/research.reading.ac.uk\/research-blog\/2023\/08\/21\/depression-isnt-just-sadness-its-often-a-loss-of-pleasure\/","title":{"rendered":"Depression isn\u2019t just sadness \u2013 it\u2019s often a loss of pleasure"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text]It\u2019s often thought that if someone is depressed, they will feel sad or low most of the time. But what many don\u2019t realise is that these aren\u2019t the only symptoms of depression. Another common symptom of depression that is sometimes overlooked is the feeling that you no longer find the things you used to enjoy to be interesting or pleasurable.[\/vc_column_text][vc_single_image image=”28041″ img_size=”full” alignment=”center”][vc_column_text]Known as anhedonia, this symptom is present in\u00a0up to 75%<\/a>\u00a0of adults and\u00a0young people<\/a>\u00a0with depression. But despite how common this symptom is, it remains one of the most difficult symptoms to treat and manage.<\/p>\n

Loss of pleasure<\/h3>\n

Anhedonia<\/a>\u00a0is defined as the reduced interest or pleasure in all \u2013 or almost all \u2013 activities a person previously enjoyed. If a person has anhedonia for an extended period of time (at least two weeks consistently), they can be diagnosed with depression \u2013 even if they may not feel sad or low.<\/p>\n

Although mainly associated with depression, anhedonia can also be a symptom of other disorders \u2013 such as\u00a0schizophrenia<\/a>,\u00a0anxiety<\/a>\u00a0and\u00a0Parkinson\u2019s disease<\/a>.<\/p>\n

In\u00a0in-depth interviews<\/a>\u00a0my colleagues and I conducted with young people about depression, anhedonia was described by many as not just a loss of joy, but also less motivation to do things. For some, this lack of drive was only related to specific things \u2013 such as going to school or seeing friends. But for others, it was more severe, and they felt they didn\u2019t want to do anything at all \u2013 not even live.<\/p>\n

But despite how troubling anhedonia can be, it\u2019s often not the main target of depression treatment.<\/p>\n

It\u2019s recommended that cases of mild depression are treated with\u00a0talking therapy<\/a>. People with more moderate or severe cases of depression may be prescribed antidepressants. While all these treatments aim to help patients cope with and overcome symptoms, over half of people with depression don\u2019t respond to their first recommended treatment. Even after changing treatments, approximately\u00a030% of patients<\/a>\u00a0still experience symptoms.<\/p>\n

It\u2019s been argued that one reason for these low response rates may be because current treatment techniques don\u2019t\u00a0adequately target anhedonia<\/a>. Research also shows that having anhedonia predicts\u00a0chronic relapsing<\/a>\u00a0of depression. It\u2019s even possible that some antidepressant treatments might\u00a0make anhedonia worse<\/a>.<\/p>\n

Why might this be? One possibility is that current standard treatments focus mainly on treating the\u00a0depressed mood<\/a>\u00a0and brain processes that underpin low mood \u2013 but not anhedonia. For example the main aim of talking therapies, such as cognitive behavioural therapy, is to reduce\u00a0negative thinking in patients<\/a>. The most common antidepressant medications also mainly target\u00a0serotonin<\/a>, which is thought to underpin in part, how the brain processes negative information.<\/p>\n

But as anhedonia is reduced joy in life, treatments such as\u00a0behavioural activation<\/a>\u00a0(a form of talking therapy) could be better for anhedonia. This is because behavioural activation aims to help people with depression take simple, practical steps towards enjoying life again. Yet some studies find behavioural activation is no better than\u00a0standard treatments<\/a>\u00a0in managing anhedonia. This might be because the very nature of anhedonia includes a lack of motivation \u2013 making it difficult for patients to\u00a0engage in any therapy<\/a>, even forms which may most benefit them.<\/p>\n

Anhedonia has also been linked to\u00a0dysfunctional reward mechanisms<\/a>\u00a0in the brain. As such, treatments which focus more on improving the way the\u00a0brain processes reward<\/a>\u00a0could help alleviate anhedonia more effectively than current treatments.<\/p>\n

But the brain\u2019s reward system isn\u2019t straightforward, and actually involves various subprocesses \u2013 including anticipation, motivation, pleasure and learning about reward. Problems with any one of these subprocesses could be contributing to anhedonia. As such, it will be important for research to uncover\u00a0how these subprocesses operate<\/a>\u00a0in people with anhedonia to develop better targets for treatment.<\/p>\n

Treatment options<\/h3>\n

While anhedonia may be complex, that doesn\u2019t mean there\u2019s no hope for those who are affected by it.<\/p>\n

For instance, research shows that talking therapies which\u00a0focus on reward processing<\/a>\u00a0could help reduce anhedonia. A recent\u00a0pilot study<\/a>\u00a0also found that a new type of talk therapy called augmented depression therapy may work better than cognitive behavioural therapy in treating depression. This is because augmented depression therapy specifically targets anhedonia by having patients focus on both their negative and positive experiences.<\/p>\n

Further, antidepressants that target neurotransmitters involved in the reward system (such as\u00a0dopamine<\/a>) might be better suited for patients with anhedonia. Early work examining drugs such as\u00a0ketamine<\/a>, which can affect dopamine activity, suggest it may have promise for treating anhedonia.<\/p>\n

And while it can be hard to find motivation if you\u2019re experiencing anhedonia, trying to find time for fun, enjoyable activities or experiences like a hobby you used to love \u2013 or even a new hobby \u2013 could help alleviate anhedonia.[\/vc_column_text][vc_column_text]Ciara McCabe is Professor of Neuroscience, Psychopharmacology and Mental Health at the University of Reading.<\/p>\n

This article is republished from The Conversation<\/a> under a Creative Commons Licence.[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"

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