According to the Mental Health Confederation of Spain, 1 in 4 people will have a mental disorder in their lifetime.. 12.5% of all health problems worldwide are distributed in psychological disorders but, even so, 30 to 50% of patients do not seek help because of fear, feelings of vulnerability, social impositions and many other things.
The figures provided by this entity go even further, since it is estimated that 450 million people in the world are affected by a mental health problem, which seriously hinders their lives. At the symptomatological rate at which we are going as a society, it is estimated that mental disorders will be the leading cause of disability worldwide by the year 2030.
With these data, we do not intend to scare anyone or paint a disastrous future, but to highlight the importance of mental disorders globally and to emphasize that, in any case, an emotional symptom should be treated with the same seriousness as a physical one. Once we have established this essential idea, we will now present the characteristics of anhedonia, a vital component in understanding depressive disorders.. Don’t miss it.
What is anhedonia?
The medical journal Dialogues in Clinical Neuroscience defines anhedonia as the reduced ability to feel pleasure.. In addition to lack of pleasure, it also takes the form of reduced motivation, loss of pleasurable anticipation (wanting something), reduced pursuit of pleasure-generating activities, and problems in developing reinforced learning circuits.
Anhedonia is one of the key pillars of depression, occurring in approximately 70% of people with major depressive disorder (MDD). In addition, it is also part of the negative symptoms of schizophrenia, along with lack of energy and interest (abulia-apathy), impoverished thinking and cognition (alogia), and marked affective flattening.
This pillar of depression is a multi-faceted symptom which includes deficits in perceiving pleasure, reduction of focus-related motivated behavior and/or impaired learning about rewards in the environment. From a clinical point of view, anhedonia can be explained by failures at the neuronal level. Let us see what this is due to.
The neurological basis of anhedonia
There is ample scientific evidence linking the link the relationship between dopamine and the reward circuitryThe reward circuit, a set of interrelated mechanisms in the brain region that allow us to associate certain sensations with a situation of pleasure. In laboratory animals (and humans), dopamine is released in activities such as food consumption and foraging, sex, and drug administration and consumption.
Dopamine is released in neurons in the nucleus accumbens (brain), but these are in turn stimulated by dopaminergic hormones in the ventral tegmental area (VTA). The more the dopaminergic circuit is exposed to a substance, the more difficult it is for these neuronal groups to be stimulated and release dopamine, hence the mechanisms of substance addiction. It is estimated, to some extent, that a dose of heroin increases circulating dopamine levels in this circuit by 200 in experimental models.
As dopamine plays an essential role in immediate well-being, it has been postulated that anhedonia could be due to alterations in the mesolimbic dopaminergic pathways and their terminal fields, such as the amygdala and the prefrontal cortex, among other structures. Dopaminergic receptors, glutamate receptors and serotonin (a very important neurotransmitter) may also modulate the reward response and may modulate the reward response and thus explain (in part) the neurological mechanisms of anhedonia..
Anhedonia and depression
As we have said, up to 7 out of 10 people with major depressive disorder have anhedonia.although a person can also present this symptom without suffering from depression, whether schizophrenic or not. In any case, since it is one of the bases of depression, a patient can be diagnosed with a depressive disorder based on anhedonia and a few other clinical signs.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published and updated by the American Psychological Association in 2013, shows us the clinical signs of a major depressive disorder. For this entity to be such, the individual must present 5 or more of the above symptoms, with one of the two cores included:
- Core I: depressed mood throughout the day, almost every day.
- Core II: a marked decrease in the experience of pleasure in all (or almost all) activities, for most of the day and almost every day. This is anhedonia.
- Significant weight loss when not wanted or atypical weight gain. Increased or decreased appetite almost every day, for most of the day.
- A slowing of thinking and a reduction in physical movement. This clinical sign should be observable by others, not just the patient.
- Fatigue and loss of energy present almost every day.
- Almost constant feelings of worthlessness or feelings of guilt.
- Recurrent thoughts of death, recurrent suicidal plotting without a specific plan, and even a suicide attempt or the development of a specific plan to commit suicide.
As you can see, anhedonia is very important in detecting major depressive disorder. If a patient presents this core symptom and 4 others, he may be diagnosed with depression.The results of this study show that the patient has a depressive mood, despite not presenting a depressed mood for a large part of the day and repeatedly (depressive mood). Of course, it is paradoxical and interesting to know these criteria. In addition, it should be noted that there are two branches that are split off from the main complex of anhedonia, with quite different themes. We will tell you about them in a simple way.
1. Sexual anhedonia
Interestingly, anhedonia can also be perceived in the sexual sphere, but it does not necessarily have to be related to other emotional fronts. Sexual anhedonia is experienced when the person is aware of having an orgasm (i.e., climaxes in the sexual act, unlike other sexual disorders), but is unable to perceive the sense of euphoria and well-being that this act usually brings.
This condition, beyond depression, may be due to low testosterone levels.The most common cause of sexual anhedonia is sexual anhedonia, spinal cord damage, multiple sclerosis, the use of antidepressants (SSRIs), the use of antipsychotics, fatigue or a physical illness. Sexual anhedonia is much more common in men, but women can also suffer from it.
2. Social anhedonia
Social anhedonia is defined as a clear disinterest in seeking contact with other people, but also as a lack of pleasure when engaging in activities involving other individuals. This condition should not be confused with introversion.Unlike introversion, in this pathological condition the person is unable to receive pleasure from social exchange (not that it is more difficult for him/her than for others).
Some of the symptoms of social anhedonia are the following:
- Reduced abilities in the area of feeling interpersonal pleasure.
- Social withdrawal and isolation.
- Reduced capacity for social interaction and contact.
- Lack of friends and close contacts. The strength of established relationships is very weak.
- Depressive moods, among others.
Social anhedonia is another of the basic pillars of depression and schizophrenia.. It also often occurs together with social anxiety: although they are not the same, in some patients the two go hand in hand.
Summary
As you may have gathered, anhedonia is a clinical symptom of an underlying pathology, be it major depressive disorder, schizophrenia or another related condition. On the other hand, sexual anhedonia need not be linked to a psychological disorder and, alternatively, may arise from the use of certain drugs or physical injury.
To sum up, all types of anhedonia converge on a common point: the inability to feel pleasure in one way or another.. If you feel that the activities you used to enjoy are now innocuous and that you are not able to show any of their facets of eagerness and joy, it is best to see a psychologist with alacrity. Depression manifests itself in many ways, and anhedonia is one of them.