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Feeling blah? It could be anhedonia

5 minute read
Man sitting on couch across from the therapist for an article about anhedonia

What to do about emotional flatlining — and why it matters. 

Nancy Fitzgerald

By Nancy Fitzgerald

Something strange is going on: The things you’ve always enjoyed doing aren’t much fun anymore. Meeting up with good friends — once the highlight of your week — doesn’t bring the sense of joy and anticipation it used to. And hanging out with your partner feels meh. Sound familiar? You might be experiencing a condition known as anhedonia.

What is anhedonia?

Anhedonia is a loss of the ability to feel pleasure while doing things that are normally enjoyable. There are two main types:

  • Social anhedonia: You experience less pleasure when interacting with friends and feel less motivated to do so.
  • Physical anhedonia: You don't enjoy physical sensations such as hugs or delicious food.

Anhedonia is often a symptom of other mental health conditions such as depression and schizophrenia, but not always. And it seems to be a more common problem these days.

“I think what’s happening is that after so many months of the pandemic, people are feeling depleted,” says Kerrie Smedley, PhD. She is a clinical psychologist in Annville, Pennsylvania. “Everything has become so fraught and effortful and complicated, from whether or not to wear a mask at the grocery store to challenges with family members about politics. We’re anxious and stressed and chronically tired. And that’s keeping people from finding joy and predisposing them toward depression.”

Woman smiling
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What causes anhedonia?

Scientists don’t have all the answers, but they point to a brain chemical called dopamine. Among other things, dopamine plays a role in the way your brain decides whether a task is worth the effort.

“Dopamine is known as the reward-pleasure neurotransmitter,” explains Andrew Dewald, PhD. Dewald is a biopsychologist and assistant professor of psychology at Hawaii Pacific University in Honolulu.. “When it’s out of balance, your brain isn’t as sensitive to dopamine and doesn’t process it well. When that happens, you have a drop in motivation and a sense of emotional flatlining. Without dopamine to stimulate your emotions, you don’t experience pleasure. Food doesn’t taste good and being with loved ones isn’t enjoyable.”

How common is anhedonia?

There’s some evidence that it’s becoming more widespread as a result of the COVID-19 pandemic. People who have had a past case of COVID-19 are significantly more likely than those who haven’t to report feelings of anhedonia. One recent study looked at university students during the pandemic. It found that a whopping 57.4% of the students scored high on measures of anhedonia.

It’s also a common symptom in people with serious illnesses such as schizophrenia and Parkinson’s disease. And anhedonia is one of the hallmark symptoms of major depressive disorder, which has increased by 27.6% worldwide because of the COVID-19 pandemic, according to a study published in the medical journal The Lancet.

The main takeaway: Anhedonia isn’t something to ignore. “I’d anticipate that anhedonia could snowball if left untreated,” says Dewald. “It’s not likely to get better on its own. In schizophrenia, for example, it gets progressively worse over time.” And untreated depression could lead to a very dangerous downward spiral.

Can medications help anhedonia?

Maybe, says Dewald. Studies show that medications including fluoxetine (Prozac®), escitalopram (Lexapro®) and ketamine (Ketalar®) can ease symptoms of anhedonia in patients with depression. Recent research has found that vortioxetine (Trintellix®) a newer medication, may have a significant impact on depression and social anhedonia. These medications may help because they boost levels of serotonin, a neurotransmitter. Serotonin is in the same class as dopamine and indirectly affects dopamine levels.

(If you’re already on a medication for a mental health disorder, the Optum Store can manage your prescriptions for you and have it mailed to you. No need to worry about missing a refill again.)

What about therapy for anhedonia?

Old-fashioned talk therapy may be your best bet. “One well-researched approach in people with anhedonia is a technique called behavior activation,” says Smedley. “When you’re emotionally depleted and you’ve started pulling away from things you used to do — gatherings, exercise, hobbies — that leads to less positive reinforcement and fewer rewards.”

Smedley says therapy can help short-circuit this cycle. “In my practice, I use cognitive behavioral therapy, and the ‘behavior’ part is really important. I encourage people to start adding back things in small ways so they can start to experience pleasure and mastery again. Do some things just for joy and some things just for the sense of accomplishment. Try listening to music that used to bring you pleasure. Go for a walk even if you don’t feel like it. Or just pay the bills or make a meal.”

You can talk to an Optum network therapist from the comfort of your home through our virtual care portal—no insurance required. Start your assessment.

Those simple actions, she says, can make you feel better and even change your thought patterns — they’ll make you start to feel more positive. A 2019 study in the Journal of Affective Disorders showed that behavioral activation therapy may decrease anhedonia in people with major depressive disorder.

What steps should I take next?

Even if you don’t feel like making an effort, push yourself to try. “Be honest with yourself about what you’ve been experiencing,” says Smedley. “Mindfulness is crucial. Being aware of the patterns you’ve been seeing is the first step in making a change.”

If you’re concerned, talk to your doctor or reach out to a mental health provider.

Additional sources
Facts about anhedonia: Archives of Psychiatric Nursing, 2013. “Anhedonia: A Concept Analysis.”
Dopamine: National Institutes of Health. Dopamine Affects How Brain Decides Whether Goal is Worth the Effort.
Covid-19 and mood: Brain, Behavior, & Immunity - Health, 2021 “Post-acute sequelae of COVID-19: Evidence of mood & cognitive impairment”
Anhedonia, Covid-10 and university students: Psychology Research and Behavior Management 2021 “The Psychological Impact of COVID-19 Pandemic on Graduating Class Students at the University of Gondar, Northwest Ethiopia.” 
Trintellix: Frontiers in Psychiatry, 2019. “The Efficacy of Vortioxetine on Anhedonia in Patients with Major Depressive Disorder.”
Behavioral activation therapy: Journal of Affective Disorders. 2019 ”Pretreatment brain connectivity during positive emotion upregulation predicts decreased anhedonia following behavioral activation therapy for depression.”