What's it like living with anhedonia?


Anhedonia is the inability to gain pleasure from enjoyable experiences.

It was first identified in the 19th century, but was largely ignored until the late 1980s in favour of more obvious depressive symptoms such as low mood, poor concentration, tiredness, disturbed appetite and sleep, and suicidal thoughts.

Anhedonia is now recognised as a core symptom of depression and research by the Institute of Psychiatry in London is throwing new light on the links between the brain and depressive illness.


Symptoms of anhedonia

People with anhedonia have an incredibly flat mood. They can't react properly or feel anything. There is no variation of mood, making it difficult to take things forward.

It is best described by examples. An anhedonic mother gains no joy from playing with her baby, a footballer isn't excited when he scores the winning goal, a teenager is left unmoved by passing her driving test.


Anhedonia places a great strain on relationships and is usually accompanied by a loss of sex drive.

Anhedonia and depression

Depression affects one in every five people at some time in their lives and is a potentially fatal illness through suicide.

Depression can be triggered by a sad event like a bereavement, by a physical illness or by imbalances in brain chemistry.

Not everybody who has depression has anhedonia. While rare in mild depression, it can be a serious problem for people who are severely depressed.

Anhedonia can continue after depression, but usually it goes away at the same time.

Antidepressant medicines only partially deal with anhedonia symptoms.

Watching the brain in action

There have been various studies to try to identify the specific areas of the brain involved with anhedonia and depression.

An imaging technique called functional magnetic resonance imaging (fMRI) is used to scan the brain at work.

For example, as you talk, you use the brain cells in the front part of your brain. The increase in neural activity means there is an increased need for oxygen in this area.

Oxygen is delivered by the haemoglobin, which carries oxygen in the blood to all the cells of the body.

The fMRI scan picks up the difference in the magnetic properties of oxygenated and deoxygenated haemoglobin as the oxygen is delivered to the active area of the brain.

This means scientists can see changes in the brain as they happen. Not only can the activity of the brain be recorded when the person moves or signals the answer to a question by pressing a button, it can also be observed when the brain is active during thinking or planning.

Studies on depression and anhedonia

Some differences in the brains of depressives have already been observed. For example, in comparison with healthy volunteers, depressives have:

  • smaller hippocampi (the area that deals with emotion)
  • larger white matter lesions
  • differences in brain metabolism.

One study found that when depressed people were shown film clips designed to cause passing sadness, they activated areas of the brain that were not involved in the reaction of a group of healthy controls. The investigators suggested that this activation might disconnect the limbic system, which is linked to both rage and pleasure, from the normal prioritisation of emotional importance.

In 2005 the Institute of Psychiatry in London used fMRI to compare 12 people with anhedonia and depression to 12 healthy individuals. They identified three areas of the brain that worked differently:

  • ventromedial prefrontal cortex - the front part of the brain associated with empathy and regulation of negative emotions
  • ventral striatum - the area of the brain that signals reward
  • amygdala - almond shaped area of the brain associated with mood and 'forgetting' fears (memory of recent events).

All three are involved in the brain's reaction to sad and happy stimuli.

In those people with anhedonia, the prefrontal cortex had to work harder to register happiness, and there was less activity in the amygdala and striatum.

The study's authors believe this lack of activity may be what causes the prefrontal cortex not to process happy (rewarding) experiences. In effect, the reward system of the brain breaks down, resulting in anhedonia.

It's hoped the findings of these studies will eventually lead to new treatments that could target specific regions of brain - either with existing drugs that can be shown to work, or with new medicines or psychological treatments.

Living with anhedonia

Lizzie Gardiner, a writer and single mother from South London, spoke to NetDoctor about how depression and anhedonia affected her life.

After several short bouts of the illness in her teenage years, Lizzie was hit by a major depression at the age of 31. It was brought on by a series of events: the break-up of her marriage, a move from one end of the country to another, bad health, financial problems and the threat of eviction.

Driven by the need to keep the lives of her two children as normal as possible, antidepressants and psychological treatment helped Lizzie through. She didn't know about anhedonia then, but has since taken part in the Institute of Psychiatry's research.

Lizzie's anhedonia took many forms and partly remains with her. She still can't gain pleasure from her own achievements or see that her children are a credit to her as well as to themselves.

One of her darkest moments was when she sat down to listen to Elgar's Enigma variations. To her horror, she felt unmoved by the music she had always loved.

Lizzie has learned to live with her symptoms, and says being given information and reassurance helped when she was depressed. 'Up to now it has been an invisible illness,' she said.

'If the research can show physical evidence that depression is caused by changes in the brain, it will be immensely helpful in removing the stigma that is attached to it.'

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