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12 Things You Should Know About Anhedonia

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Anhedonia has received an increasing amount of attention in the past few years. What exactly is it? A working definition of anhedonia would be that it is one of the primary symptoms of major depressive disorder (MDD).

In Greek, anhedonia directly translates to “without pleasure.” Anhedonia is a symptom of other psychiatric illnesses, such as schizophrenia. Note that major depressive disorder/anhedonia are not the same thing as dysthymia, which is also known as a persistent depressive disorder.

Have you ever gone through a phase (perhaps you’re in the middle of one now) when you wake up in the morning without any emotion, opinion, or interest in life? Completely “blah” about everything? Caring about nothing? Emotionally flat?

Typically, when you experience something pleasurable, the “happy chemical” dopamine rushes through your brain’s reward mechanism. Some research indicates that anhedonic conditions might be caused by lower activity in a region of your brain called the medial prefrontal cortex (mPFC).

Anhedonia inflicts a loss of interest in activities and hobbies that you once found pleasurable, such as eating, socializing, touching, friendships, relationships, music, events, conversations, and even sex. It’s as if the brain’s pleasure/satisfaction center shorts out or shuts down completely.

This inability to experience pleasure (or to maintain a good mood for very long) can severely impact the quality of your life.

Anhedonia symptoms and signs

How does anhedonia manifest? Following are some common symptoms/signs to be aware of:

  • Despondent and with feelings of sadness and hopelessness
  • Inconsolable, and non-respondent when comfort is offered
  • Practically impossible to smile or laugh at anything; mirthless
  • Unexplained paranoia, dread, fear, social/emotional withdrawal, and/or irritability
  • Frequently sick, with the flu, colds, etc.
  • Increased difficulty adjusting in social situations; intently observant of others, but without engaging socially, almost as if not present in the room
  • Severe difficulty following a conversation; lack of interest in listening
  • Refusal to seek support or assistance
  • Negative feelings about self and others
  • Significantly reduced emotional abilities, including difficulty articulating thoughts and feelings
  • Difficulty pinpointing exactly what you feel, if anything at all
  • “Going through the motions,” with a tendency to act out emotions, because that is “how you’re supposed to feel”
  • Decreased sex drive, and lack of interest in physical intimacy
  • Suicidal ideation, fixation with death

Anhedonia risk factors

Risk factors for anhedonia include a family history of schizophrenia, bipolar disorder, or major depression. Females are at a heightened risk of suffering from anhedonia.

Other risk factors include eating disorders, a history of abuse and/or neglect, recent trauma and/or heightened stress, major illnesses, etc.

12 things you may not have known about anhedonia:

  • There are two types of anhedonia: Social Anhedonia and Physical Anhedonia. Social anhedonia is manifest by an overall disinterest in social situations and engagement. Physical anhedonia is a pronounced inability to feel pleasure from everyday activities.
  • Depression may reduce the brain’s hedonic (pleasure) capacity, but studies have led some researchers to formulate another theory: that anhedonia is not caused by an inability to feel pleasure so much as it is caused by difficulty sustaining positive feelings consistently.
  • Some people who suffer from anhedonia don’t have any mental illness at all.
  • Aside from MDD and schizophrenia, anhedonia can result from other conditions/illnesses such as Parkinson’s disease, psychosis, anorexia nervosa, and substance abuse-related disorders.
  • Anhedonia may have a role in sparking a desire to take part in risky behaviors, such as bungee jumping or skydiving.
  • One of the reasons that anhedonia has received increased attention is the fact that it has come to be known as a good predictor of whether someone with depression will respond to treatment. Popular anti-depressants typically don’t work as well for people who have depression with anhedonia than for those with depression, without anhedonia. Research continues to demonstrate that common treatments for depression don’t help alleviate anhedonia and may even exacerbate the problem by inflicting sexual anhedonia, anorgasmia (the inability to orgasm), and what’s known as emotional “blunting” (feeling an utter lack of any kind of emotion).
  • Some evidence indicates that an anhedonic state can increase the risk of suicidal tendencies.
  • Some research shows that many individuals with anhedonia can experience pleasure along with the best of them. The problem is that there is something “off” in regard to the dynamics between motivation, anticipation, and reward.
  • Anhedonia may also sap your energy significantly.
  • Currently, there are no treatments specifically to treat anhedonia. It is usually treated in tandem with depression, bipolar disorder, schizophrenia, etc.
  • Anhedonia may bring about thought disorder (TD) or formal thought disorder (FTD) which shows up as disorganized thinking and disorganized speech. Thought distortion includes such issues as: poverty of speech, tangentiality (tendency to speak about topics unrelated to the main topic of discussion), derailment (conversational narrative consisting of a sequence of unrelated or only remotely related ideas), illogicality (drawing conclusions that do not follow from the premises), perseveration (repetition of a particular response (such as a word, phrase, or gesture), and “thought blocking” (ceasing to speak suddenly and without explanation mid-sentence).
  • Anhedonia can cause emotional detachment, which can mean a couple of different things. It can mean an inability to connect with others on an emotional level, and it can also refer to a means of coping with anxiety by avoiding trigger situations (also known as dissociation, or “emotional numbing”).

As mentioned, anhedonia can bring about suicidal thoughts and intents and can be very dangerous. If you suspect that you or someone you love is experiencing anhedonia, contact your primary care physician or a mental health professional as soon as possible. Anhedonia tends to dissipate when depression is being managed properly.

Are you going through a phase experiencing anhedonia? It is very treatable and manageable. If you or someone close to you need to talk to someone about mental health issues that seem overwhelming, we can help. Consider reaching out to our expert team at Solara Mental Health at 844-600-9747.

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5 Things You Should Know About Psychotic Depression

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Psychotic depression (also known as major depression with psychotic features) is a very serious form of disorder characterized by delusional thinking affected by mood swings and observable changes in cerebral tissue. It is estimated that 10 to 15 percent of people with severe depression will eventually develop symptoms of psychosis. It is considered to be underdiagnosed and undertreated, though scientific knowledge and awareness regarding this form of depression have been on the rise in recent years due to advances in research.

Psychotic depression is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM)-V as a subclassification of major depressive disorder. One key optic the disorder exhibits is a combination of depressed mood with psychosis, typically in the form of persistent and morbid hallucinations or delusions.

Psychosis: the Lowdown

What is psychosis? Psychosis can occur in the form of an episode or a condition in which an individual cannot clearly distinguish between what is real and what is imagined.

A “psychotic break” occurs when an individual experiences an episode of acute psychosis after a significant symptom-free period, though more typically for the very first time. This psychotic break may or may not be related to depression. Similarly, a psychotic disorder, or delusional disorder, can occur independently of or in relation to a depressive disorder.

Psychotic, or psychosis, symptoms typically develop after the patient has had several bouts of severe depression without psychosis. Once psychotic symptoms have manifested themselves, they tend to reappear with each future depressive episode.

Anyone who has been diagnosed with major depressive disorder should become educated in psychotic depression to better understand what they might need to be on the watch for. Here are five things to be aware of.

  1. Misdiagnosis of psychotic depression is often a result of clinicians’ lack of recognition of pertinent psychotic symptoms, according to the National Institute of Mental Health (NIMH). Close to one-third of observed misdiagnoses in one study most commonly misdiagnosed psychotic depression as major depressive disorder without psychotic features. Other misdiagnoses included depression not otherwise specified (NOS), or mood disorder Surprisingly, none of the misdiagnosed individuals were considered to have any psychotic disorder whatsoever. This appears to suggest that the diagnosing mental health professionals were completely missing the psychosis rather than the mood disorder.
  2. Major depressive disorder (including psychotic depression) and dysthymia (persistent depression) can “play off” of one another to create what is known as “double depression.” When dysthymia is present, a major depressive or depression-related psychotic episode can end, but an individual will revert to his or her normal, chronic level of persistent depression. Without proper treatment for double depression, the individual is likely going to continue relapsing into double depression.
  3. Psychotic depression and bipolar disorder have shown signs of being interrelated. A family history of bipolar disorder has been shown to be a risk factor for psychotic depression but not for non-psychotic depression. Research has indicated that individuals with psychotic depression (particularly those diagnosed at an early age), may have a higher risk than non-psychotic depressed individuals of later developing bipolar disorder. Those related to individuals with psychotic depression are also at higher risk of developing bipolar disorder than relatives of those with nonpsychotic depression.
  4. Hallucinations vs. Delusions. Hallucinations are more typically visual or auditory, though they may also be olfactory (smell) or tactile (touch). Delusions may or may not be tied in with an individual’s depressive mood (mood-congruent delusions vs. mood-incongruent delusions). Mood-congruent delusions might involve overwhelming feelings of inferiority, illness, severe guilt, or deserving of punishment. Mood-incongruent delusions might involve heightened, artificial feelings of grandeur, despite a depressive mood (you may have heard the term “delusions of grandeur”). About half of those coping with psychotic depression experience more than one kind of delusion, usually without any hallucinations.
  5. It is common among those with psychotic depression to also experience severe anhedonia, or the inability to take pleasure in activities that are commonly considered to be pleasurable. Social anhedonia is a pronounced lack of interest in social contact, and decreased pleasure in social situations. Physical anhedonia is an inability to feel sensory pleasures in regard to eating, touching, or sex. Psychomotor retardation (a slowing down of cognitive processes and significantly slowed physical movements) is another common symptom of psychotic depression.

Needless to say, psychotic depression can be dangerous to someone. If you suspect that you or someone you love might be having a psychotic episode, or worse, might become suicidal or exercise poor judgment that could end up being dangerous for anyone, get help as quickly as possible. If you are protecting a loved one, avoid a confrontation and secretly hide car keys, guns, alcohol, and any drugs, prescription or illegal, that could possibly result in an overdose. If a situation becomes urgent, you may need to call 911 and request a “mental health check.”

Are you or someone you know dealing with hallucinatory experiences in addition to depressive symptoms? It doesn’t have to get into crisis mode before professional help is sought. Arrange a visit to talk to someone about mental health issues that seem overwhelming. Consider reaching out to our expert team at Solara Mental Health at 844-600-9747.