Anhedonia is simply defined as an inability to feel pleasure, even when taking part in activities or experiences which had previously caused a joyful response. It can be a symptom or a cause of other psychological disorders, notably depression. Psychologists distinguish between two varieties of the disorder: Social Anhedonia, which usually causes the sufferer to avoid friends, family, and interactions with others; and Physical Anhedonia which leaves the sufferer unable to enjoy physical sensations, whether a hug, the taste of a favourite food, or even sex.
Anhedonia saps the ability of individuals to find pleasure and meaning in life, and drains the sufferer’s motivation to participate in meaningful relationships with others. Most relationships thrive on positive feedback, and for those deprived of the ability to smile, compliment others, and enjoy shared experiences, it is extremely difficult to build or maintain connections.
Here is a description of the disorder from a firsthand account: “For the past 7 years, I have had the smallest flickering of emotions, what I feel on a daily basis is practically nil. I have no desires to truly speak of, as nothing I do is rewarding or satisfying… Essentially, I gain nothing from my daily life; my world is cold and, as such, it makes life seem the same way. Everything I look at, everything I do, looks and feels the same.”
If you’re looking to develop your understanding of the condition, we’d recommend the strangely compelling 2015 film “Anomalisa.” Written and directed by Charlie Kaufman, the Oscar-winning creator of “Being John Malkovich” and “Adaptation”, the film is a fascinating portrait of a world stripped of joy, colour, and meaning, and an individual regaining the capacity to feel.
What Does Science Say About Anhedonia?
There are close links between anhedonia and depression, but not all who are afflicted with the former suffer from the latter. It also affects people with schizophrenia and bipolar disorder, and “shows up in people with seemingly unrelated health concerns like Parkinson’s disease, diabetes, coronary artery disease, and substance abuse issues.” Some researchers have also found links between anhedonia and eating disorders such as anorexia nervosa.
The causes of this disorder are not entirely clear. Researchers speculate that areas of the neural circuitry governing interest, anticipation, motivation, expectation, effort prediction, and of course reward and pleasure all play a part in the condition. A study on physical anhedonia found that individuals with the condition can experience pleasure in the normal way, but that something was wrong with the way their brains dealt with motivation, anticipation, and reward.
Some experts simplify the problem with a metaphor involving a candy bar. It is delicious and creates pleasure, but if it had 6,000 calories and you had to slog through a 5 km walk in the pouring rain to get it, would it seem worth the trouble? For those with anhedonia, almost all of life’s pleasures can seem fraught with complications and immensely difficult to access.
Studies have shown that various parts of the brain are affected by the condition, including the pre-frontal cortex, amygdala, striatum, insula, and basal ganglia. A great deal of research is focused on dopamine receptors and transmitters and the role of the pre-frontal cortex, and some studies have found links between inflammation, depression, and anhedonia. As with many neurological problems, the complexity of the brain and its reactions and interactions makes it extremely difficult to pinpoint a single cause and an easy answer.
Anhedonia And SSRIs
Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed to treat depression. You might know them better by brand names like Zoloft, Prozac, Paxil, and Celexa. In spite of their widespread use, many researchers and clinicians have noted that there is an unhealthy relationship between SSRIs and anhedonia. While a doctor might prescribe these drugs to treat anhedonia, research indicates that they can often blunt emotions and worsen the problem they are meant to treat. As a recent study reports: “Anhedonia is a particularly difficult symptom to treat, as increasing evidence suggests that second-generation antidepressants, such as SSRIs, are not effective in treating positive affect deficits, such as motivation and reward-related cognitive impairment in depression.”
SSRIs may actually cause the disorder for some individuals. One of their most common side-effects is reducing interest and pleasure in sex. As Harvard Medical School has noted: “In addition to reducing interest in sex, SSRI medications can make it difficult to become aroused, sustain arousal, and reach orgasm. Some people taking SSRIs aren’t able to have an orgasm at all.”
And this condition is known to persist even after patients stop taking SSRIs. In fact, the European Medicines Agency moved to recognize Post SSRI Sexual Dysfunction as a medical condition in June of last year. The agency named “hypo-anesthesia [marked numbness] of the genital area, loss of libido, and erectile dysfunction” as symptoms.
This designation came on the heels of a review of scientific literature in 2018 which was more damning and graphic in its conclusions. The authors declared the condition to be “debilitating and under-recognized” while adding to the list of symptoms. They observed that many sufferers experienced “genital anesthesia, failure to become aroused or orgasm, pleasure-less or weak orgasm, decreased sex drive, erectile dysfunction, and premature ejaculation.”
And studies have shown that a majority of patients treated with SSRIs have shown symptoms of sexual dysfunction, with one survey finding that 62.4% of men and 56.9% of women treated with the drugs showed signs of sexual dysfunction. The same study reported that 40% of the patients continued to experience symptoms after ceasing to take the medication. One hypothesis on what causes the dramatic loss of sexual interest are the changes wrought in interactions involving dopamine and serotonin in the brain, though the exact cause behind SSRI related sexual dysfunction has yet to be pinpointed.
In 2018 RxISK, a non-profit organization which seeks to make the public aware of the dangers posed by unsafe medications led a UK campaign to petition for explicit warnings about the danger of SSRI related sexual dysfunction at the moment the drugs are prescribed. Dr. Dennis Healy, who led the campaign, told the Daily Mail:
“The general message from doctors has been that this happened to a minority of people … and that these sexual problems were very short-term. Another argument was that depressed people tend to lose their sex drive anyway—but in drug trial data I have had access to as an expert witness, even the healthy volunteers taking the medication reported problems with their sex drive, and that is without prompting.”
It may seem obvious to state that losing one’s sex drive for a prolonged and indefinite period of time is something that will decrease enjoyment in life. Who knows how many relationships have been destroyed, how many individuals have been pushed into an anhedonic state, or how many people have been driven to despair by this disorder?
We have testimonials from some of the sufferers, and the ordeals they’ve been through suggest a close link between anhedonia and Post SSRI Sexual Dysfunction (PSSD). One woman wrote “I am a 30-year-old woman with PSSD for over 4 years after citalopram suspension. There was nothing more traumatic in my life than losing the sexuality that had always grown with me. My body no longer reacts to any sexual stimulation, I can no longer feel excitement and pleasure.” Another patient wrote “My original illness was nothing compared to all the new symptoms brought on by antidepressants and withdrawal. SSRI and SNRI medications have left me feeling permanently chemically lobotomized and castrated.”
It would appear that there is a clear link between the side-effects of SSRIs and anhedonia, and it seems likely that antidepressants may not be the answer you’re looking for.
How Can You Treat Anhedonia?
There are many natural cures which have shown promise in treating anhedonia. We would recommend starting off with remedies that are accessible to absolutely everyone, and completely risk-free: proper nutrition, exercise, healthy sleep patterns, mindfulness, and a search for meaning.
Nutrition is extremely helpful because ensuring that your body and mind have the right nutrients can alleviate some symptoms of the disorder, and also because a poor diet high in sugars and fats will deplete your brain’s store of pleasure causing chemicals several times each day. Exercise and sleep can also be game-changers. Exercise has been proven to alleviate symptoms of depression and anxiety, and also to improve cognitive performance. It can also help you build the habit of overcoming physical and psychological resistance to eventually gain pleasure. Sleep also has the power to alleviate fatigue, improve cognition, and increase motivation.
Mindfulness and the search for meaning and passion in your life can also have huge benefits in the battle against anhedonia. Mindfulness can help you learn to appreciate moments, and focus on what truly matters to you. Practicing mindfulness through meditation, yoga, or another method has also been proven to reduce levels of cortisol, a hormone related to stress which has a number of deleterious effects. Discovering your purpose and passion in life can also be a tonic for sufferers. Instead of a hedonistic search for pleasure, a mindful and committed journey toward a worthy goal will lead to learning, laughter, and happiness over the long term.
Another option to consider is ibogaine therapy. Andrew, a young man who had been struggling with anhedonia for two years, recently visited us and described his experience here. Following treatment he remarked “I’d like to say to anyone suffering from this condition that there is some hope, and I’d say that you should absolutely consider this treatment.” Ibogaine is an oneirogenic substance derived from the roots of an African shrub. It has the power to reset dopamine receptors in the brain back to healthy levels, and also to convince sufferers from a variety of mental illnesses, including anhedonia, depression, and addiction, that change is possible, and that they can reconnect with their best and truest selves. If the remedies listed above don’t work for you, it may be time to consider getting in touch with Tabula Rasa Retreat, and beginning your journey back to joy!
FAQs
Are there people who have cured anhedonia?
As we’ve noted, at Tabula Rasa Retreat we recently used ibogaine to treat Andrew, a young man who felt immeasurably better after treatment. Most mental health issues are lifelong struggles, but ibogaine has shown great promise in the battle against this debilitating condition.
Do SSRIs Cause Anhedonia?
Post-SSRI Sexual Dysfunction (PSSD) seems to be, if not a form of physical anhedonia, remarkably similar to the condition. The loss of pleasure, motivation, and interest in sex is a hugely traumatic side-effect of these medications, and far too many have suffered in silence for far too long. Intimacy is one of life’s greatest pleasures and is necessary for successful relationships. The loss of desire and arousal is closely related to the anhedonic state.
Can ibogaine treat anhedonia?
We can’t be sure of the exact mechanism which makes ibogaine an effective treatment for anhedonia, but the anecdotal evidence suggests that it can help the afflicted overcome this condition. Many researchers speculate that anhedonia is caused by an alteration in the relationship between serotonin and dopamine in the brain. Ibogaine’s ability to reset dopamine levels and receptors might be the reason behind its efficacy.
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