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What is Anhedonia? Why Don't You Enjoy Anything

Now today we're gonna talk about anhedonia. Weird word, I know, but what is it and why does it happen? Anhedonia is the inability to experience pleasure during activities that you used to enjoy. Means that if you used to love snowboarding, guilty, but now it just seems like too much work, and even when you get up onto the hill and you just wish you could just go back down and go to bed, and so that's what anhedonia is.

We just don't feel pleasure in things that we used to feel pleased about. And just so we can understand anhedonia a little bit more, I always think of it as a big loss in our life. I mean, it can feel like we can't enjoy anything anymore. Food could lose its taste. Or just seem, all, not what it used to be. Or it could rob us of our social life. Or even the ability to enjoy sex. And anhedonia can be part of many mental illnesses, even though we mainly hear it talked about with regard to major depressive disorder. But it can be part of schizophrenia, eating disorders, anxiety disorders, BPD, et cetera. And so just know that it's not just depression. 

What is Anhedonia? Why Don't You Enjoy Anything
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Anhedonia, that lack of enjoyment or pleasure, can be a symptom of a lot of things. And I think that's why it's really important that we don't just self-diagnose. We also see a mental health professional or another health professional so that we are properly diagnosed and treated. Because if we have schizophrenia, that's very different from having an eating disorder, and the treatments are gonna be very different. 

And so just make sure that even as I'm talking about this and describing to you what anhedonia is, we're not jumping to the conclusion that it only happens with depression, okay. And an interesting side effect of anhedonia that I've been noticing more and more with my patients, maybe it's because I, I don't know if you guys know, I specialize in self-injury as well as eating disorder work, and so I'm noticing that this lack of enjoyment, or honestly it can be like a total numb-out where we just don't feel anything, it can lead us to engage in some dangerous behaviors in order to quote, unquote, feel something. 

Even recently I was just watching a "Law and Order: SVU" show, you guys know I watch that a lot, but the main character, or actually the person who was on trial, engaged in extreme wrestling and it was a way for them to feel something. They talked about it in the courtroom and it was really interesting to me because I've had patients that find self-injury this way. 

Or even signing up for bungee jumping or other adrenaline-inducing activities. And so just pay attention that if you aren't finding joy or you feel like you're numbed-out, you're not feeling anything, be cautious about saying you're an adrenaline junkie and taking on new activities that could be really dangerous for you. It's more important that we figure out what's causing this for us and we get it treated, okay. And also I just want to say that anhedonia can harm our relationships because if nothing seems enjoyable, we can be hard to be around. We could totally be a negative Nancy. Or not up for as much as we used to be. Because it can seem, or it can feel like a lot of work and maybe we don't enjoy that work anymore, right. I don't want to go out. That just, I don't wanna shower and get dressed up and be around people. It can feel really like too much. And if none of that is fun, what's it worth? What's the use of doing it? We just aren't gonna want to. Okay, now let's get into the second part of this question. 

Why anhedonia happens

Now, like everything in psychology, we don't know for sure, because our brain is complex and everybody's different and we aren't able to study a brain while it's doing what it does each and every day. But we do know that dopamine, which we don't know what dopamine is. It's a neurotransmitter or a chemical in our brain, it's what makes us feel good, and so it's responsible for attention, movement regulation, and emotional responses, and so we know that lower levels of dopamine in specific parts of our brain are connected to anhedonia. And they've also connected lower levels of serotonin and GABA, which are just other neurotransmitters or other chemicals in our brain. 

They've connected those to anhedonia as well. And we also know that feeling of joy, excitement, and reward come from specific parts of our brain. Kinda cool. These parts are called the mesolimbic dopamine pathway, and the mesocortical pathway. And you can dig into what those really are, really the name like mesolimbic and mesocortical kinda tell you where they lie in the brain. And it involves various parts of our brain, right. 

These are both pathways, so they're going through our brains. But it involves areas like the prefrontal cortex, right, right behind our forehead. Our amygdala, talked about that a lot. And many, many more, so if there are any abnormalities in these parts of our brain, even if we've had like a head injury or if we were in sports and we'd been knocked out, we could have a concussion, that could maybe cause this as well. And so if anything's happening in those areas, it could lead to us not enjoying things anymore. Or at least, those are one part of what is a very complex problem. So that's what we know about why anhedonia happens. But let's talk a little bit about treatment. And unfortunately, not all SSRIs or SNRIs, otherwise known as antidepressants, treat anhedonia. 

Obviously, everyone is different, but because anhedonia is one of the leading causes of suicidal thoughts, we need to get much better at treating it. And newer research does show that ketamine infusions can help treat it. And if you don't know what ketamine infusions are, you have to go, the thing that is kinda sucky about this, and hopefully they'll get better at allowing us to take ketamine, but for now, you have to go to the doctor and you get hooked up to an IV with the ketamine, and you have to sit there, for like minutes. And then after the infusion's done, they want you to sit for a while as well. And you have to have someone drive you home. 

It can be very difficult to manage when we have very busy lives or we work lotta jobs and a lot of insurance does cover it, which is great, but it's just very time-consuming. But it's great that at least we know that it does help those of us who suffer from anhedonia. There's also TMS treatment, which if you don't know what that is, it's transcranial magnetic stimulation. And this again is also very time-consuming. Most of my patients who've tried TMS go like five times a week, three to five times a week, and you have to sit there for at least / an hour, sometimes more, with it's like a helmet that you put on and it has these magnets that are specifically placed to kind of jump start different parts of your brain.

So if we think the depression or the anhedonia symptoms are over here, we might trigger that. And it might stimulate it because it's trying to get your brain going. It's like hey, you're not doing this thing you're supposed to do and it might, potentially, since we talked about Gaba and dopamine, it might make that start up again. 

Maybe it will trigger it and maybe we'll start to feel better. And I've heard from a lot of you and a lotta my patients that it's been really beneficial. So that's something that can help. Also, some research and I know people are gonna get frustrated with this, but a lot of research shows that ECT, or electroconvulsive therapy, has helped those with anhedonia. 

But I believe that it's a pretty barbaric treatment option. It's something that we can do and it's there. It is an option if you need it. No shame if you've tried it. You have to do what's best for you. But that's just another one of the treatment options that they know, through research, that's improved the symptoms of anhedonia. And I also had a patient in the hospital years ago who struggled with this, and the only thing that helped her was Vagus nerve stimulation. 

And I haven't really talked about this much, but this is something that has to be placed, it was like here on her and it's in your upper chest and it's placed by a doctor. It's kinda like outpatient surgery, really. And what it does, it's like a, almost like a pacemaker or something and it stimulates the Vagus nerve. And the reason that this helps with severe symptoms of depression or anhedonia or other mental illnesses is that the Vagus nerve is what connects our brain stem to our body. 

So by stimulating it, we could be stimulating parts of our brain, kinda like the TMS stimulates, right. And possibly it could stimulate the ones that are involved in the reward system in our brain. So I hope that that gives you some hope and lets you know that if you've been struggling with anhedonia for years, there are treatment options out there. And there are things that we can do to make it feel better for you because it can and will get better. 

But I would love it if you would leave in the comments down below, have you suffered from this and what has helped you, because those were only, four options that I offered and I know there are more out there. And obviously, talk therapy can sometimes help, but for many people, when I was reading the research, they reported that it didn't benefit them that much. It like brought it from let's say here to here. And we wanna get it all the way over here. And so I'd love it if you'd leave some tips and tricks and tools and things that work for you in those comments down below, and I will see you next time, bye.