The term anhedonia designates a symptom encountered in cases of depressive syndrome or schizophrenia and in other neuropsychiatric disorders. It is characterized in particular by the absence of desire…
Anhedonia is a concept that was defined at the end of the 19th century. It’s a French psychologist, Théophile Ribot who created this neologism from the Greek a “without” and hêdonê “pleasure.” Of the loss of ability to feel pleasure and interestthis concept has evolved over the past 20 years. “The concept was clarified. Anhedonia was broken down into types of anhedonia including 2 main ones : motivational anhedonia (wanting: no motivation to do things) and consumption anhedonia (linking: no pleasure felt in doing something)” says Prof. Pierre-Michel Llorca, Head of the Psychiatry Department at Clermont-Ferrand University Hospital. “These are not not the same biological mechanisms underlying these 2 types of anhedonia. These are distinct neurological processes that are altered in motivational anhedonia and consumptive anhedonia.” he explains. Moreover, “another dimension of anhedonia refers to a achievement of ‘learning’, which includes the associations, representations and predictions that one makes of future rewards during an experience, based on past experiences.
Abulia is defined as theinability to do anything. “Aboulia is a more general term which, in French, would cover motivational anhedonia and another clinical dimension which is apathy” informs Professor Pierre-Michel Llorca. “The definitions of anhedonia and abulia are quite overlapping.”
Motivational anhedonia is manifested by a loss of cravingsconsumption anhedonia by loss of pleasure in doing things that the person enjoyed doing before.
Anhedonia is one of cardinal symptoms of depression and schizophrenia. “Anhedonia is part of the diagnosis of depression along with depressed mood. At least one of these two symptoms must be present for the diagnosis of depression to be made. Anhedonia is one of negative symptoms of schizophrenia (the positive manifestations being delirium, hallucinations…)” says the psychiatrist. Anhedonia is found in other neuropsychiatric disorders such as substance abuse disorders (especially in the withdrawal phase), eating disorders, Parkinson’s disease and Alzheimer’s type dementia.
The diagnosis of anhedonia is based on the clinical interview but also on different evaluation scales. “Currently, these standardized scales make it possible to measure the different components of anhedonia and to understand what is the dimension of the most marked anhedonia” says Professor Pierre-Michel Llorca. For the moment, the treatment does not differ according to this dimension.
Anhedonia is a hard-to-treat symptom. “The drugs have a relative effectiveness. Those which are the most effective on anhedonia whatever its type, are the anti-depressants which act with dopamine (a neurotransmitter). But dopaminergic antidepressants are few in number.” inform the psychiatrist. THE cognitive behavioral therapies (TCC) can be useful, with specific exercises in relation to anhedonia: work on the ability to feel pleasure by imagining what gave pleasure before or in practice.
Thanks to Pr Pierre-Michel Llorca, Head of the Psychiatry Department at Clermont-Ferrand University Hospital.
Source: Article Anhedonia in depressionVol 39 – N° 4 P. 296-305 – R. Gaillard, D. Gourion, PM Llorca, September 2013