What Is Anhedonia?

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By Dr. David Woo - October 14, 2024

Anhedonia, a condition where an individual cannot experience pleasure from activities that are usually enjoyable, is a common symptom of depression and related mental health disorders. Traditional anhedonia treatments include talk therapy and medications, but these do not work for everyone. However, transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique, has shown promising results in improving anhedonia symptoms, especially in cases of treatment-resistant depression.

At Madison Avenue TMS & Psychiatry, we provide comprehensive mental health services, including medication management, telehealth consultations, and TMS for people struggling with anhedonia. Let’s take a closer look at what exactly anhedonia is, how to recognize it, and what TMS can do to help.

Understanding Anhedonia And Its Symptoms

Anhedonia is more than just a feeling of sadness or a temporary emotional downturn. It involves a significant loss of interest in previously pleasurable activities, which can impact daily life and relationships.

Anhedonia symptoms can be categorized into:

Social Anhedonia: Reduced interest or pleasure in social interactions.
Physical Anhedonia: Reduced ability to experience physical pleasures, such as eating or physical affection.

Individuals with anhedonia often feel disconnected from life’s pleasures, leading to a more profound sense of isolation. This can lead to a vicious cycle, as withdrawing from activity takes individuals further away from their support network and damages relationships, which in turn reinforces feelings of loneliness. People with anhedonia can also neglect their physical health and hygiene, which can cause or exacerbate other medical conditions.

Relationship Between Anhedonia And Depression

Anhedonia is a core symptom of major depressive disorder (MDD) and is often prominent in what is known as anhedonic depression. It can also occur in other mental health conditions, such as:

Anhedonic depression is characterized by impairments in the brain’s neurotransmitter systems, especially a decrease in dopamine activity (1). Dopamine is a crucial part of the brain’s reward system, which controls motivation and pleasure. When you lack dopamine, formerly pleasurable activities can feel dull and uninteresting.

Comparing Anhedonia Treatments

Treatment for anhedonia typically involves a combination of therapies and medications, such as:

Talk therapy
Anhedonia medications
Transcranial magnetic stimulation (TMS)

Talk therapy: Conversational techniques that focus on changing negative thought patterns, such as cognitive behavioral therapy (CBT), can help the patient manage their symptoms. However, additional treatment is usually required to address the underlying brain chemistry imbalances that cause anhedonia.

Anhedonia Medications:

Selective Serotonin Reuptake Inhibitors (SSRIs): These commonly used antidepressants that increase the availability of serotonin in the brain.
Dopamine agonists: These drugs help increase serotonin or dopamine levels.

Limitations Of Medications For Anhedonia

Many patients do not respond adequately to medications, and side effects can sometimes outweigh the benefits. For example, while SSRIs can effectively improve mood symptoms in depression, they can also indirectly inhibit dopamine release in certain brain regions, which can make anhedonia worse.

These kinds of counterproductive side effects illustrate why depression medication should always be accompanied by regular consultations with a psychiatric professional. At Madison Avenue TMS & Psychiatry, we offer medication management services to help patients find the medication type and dosage that works best for them as well as assess potential risks and side effects. These consultations are conveniently accessible via telehealth video chats, making it easy to arrange sessions at a time and place that suits your schedule.

For those with treatment-resistant anhedonic depression who have tried and failed to find relief by taking medications, alternative treatments like TMS can offer new hope.

TMS For Anhedonia

TMS for anhedonia is gaining attention as an anhedonia treatment due to its effectiveness in targeting specific brain regions associated with mood regulation:

How TMS works: TMS is a non-invasive therapy that is applied via a helmet-like device over the scalp. Sometimes nicknamed the “depression helmet”, this device uses tiny, gentle magnetic fields to stimulate the dorsolateral prefrontal cortex (DLPFC), a brain region often underactive in patients with depression and anhedonia.
Research Support: The efficacy of TMS as an anhedonia treatment is well-documented, with numerous studies showing that treatment reduces both anhedonia symptoms and suicidal ideation as well as general depression symptoms (2, 3, 4).

As a drug-free depression treatment, TMS is suited for individuals with anhedonia whose depression medications aren’t working for them. TMS is safe and well-tolerated, with the vast majority of patients experiencing zero or mild side effects (e.g., short-lived mild headache or scalp irritation). Although TMS costs can range from $6000-$10000 for a full multi-week course, TMS is often covered by insurance, especially for patients with treatment-resistant depression.

Comparative Table: Anhedonia Treatment Options

Treatment	Mechanism	Benefits	Drawbacks
Cognitive Behavioral Therapy (CBT)	Addresses negative thought patterns and behaviors	Non-invasive, no medication required	May take time to show effects; not always effective for everyone
Medications (SSRIs, etc.)	Increases serotonin/dopamine levels in the brain	Easy to administer, widely used	Potential side effects; may not work for all patients
Transcranial Magnetic Stimulation (TMS)	Stimulates specific brain regions (e.g., DLPFC) to enhance activity	Non-invasive, minimal side effects, highly effective for treatment-resistant cases	Requires multiple sessions, can be costly (but often covered by insurance)

Anhedonia Therapy At Madison Avenue TMS & Psychiatry

Dealing with anhedonia can be challenging, but it’s important to know that there are effective treatments available. At Madison Avenue TMS & Psychiatry, we offer an integrative approach to treating anhedonia, combining:

Medication Management: Finding the right anhedonia medication suited to individual needs.
Telehealth Consultations: Convenient access to psychiatric consultations from the comfort of home.
TMS Therapy: Non-invasive and effective, particularly for those with treatment-resistant depression. We use the latest innovative TMS treatments, including deep TMS therapy, a technique that allows for a more targeted, effective therapy for specific symptoms.

If you or a loved one is struggling with anhedonia, contact us online or call (212) 731 2033 today. Our team is here to help you find joy and pleasure in life again, starting with a consultation that could pave the way to recovery and renewed well-being.

More resources on TMS and depression:

Sources

Dresp-Langley, B. From Reward to Anhedonia-Dopamine Function in the Global Mental Health Context. Biomedicines. 2023;11(9), 2469. Link. Accessed September 13, 2024.
Wang X, He K, Chen T, Shi B, Yang J, Geng W, et al. Therapeutic efficacy of connectivity-directed transcranial magnetic stimulation on anticipatory anhedonia. Depress Anxiety. 2021;38:972–984. Link. Accessed September 13, 2024.
Sonmez, A. I., Webler, R., Krueger, A. M., Godoy-Henderson, C., Sullivan, C., Wilson, S., Olsen, S., Schmid, S., Herman, A., Widge, A., Peterson, C., Nahas, Z., & Albott, C. S. Effects of TMS on anhedonia and suicidal ideation in treatment-resistant depression: Outcomes from the University of Minnesota Interventional Psychiatry Program. Journal of Mood & Anxiety Disorders. 2024;8, 100073. Link. Accessed September 13, 2024.
Wang, Y., Y. Lui, S. S., & K. Chan, R. C. The effect of noninvasive brain stimulation on anhedonia in patients with schizophrenia and depression: A systematic review and meta-analysis. PsyCh Journal. 2024;13(2), 166-175. Link. Accessed September 13, 2024.

Dr. David Woo

Dr. David Woo is the owner and head clinical psychiatrist at Madison Avenue TMS and Therapy in New York City. Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.

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