Anhedonia: when nothing brings joy

Food still has a taste, but it no longer gives any pleasure. A favourite song comes on and nothing stirs. Friends are funny, the weekend is free, a partner’s hug is warm – and all of it seems to happen on the other side of a glass wall. A person may know perfectly well that they love their family, yet be unable to remember the last time they actually felt it.

This state has a name: anhedonia, a loss of the ability to feel pleasure. The French psychologist Théodule Ribot introduced the term in 1896 as the counterpart of analgesia: just as analgesia means not feeling pain, anhedonia means not feeling joy. It is a frightening and lonely experience, partly because from the outside everything may look fine. Understanding how it works makes it easier to see what is happening and what can help.

What it feels like

Anhedonia rarely switches everything off at once. For some people it mostly affects physical pleasures: food, music, touch, sex, the sun on their skin. For others it affects people: conversations feel like a duty, meeting friends brings no lift, and being alone becomes a relief. Often the future goes flat as well: a holiday or a free weekend no longer brings anything to look forward to.

Many people go on doing everything they did before (work, exercise, seeing friends) and still feel nothing. They smile at family gatherings because it is expected. One of the most painful parts is not feeling love for a partner or children. It does not mean the love has gone: the feeling is muffled, but the attachment is still there.

Wanting and liking

Research by Kent Berridge’s group at the University of Michigan in the US has shown that the brain’s response to something good has at least two parts, run by different systems. “Wanting” is the pull towards something good: anticipation, the urge to get started. It depends heavily on dopamine. “Liking” is the pleasure itself, in the moment. It is produced by small, separate areas of the brain and does not depend on dopamine.

In anhedonia these two parts can be affected differently. Sometimes pleasure is still there once a person is doing something, but there is no pull to begin: a walk with a friend turns out to be quite nice, although beforehand it seemed pointless. Sometimes the pleasure itself fades.

Effort suffers too. In a study at Vanderbilt University in the US, people with depression were less willing to work for a reward, and how large or how likely the reward was made less difference to their choices; the longer the current episode had lasted, the more marked this was. From the outside it can look like laziness, and people often blame themselves for it. In fact it is part of the condition: the brain becomes less able to weigh up whether the effort will pay off.

Why pleasure fades

Most often anhedonia is part of depression. In both main diagnostic manuals, the American DSM-5 and the WHO’s ICD-11, loss of interest or pleasure is one of the two core symptoms of depression, alongside low mood. This means depression can exist without sadness, as emptiness and flatness. A 2020 analysis from the University of Oslo in Norway, which brought together studies of more than 16,000 people, found anhedonia much more pronounced in depression than in the other conditions it examined, although it was also raised in schizophrenia, Parkinson’s disease, chronic pain and alcohol and drug problems.

Prolonged stress may play a part. Diego Pizzagalli at Harvard in the US has proposed that chronic stress disrupts the brain’s reward system; this idea rests mainly on animal research and early studies in people. Research also suggests that in some people inflammation in the body dampens the brain’s response to rewards.

Pleasure can also fade after stopping heavy, long-term drinking. Nearly one in five people in the later phase of alcohol withdrawal report anhedonia; it may ease somewhat during the first month, but for some people it lasts many months.

Medication can matter too. Many people taking SSRI antidepressants describe emotional blunting: both bad and good feelings become muted. In an online survey of 669 people taking antidepressants for depression, led by University of Oxford psychiatrists, almost half reported it, and the more severe the depression, the stronger the blunting – so it is partly a symptom of depression, not only a side effect. In an experiment led by the University of Cambridge in the UK and carried out in Copenhagen, healthy volunteers who took the antidepressant escitalopram for three weeks learned less from both rewards and setbacks than those taking a placebo. If blunting appears during treatment, it is worth discussing with the doctor who prescribed the medication rather than stopping it abruptly.

How anhedonia differs from apathy, numbness and burnout

These states are easy to confuse, and they often overlap.

• Anhedonia: things bring no pleasure, or there is no pull towards them.
• Apathy: a loss of drive and interest. Nothing seems worth doing, and it does not seem to matter.
• Emotional numbness: all feelings are muted, pleasant and unpleasant alike. A person can neither laugh nor cry. It often appears after trauma, under severe stress or as a side effect of antidepressants.
• Burnout: exhaustion, cynicism about work and a sense of being less effective, caused by long-term stress at work.

What can help

Act before the wanting returns. When the pull to start has gone, waiting for the desire to come back rarely works. It helps more to do small things on a plan, whatever the mood (a short walk, a phone call, cooking, an old hobby), and to notice afterwards how it went. In an analysis of 152 people in NHS Talking Therapies in England, anhedonia decreased while they were working this way and did not change while they were waiting for treatment.

Look forward, notice, remember. Because wanting and liking can be affected separately, it helps to support each one: imagine a pleasant thing in detail beforehand, slow down and notice what can be seen, heard and tasted while it is happening, and recall it or tell someone about it afterwards. A therapy built on this principle was tested by researchers at the University of California, Los Angeles: in a 2019 trial with 96 people with low mood or anxiety, it increased positive feelings more than a therapy focused on reducing fear and negative feelings.

Lower the bar: waiting for the old, big joy turns every experience into a disappointment. It is more useful to notice when something is a little less flat: a pleasure of two out of ten instead of zero is already a change.

Move: in a US study of people whose depression had not fully lifted on antidepressants, twelve weeks of added exercise was followed by less anhedonia and more energy and motivation.

Protect sleep: in a US experiment with healthy adults, a single night of broken sleep reduced positive mood while leaving negative mood unchanged.

When it is more than a passing dip

Temporary flatness is common. After a loss, numbness is often the first reaction, and feelings return over time; after a long stretch of overwork or illness, joy may also take a while to come back. But if loss of pleasure or interest lasts most of the day, every day, for more than two weeks, it may be depression, even without sadness. The NHS advises seeing a GP in that case.

Anhedonia deserves attention in its own right. When loss of interest and pleasure is prominent, depression tends to respond less well to standard antidepressants, and treatment may need more careful planning.

Where to get help

• A GP: to assess possible depression, check physical health and medication, discuss treatment and refer to talking therapies (in England people can also refer themselves).
• A psychiatrist: if depression is severe or does not respond to treatment, or if medication needs reviewing, including emotional blunting on antidepressants.
• A psychotherapist: when anhedonia is part of depression, where psychotherapy is one of the main treatments, and when joy has faded after a long period of stress or loss without a disorder.

When nothing brings joy, it can feel as if it will always be this way. But in depression anhedonia is a state, not a personality trait: people who have recovered feel as much pleasure as those who never had depression. Pleasure often comes back gradually, starting with small things.