Why does nothing feel good anymore?
Why is it that nothing feels good anymore, and everything no longer brings a sense of pleasure? | Photo credit: ©Goffkein / Adobe Stock
The article explores anhedonia , a condition where individuals lose interest or pleasure in activities they once enjoyed, which is a core symptom of depression and other mental health disorders.
Current depression treatments like cognitive behavioral therapy (CBT) and antidepressants primarily target low mood rather than anhedonia, which may explain why many people experience persistent symptoms despite treatment.
Potential treatments for anhedonia include augmented depression therapy, which encourages patients to focus on both positive and negative experiences, and medications targeting the brain’s reward system, such as dopamine-affecting drugs like ketamine.
The article emphasizes that seeking help is crucial , recommending that individuals experiencing anhedonia speak with a trusted person or a medical professional to explore effective treatment options.
Quick Guide: Why Does Nothing Feel Good Anymore? (Table of Contents)
Why Does Nothing Feel Good Anymore? Understanding Anhedonia, Depression, and the Loss of Pleasure
Depression isn’t just sadness – it’s often a loss of pleasure
Ciara McCabe, University of Reading
It’s often thought that if someone is depressed, they will feel sad or low most of the time. But what many don’t realise is that these aren’t the only symptoms of depression. Another common symptom of depression that is sometimes overlooked is the feeling that you no longer find the things you used to enjoy to be interesting or pleasurable.
Referred to as anhedonia, this particular symptom is observed in as many as 75% of adults and young individuals who are experiencing depression. However, even though this symptom is quite prevalent, it continues to be one of the most challenging symptoms to address, treat, and effectively manage.
What is Anhedonia?
Anhedonia is defined as the reduced interest or pleasure in all – or almost all – activities a person previously enjoyed. If a person has anhedonia for an extended period of time (at least two weeks consistently), they can be diagnosed with depression – even if they may not feel sad or low.
Although mainly associated with depression, anhedonia can also be a symptom of other disorders – such as schizophrenia, anxiety and Parkinson’s disease.
In in-depth interviews my colleagues and I conducted with young people about depression, anhedonia was described by many as not just a loss of joy, but also less motivation to do things. For some, this lack of drive was only related to specific things – such as going to school or seeing friends. But for others, it was more severe, and they felt they didn’t want to do anything at all – not even live.
Why is it that everything no longer brings a sense of pleasure? Why does nothing feel good anymore?
But despite how troubling anhedonia can be, it’s often not the main target of depression treatment.
It’s recommended that cases of mild depression are treated with talking therapy. People with more moderate or severe cases of depression may be prescribed antidepressants. While all these treatments aim to help patients cope with and overcome symptoms, over half of the people with depression, don’t respond to their first recommended treatment. Even after changing treatments, approximately 30% of patients still experience symptoms.
It’s been argued that one reason for these low response rates may be that current treatment techniques don’t adequately target anhedonia. Research also shows that having anhedonia predicts chronic relapsing of depression. It’s even possible that some antidepressant treatments might make anhedonia worse.
Why might this be? One possibility is that current standard treatments focus mainly on treating the depressed mood and brain processes that underpin low mood – but not anhedonia. For example, the main aim of talking therapies, such as cognitive behavioural therapy, is to reduce negative thinking in patients. The most common antidepressant medications also mainly target serotonin, which is thought to underpin, in part, how the brain processes negative information.
But as anhedonia is reduced joy in life, treatments such as behavioural activation (a form of talking therapy) could be better for anhedonia. This is because behavioural activation aims to help people with depression take simple, practical steps towards enjoying life again. Yet some studies find behavioural activation is no better than standard treatments in managing anhedonia. This might be because the very nature of anhedonia includes a lack of motivation – making it difficult for patients to engage in any therapy, even forms that may most benefit them.
Anhedonia is directly associated with dysfunctional reward mechanisms in the brain. Therefore, treatments that enhance the brain's reward processing are likely to alleviate anhedonia more effectively than existing options.
But the brain’s reward system isn’t straightforward, and actually involves various subprocesses – including anticipation, motivation, pleasure and learning about reward. Problems with any one of these subprocesses could be contributing to anhedonia. As such, it will be important for research to uncover how these subprocesses operate in people with anhedonia to develop better targets for treatment.
Treatment options when nothing feels good anymore
While anhedonia may be complex, that doesn’t mean there’s no hope for those who are affected by it.
For instance, research shows that talking therapies that focus on reward processing could help reduce anhedonia. A recent pilot study also found that a new type of talk therapy called augmented depression therapy may work better than cognitive behavioural therapy in treating depression. This is because augmented depression therapy specifically targets anhedonia by having patients focus on both their negative and positive experiences.
Further, antidepressants that target neurotransmitters involved in the reward system (such as dopamine) might be better suited for patients with anhedonia. Early work examining drugs such as ketamine, which can affect dopamine activity, suggests it may have promise for treating anhedonia.
And while it can be hard to find motivation if you’re experiencing anhedonia, trying to find time for fun, enjoyable activities or experiences like a hobby you used to love – or even a new hobby – could help alleviate anhedonia.
If you think you have anhedonia – or other symptoms of depression – it’s important not to ignore your feelings so you can get the help and treatment you deserve. If you aren’t sure where to begin, you could try sharing how you feel with a loved one or with your family doctor.
"Why does nothing feel good anymore" is republished from The Conversation under a Creative Commons license. Read the original article.
