Anxious, Depressed, Stressed?

In my practice, I treat various conditions, including anxiety, depression, stress disorders, relationship challenges, and sexual dysfunctions. Despite their differences, these issues share a common thread: the diminished ability to experience satisfying pleasures, formally known as anhedonia. Anhedonia is both a symptom of mental health challenges and a contributor to them. It's a complex phenomenon often overlooked when discussing mental health and sexual well-being. In this post, we'll delve into anhedonia, its manifestations, and its intersection with mental health and sexual well-being.

A Bit of Personal Background

Readers of my book are familiar with my history of anxiety and panic attacks. In my next book, tentatively titled Why It’s Never Too Late to Have a Happy Childhood, I'll share more about my childhood trauma, largely resulting from my mother's untreated mental illness, which affected her emotional regulation.

In the past six months, I've experienced significant losses, including both of my parents and a favorite uncle. After my dad's death, I addressed the neuroscience of grief in a post titled Why Good Grief Matters. And within 90 days, my mom also passed away. On the flip side, I experienced the birth of two new grandchildren, bringing both joy and challenge. When I tally these stressors on the Life Change Index scale, I score so high that, on average, the likelihood of experiencing some form of illness in the near future is estimated to be between 50% and 80%. Fortunately, four decades of work in psychology have equipped me with numerous effective coping tools (see previous posts on neuroscience hacks to foster happiness and tools for dealing with stress). Through this work, I've learned that addressing challenges to the ability to feel satisfying pleasures is key to restoring well-being.

What Is Anhedonia?

Anhedonia is the diminished ability to experience pleasure or joy from activities that were once enjoyable or rewarding. It's not merely a transient feeling of boredom or dissatisfaction but a persistent state that can permeate various aspects of life. Those experiencing anhedonia may find themselves disinterested in hobbies, social interactions, sex, or even basic self-care activities that used to bring them happiness.

Understanding anhedonia requires exploring its underlying mechanisms. Neuroscientific research suggests that anhedonia is closely linked to brain reward circuitry dysregulation. The reward system, primarily governed by neurotransmitters such as dopamine, serotonin, and endorphins, plays a crucial role in modulating our responses to pleasurable stimuli. When this system is compromised, as is often the case in conditions like depression or schizophrenia, anhedonia can manifest as a core symptom.

Healthy Pleasures Versus "Faux Rewards"

As explained in my book, the overuse of smartphones is derailing our attention and hijacking the "SEEKING system" (another name for reward circuitry). This imbalance in our “core” emotional systems contributes to the current anxiety epidemic. What we experience on our devices are“ faux rewards” that do not fulfill our brain-driven needs for the real thing and do more harm than good.

Healthy pleasures are pleasures that feel good and are good for us. These are the activities and pursuits that contribute to overall well-being, such as true social connection (rather than the “faux” social interactions on social media). What I tell clients is to think about social media interactions as empty calories. Just like how eating a whole bag of potato chips might feel good at the moment, it won’t contribute to our well-being. It will make us feel bloated and miserable after the short-term pleasure of consumption. The same is true for time spent scrolling the internet.

Anhedonia and Mental Health

The impact of anhedonia on mental health cannot be overstated. It often co-occurs with mood disorders such as major depressive disorder, bipolar disorder, and psychotic disorders like schizophrenia. It's considered one of the hallmark symptoms of depression, contributing significantly to the profound sense of emptiness and despair that individuals experience. Therapeutic interventions and medication management aim to restore balance to the brain's reward circuitry. However, individuals with anhedonia may struggle to engage in these treatments due to a diminished capacity for pleasure and motivation, posing a significant challenge for clinicians striving to help their clients regain a sense of fulfillment and purpose in life.

Anhedonia and Sex

Anhedonia doesn't exist in isolation; it has far-reaching implications for sexual well-being as well. Human sexuality is inherently linked to pleasure and reward, both physiologically and psychologically. When anhedonia takes hold, it can dampen libido, impair sexual arousal and responsiveness, and diminish the overall satisfaction derived from sexual experiences.

For individuals struggling with anhedonia, the prospect of intimacy and sexual connection may feel like an insurmountable obstacle. They may find themselves disconnected from their bodies and desires, unable to derive pleasure from physical touch or sexual stimuli. This can strain romantic relationships and lead to feelings of inadequacy, guilt, or shame for both partners. Moreover, anhedonia can exacerbate existing sexual dysfunctions or disorders, creating a vicious cycle wherein sexual difficulties contribute to feelings of frustration and despair, perpetuating the sense of anhedonia and further eroding sexual well-being.

A Novel Approach to Reversing Anhedonia: Prescribe Healthy Pleasures as Medicine

How do we reverse the soul-crushing toll of anhedonia? What I find most effective is teaching clients that the ability to experience healthy pleasures can be cultivated and pursued as the active ingredient in restoring well-being. By prescribing the pursuit of healthy pleasures, I help clients prioritize finding their way back to small pleasure practices. By harnessing attention on doing so, they begin to activate their "SEEKING systems," priming the pleasure pump.

Conclusion

Pleasure is not a luxury but a necessity for the proper functioning of the brain/mind.