Anhedonia, the inability to experience joy or pleasure, affects as many as 90% of those with depression and is a primary predictor of suicide and chronic illness, according to research. It is also a transdiagnostic domain that leads to poor disorder outcome and low remission rates, studies suggest. Despite its prevalence and severity, treatment for depression has typically focused on reducing negative emotions but hasn't really addressed anhedonia.
Traditional antidepressants, such as SNRIs and SSRIs, are less effective for anhedonia, research indicates. com, which cited psychologist Steven Hollon. Some people with mental illnesses like depression have said they were more interested in feeling positive emotions than they were in stopping the negative ones completely, major media reports.
Positive Affect Treatment (PAT) is designed to activate the brain's reward system and can involve activities which train the mind to focus on gratitude, joy, connection, and 'loving kindness', and encourage rewarding activities. com, Alicia Meuret described PAT as targeting the brain's reward system directly. PAT is designed to help people find more joy, connection, and meaning, researchers say.
In a series of three randomized clinical trials, PAT has shown effectiveness, according to studies. One randomized controlled trial included 98 people with severe anhedonia, depression and anxiety. PAT lasted 15 sessions.
Compared to the same amount of more traditional 'negative affect' treatments (NAT), participants who'd had PAT saw a greater reduction in anxiety and depression symptoms. Participants who'd had PAT appeared to experience more positive emotions and fewer negative ones. Clinical status improved more rapidly with PAT than NAT, with superior outcomes one month later.
Psychotherapy and medication can be very effective at reducing negative emotions, but getting people to actually feel good has been more elusive.
Dr. Meuret and her team have been able to replicate the finding that PAT was superior to NAT thrice. Both NAT and PAT gave participants benefits in this study, major media reports.
"I was surprised that PAT was better for improving positive affect and anhedonia, and also for decreasing negative affect, compared to NAT," said Dr. Alicia E. Meuret, study co-author and psychologist.
"There's a difference between feeling helpless and feeling hopeless. Anhedonia can look like hopelessness where taking away negative emotions doesn't fix it," she added. "Helplessness is the drive to change, while hopelessness is the belief that nothing can change," Meuret explained.
Beyond PAT, research indicates that drugs such as vortioxetine, agomelatine, bupropion, ketamine, and brexpiprazole show promising anti-anhedonic effects. Neuromodulation techniques including rTMS, tDCS, and taVNS are effective at improving anhedonia, particularly when used in targeted areas, studies suggest. Innovative treatments such as aticaprant and psilocybin showed promising results for anhedonia, according to research.
Psychotherapeutic interventions including behavioral activation, mindfulness-based strategies, and savoring techniques help re-engage patients with pleasurable activities and enhance positive affect, experts say. Improving anhedonia leads to better psychosocial functioning, quality of life, and sustained remission, according to studies. Anxiety and depressive disorders are among the most prevalent and debilitating mental health conditions globally, research shows.
PAT targets the brain's reward system directly.
Major depressive disorder (MDD) is a leading cause of disability worldwide and the most notable precursor in suicide, according to studies. In the United States, approximately 31% of adults report experiencing an anxiety disorder at some point in their lives, with 20% reporting anxiety symptoms within the past year, data indicates. 13% of adolescents and adults experience depression, with 88% reporting functional impairment, surveys suggest.
Approximately 50%-60% of those with anxiety symptoms also experience depression symptoms, according to research. Global depression rates rose to 25% in the first year of the COVID-19 pandemic, studies show. 71% of individuals with depression worldwide did not receive treatment, with stark disparities between WEIRD countries (70% treated) and non-WEIRD countries (12% treated), according to data.
A global treatment gap of 44% persists for depression despite availability of effective treatments like psychotherapy, research indicates. In Switzerland, the prevalence of depression is 15% with a 51% treatment gap, studies report. Cognitive behavioral therapy (CBT) is extensively validated as an effective treatment for both anxiety and depression disorders, according to research.
Barriers to CBT include insurance coverage limitations, treatment costs, lack of access to qualified therapists, and scheduling inconvenience, experts note. Empirically validated components of psychological interventions have been translated into digital mental health interventions (DMHIs) delivered via app or online, studies show. Recent meta-analytic evidence supports the efficacy of DMHIs for depression and anxiety, according to research.
Internet-based self-help interventions (IBIs) are effective in reducing depression symptoms and offer scalable solutions, data suggests. Unguided IBIs tend to have higher dropout rates, lower uptake, lower adherence, and sometimes lower effects, studies indicate. Peer support interventions in the form of internet support groups/discussion groups led to a reduction in depressive symptoms relative to usual care, though one study by Andersson et al.
showed no improvements in depressive symptoms due to discussion groups, according to research. More than a third of individuals with MDD do not achieve full clinical remission despite full treatment trials, studies show. Transcranial direct current stimulation (tDCS) is a form of noninvasive brain stimulation that applies a weak direct current via scalp electrodes, according to research.
Anodal tDCS over left DLPFC is associated with significant changes in connectivity in default mode, self-referential and frontoparietal networks, studies suggest. 7%) in MDD, according to data. tDCS is safe and well tolerated with no significant differences in attrition rate and adverse events between active and sham stimulation, research indicates.