I hook up to a recent news that brings up this term, anhedonia, as if it were some kind of news. Not only is it not great news, it is not absolutely new. Furthermore, the speech that has been made of it perhaps reflects what has been understood of something that has been described by a doctor, but then everything seems to have been made “news” for the lack of basic notions. Let’s try to fix it.
I make a premise: in reading journalistic articles about medicine, in general I always encounter the same problem. The news (let’s take the anticancer “news”) speaks of revolutions to come, after which in the article I read about innovative therapies that were already such when I was studying medicine. Some have remained at stake and are cyclically presented as new frontiers. Psychiatry, on the other hand, is the favorite victim of another journalistic absurdity, namely new diagnoses, perhaps partly due to the environment as well. Psychiatric diagnoses appear as if they were new diseases, while instead they are diagnoses of symptoms, or rather as if we were to say: we have discovered a new disease, the “fever”. In this case the term is “anhedonia”, that is the mental state that includes the inability to feel interest and / or satisfaction in the various activities and stimuli available. We always learn from the newspapers that it would be a “brain imbalance”, as if when we talk about psychiatry, mental and psychological disorders, we were not automatically talking about this type of object: brain, neurons, chemical mediators of neurons ( neurotransmitters), and …. trivially, of imbalances, a way like any other to say that something is wrong, is not right, and produces discomfort.
Anhedonia is therefore that condition in which you do not feel pleasure, or in which you can also try it, but you cannot go looking for it, so you remain isolated or inert, without being able to stimulate yourself as you really would like.
There are different types of anhedonia, of which one, perhaps the best known, corresponds to the typical depression, or melancholic. In this form the person loses both the initiative to seek fulfillment and the ability to experience it when exposed. All this takes place within a broader context in which the person also develops the belief that there is nothing more that can interest him, that everything is lost, that it is too late to be happy, and that nothing more can exist. relevant or interesting per se. It exists in the young adolescent as well as in the elderly, and also in the child, so it is not a state of age or experiences. It is therefore not to be taken as “normal” in an elderly or disabled person, only because one has lived a long time and no longer has much to discover, and the
The less known anhedonia is that in which the person is unmotivated, and therefore does not feel the pleasure, and who sees no reason to look for it, and to try it. Indeed, it may be that potentially pleasant and amusing situations, even before emerging as opportunities for fulfillment, are experienced only by imagining them with anxiety, dismay and fear. Going to a party, getting to know someone, trying to learn something, what inevitably passes between oneself and satisfaction, become obstacles, which are so far away, high and painful as to make the person think that he is now “out of the game”, lost, failed, light years behind what could have been. There is in this a bankruptcy vision of one’s own destiny, as if it had not been possible to become something important, good, accomplished, successful.
Then there is a different type of anhedonia, which is that of psychosis. In these cases, people complain less, even if objectively they no longer seem interested in life, especially in social relations. It should be noted that in these forms the antipsychotic therapies can have a weight in determining an attitude of detachment, of abulia, not necessarily with a state of discomfort on the part of the person.
Anhedonia is not always absolute. In atypical depressive forms, in bipolar disorder and also in psychosis it may be that the person is rather oriented towards autonomous, domestic, comforting pleasures. For example, a person may complain of lack of contentment but then find outlet in activities such as eating, masturbating, drinking, using substances. All things that maybe he would have done anyway, but in this case they become the only sources of pleasure that can be proposed because the others are “blocked”, or they become an illusion of consoling satisfaction, because then in reality it is a frustrated, unsatisfactory pleasure, or even lived with a mixture of desire and anger.
Anhedonia is present in other non-humoral syndromes, such as depersonalization, or even anxiety disorders. For example, the person who has social phobia or obsessions, being cut off or hindered in a variety of circumstances, and in a “deprived” state of pleasure. However, in fact, more than a disturbance of the satisfaction system, these are situations in which the satisfaction is lacking, and therefore the person complains how natural it is that he is deprived of it.
To conclude, the “weirdest” message seemed to me to be that of the “collapsing brain”, as in the case of the news to which the articles referred. A person who took his own life because his brain “collapsed”. Sure, in a figurative sense, as a way of saying, that’s fine. Yet it seemed that we wanted to give the idea of ​​a sort of brain that “degenerates” and at a certain point implodes. More than anything else in diseases, such as a treatment-resistant depression, or an untreated one, high levels of depressive stiffening can be reached, even delusional, with loss of contact with the real elements, filtered through the depressed brain.
It is known that some depressions, especially bipolar ones, have a tendency to leave the problem of “pleasure” open, and that the theme of pleasure that no longer returns as before is central. If substance use is involved, this is further central. The term we have used for these situations is “hypophoria”, or that form of “relative” anhedonia, in which it cannot be said that pleasure is absent, but the person is in a state of activation and motivation that corresponds to the difference between the maximum pleasure experienced and the current one, so that it is likely that it is almost always “under” a few notches, both in enjoyment and in enthusiasm above all.

35 comments

# 1

Former user
12 October 2018

Doctor,
You spoke of anhedonia in connection with depersonalization. Let’s say that in a period of high stress the person voluntarily chooses to reduce his affective participation in life, to avoid any negative long-term effects. I know that people usually turn to loved ones for regulatory purposes, but there are many situations of uprooting and loneliness in which this is not possible.
This could cause anhedonia and abulia
. And if this phenomenon of semi-autistic withdrawal remains over time as it has proved to be functional, we can logically speak of psychosis.
Thanks for the possible answer.

#2

“Choose voluntarily” would denote a voluntary detachment from pleasure. It cannot be so, if ever it can be that a person chooses to cut himself off to avoid stress, since in reality he no longer feels pleasure or even before being able to try it he sees dangers, fatigue, etc. or considers the pursuit of pleasure unlikely and painful.
In experience, therefore, there is no cause-effect relationship, there is more a consequentiality between feeling detached and seeking even more detachment.

# 3

Former User
October 12, 2018

You happened to find anhedonia with PTSD

If yes, it treats like common endogenous depression or otherwise

Thank you.

# 4

Former user
October 13, 2018

By the way, I would like to compliment the article From the individual to diagnosis and from diagnosis to the individual.
Indeed, it is not easy to accept that thoughts, behaviors and even perceptions (that is, everything that defines us as individuals) are heavily influenced by something beyond our control. It makes one feel decidedly helpless, no wonder it is a thought actively avoided by both patients and family members and institutions.
Have a good Saturday,
Infanta of France

# 5

Thank you.
Of course, since anhedonia is a symptom, it is found in many syndromes. Even the post-traumatic.

# 6

Former user
October 13, 2018

More than anything else I was interested in knowing if anhedonia is always a sign of precise brain alterations or if it is a non-specific symptom. Thanks.

# 7

It’s a generic term for a state of inability to feel pleasure, but then several particular situations open up.

# 8

Former user
October 15, 2018

# 9

Former user
November 06, 2018

Hello,
In recent months, I have always heard this term associated with the suicide of Lory del Santo’s son, so it does not cause nor consequence and, period.

# 10

# 11

Former user
06 November 2018

Suicide I know is a choice for those who can no longer bear to live with their monsters, but for those who remain they need to know or at least give a justification for this act. It’s difficult.

# 12

You don’t understand the sentence syntactically, only the first part. But it’s not that suicide has to have any meaning.

# 13

Former user
06 November 2018

If we considered suicide without meaning, then it could be compared to the slaughterhouse, at least the latter would have meaning. πŸ™‚
If I may ask, how do you consider suicide itself, without entering into anyone’s personal dynamics.

# 14

I’m not saying it has no meaning, you give it that meaning. The data does not say this, however. It does not have a linearly depressive logic, nor does it accompany extreme, desperate or irremediable conditions. It has its own evolution in gravity, a variability during the attempt, which then succeeds or fails, so in part it is a question of risky behaviors (not calculated or without interest in how it will end).
The psychological interpretation can only be done on the basis of the declarations of the suicide failures, but even here it is not said that the cold reconstruction accounts for the mental functioning at the moment of the act. Therefore, some data are known that describe the phenomenon. Finding an explanation of suicide as a category usually responds to the desire to blame or to relegate the person to a lower category, which I do not agree with. Or, in justifying it, as if to reassure those who take note: if one commits suicide, he will have done it because he had no other choice … but even on this the data does not add up.
The already known mental illness has something to do with it, but by itself it does not explain the phenomenon with a diagnosis.

# 15

User 509XXX
06 November 2018

Unfortunately, the few lines do not allow an explanation of maxi neuroscientific concepts such as perception, which it would be interesting to deepen.
I did not understand the process leading to the quoted brain collapse.
Given a stimulus, having identified the revenue in terms of pleasure, let’s put a situation of total absence of stress, between motivation and realization what intercedes We

know a method, including pharmacological, to give an encouragement to the neurotransmitter in charge of the action

# 16

the quotation marks “collapse” is a meaningless term, which I assume is said to mean that one could not take it anymore. Technically it does not mean anything, on the contrary it often gives an idea of ​​a brain that is “unloaded”, but it does not necessarily mean it is, on the contrary, perhaps it is instead agitated when it decides to make such a gesture.
The brain does not think to prevent suicide or to support a good mood, when we intervene we intervene on the person to make him feel good, but it is not that the brain always offers us an edge to work, and that there are structures ready for do therapeutic work. Therapy is a modification of what the brain would tend to do at that stage.

# 17

Former user
06 November 2018

I don’t want to, but I never stick to the statistics .. if they got one right, I’d be a winner at Totip for years .. πŸ™‚
Ok, let’s put it personally, come back, I attribute the meaning to the next action.
.

# 18

User 509XXX
06 November 2018

I think I have created confusion.
I’m the one with the quotes.
My question about the stimulus-perception-reward-pleasure-motivation-failure process is not about the attempted suicide but rather the pursuit of pleasure, so I would say an attempt at life.
I find the transition between motivation and desistance absurd, which happens abrupt and unjustified (no stress, obstacle, external factor).
(So ​​the term ‘collapse’ metaphorically renders well, at least to me, the self-induced collapse of these pieces on themselves. of the procedure corrodes over time the basis of the motivation)
I apologize to both of you for the interference.

# 19

Former user
November 6, 2018

She did very well to intrude, she is very kind, nice and competent in
Neurological matters.
Indeed he could help me communicate with the psychiatrist Matteo, who says “Finding an explanation of suicide as a category usually responds to the desire to blame or to relegate the person to a worse category,
I don’t think anyone shared the fact that someone was cataloged with a label, which I can’t stand, but when it happens and only because it could happen

# 20

User 509XXX
07 November 2018

Cute yes but competent in neurological matters no.
Precisely for this reason my contribution to the discussion would be a personal opinion of those from the bar, without sources or studies behind it.
Given the topic, it is better to leave it alone.

# 21

The statistics I would say have to do with betting I
mean one should win the lotto according to statistics
I would say no.
Instead, you need to know things, otherwise you go randomly.
For the rest, his messages are not understandable, and already the fourth time, and I do not understand why to call me by name.
So I don’t answer her, and you avoid writing again.

# 22

User 509XXX
07 November 2018

On the recommendation of the first user I read the article mentioned on diagnosis and individual. I find the idea of ​​a standard disease, for everyone, and a standard therapy, for everyone, comforting, because it allows for a scientific method. I couldn’t stand the opposite, being a single case with no related clinical history, with one ahead of me playing dice with my psyche.
The cold vision of illness is fascinating and consoling precisely because it tells us that ” thoughts, behaviors and even perception ” can be in our control. I understand poetry, but the fact that each brain responds differently to a substance / cure and also a drama.
Moreover, it is not perception that defines us as individuals, but its interpretation.
Having made this premise, and tying myself to what is written in the comments above, I go back to asking the doctor: in a case of atypical anhedonia (the patient recognizes the pleasure, desires it, feels an initial motivation and then gives up without reason), we know how to modify, how she says, “ what the brain would tend to do at that stage ”,


November 14, 2018

Reply to the friend above
If the poem is not born with the same naturalness As the leaves on the trees, it better not even be born.
Your question is interesting, deserving of continuation.

# 24

User 509XXX
November 16, 2018

And the need for poetry, or instinct for beauty, which arises spontaneously. Creation requires technique and method, effort and artifice. It is a rational intervention. And understanding as well.

# 25

Former user
November 19, 2018

Dozens of articles, and not one that deals with the only thing that patients really care about in a complete and organic way: what psychiatry can really do for those suffering from mental disorders
What exactly do the treatments do, how, and at what price, in terms of medium- and long-term side effects, and with what results, compared to those who do not suffer from these diseases
At what point is the research in psychiatry
Why it continues to there is no agreement on etiology and nosography itself between Psychology and Psychiatry
Exactly, what are you selling us
At least you know

# 26

Ah, that’s where it was going, even if it seemed a vague but still sensible reasoning. To say that psychiatrists sell fresh water or toxic stuff
. But you look at the news as a provocation.
Look, try to be less opinionated and offensive.

# 27

Former user
November 19th 2018

But it is not a provocation. And a question, which together with all the others (kind to grant that they are sensible, thank you) remains dramatically open and current. These are all things that are not clear to public opinion, and also to many professionals, given the discrepancy that is highlighted in the literature and also in clinical practice (psychologists, general practitioners, psychiatrists themselves who advise against the prolonged use of drugs or who consider it only as a last resort, for example). In fact, there remains a general confusion on the matter, and so the prejudice, the distrust and the fear that translate into the stigma and marginalization for those forced to take care of their own and others’ mental health, especially in those most disadvantaged groups of the population. from an economic, cultural and social point of view. You know, at the fiftieth and whistling article, one would expect at some point something like: “Ok, we did the psychiatric Morandini, now let’s try to explain what exactly an antidepressant does to our brain”, just to name one. But not because a passer-by says so. Because I really don’t know anyone who does.

# 28

User 509XXX
November 19, 2018

Doctor must read the user number otherwise we will not get out.
I am always on the same point from 4-5 comments.
Once the source of pleasure has been identified (let’s call it poetry, beauty, fellatio, at your choice), which biological mechanism intervenes to remove it and discourage its research / conquest
We are equipped to change this mental predisposition
. moves away.
An allergy to well-being and self-love that we know how to cure
we overcome anhedonia .
As
I think it is also interesting to talk about causes.
They are external, social
It happens that the brain recognizes a pleasure that we do not, and vice versa.
I just want to complete the article, without controversy. She says we know this well, warns against false scoops. It had to be said,
good job.
But the reader wonders how the story ends.
Two lines are missing on scientific research and treatment methodology, that’s
all.
Regards.

# 31

Scientific methodology of what
This is not research or literature review work, but the commentary on a concept.

# 32

Former user
November 30, 2018

People kill themselves, and the good doctor comments: “It doesn’t have to mean anything.”
And it censors comments, other than private comment between professionals. As proof of what was criticized, however.

# 33

I censor as and when I like, being my blog. Above all insults like his, moreover fools.
It’s not that suicide has to mean anything, of course. It doesn’t necessarily have a meaning. I comment that you believe this or want to play it as something offensive. Hard to believe that one understands so badly and has to endure such useless controversies, but clearly he hasn’t understood anything, and he doesn’t even want to understand anything. The content and soon I assume the obscure. In the meantime, I have communicated to the staff why their attitudes are unacceptable.

# 34

User canceled for violation of guidelines.
Sincerely
[email protected]

# 35

For the benefit of those who want to learn more, I don’t know exactly what comment the deleted user was referring to.
The sense that suicide does not necessarily mean something refers to the fact that the suicidal act is often “silent”. We can only speculate on why it was committed, and instead sometimes, in the experience of the unsuccessful suicides observed in the hospital, it appears clear that the person has made an act not even classifiable as suicidal, but simply lethal, or extremely risky, for reasons that may correspond to a delusion, or to a state of confusion. Certainly in other cases it is all much more linear, with an intention, messages, declarations and then the final act. But even in these cases it is not said that everything takes place in a “full stop” decision mechanism, there is an instability and changeability that goes from “wanting to switch off”

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