Doctor Explains Anhedonia and Potential Treatments (Emotional Numbness)

A few friends and I are starting a telemedicine company to improve access to fast, affordable care for insomnia. Join the email list if you would like to stay updated on our progress!

------------------
DISCLAIMER:
No content on this channel (including videos, text in the description or comments or comment replies) constitutes medical advice. I am not your doctor. Don't make any decisions or changes that can affect your health or mental health without talking to your medical provider first.
------------------

In this impromtu video I discuss what anhedonia is, potential causes and neurobiological correlates, and potential treatments. Since anhedonia treatments have rarely been studied, a large portion of this video explores potential treatments that are not firmly based in the level of evidence we seek after in modern medicine.

Summary of the video:
Anhedonia is when someone has an inability or significantly reduced ability to experience pleasure, joy, or interest in previously enjoyed/loved activities. More generally, people with anhedonia tend to feel emotionally flat or numb. They often cannot feel not only positive emotions, but can have difficulty experiencing sadness, nostalgia, anticipation, or even anxiety sometimes. Life feels muted or black and white or grey. It can make people feel like they have lost their dreams, personality, interests and aspirations. Some describe it as "feeling like a zombie." For some it can feel soul-sucking or even life-destroying and can make people think "what's even the point to life if I can't feel anything?"

Anhedonia is strongly related to reward circuitry in the brain malfunctioning, especially regarding dopamine signaling, and also likely endogenous opioid (endorphins) and norepinephrine (noradrenaline) signaling. Anhedonia also seems related to when the reward centers of the brain become decoupled or "unplugged" from the rest of the brain, making it hard to feel pleasure or reward.

There is mounting evidence that anhedonia is often related to inflammation. Others might be anhedonic from repeated, chronic mild stress, or chronic drug abuse leading to decreased dopamine D2 receptors or lower dopamine release.

*Potential* Treatments:

-Wellbutrin (Bupropion): good evidence it helps with anhedonia
-Norepinephrine-boosting antidepressants (SNRIs, TCAs): moderate evidence
-Mirtazapine: I haven't found any studies addressing if it helps anhedonia in depression but at least 5 studies show it helps anhedonia and other "negative" symptoms in patient's with thought disorders like schizophrenia
-Dopamine medications like stimulants, dopamine receptor agonists like pramipexole, etc: appear to help anhedonia and treatment-resistant depression in some
-Dopaminergic MAOIs like Nardil: almost certainly
-Behavioral Activation therapy: definitely helps anhedonia
-Lowering inflammation: almost certainly helps anhedonia as long as the anhedonic person has high inflammation (which can be measured by ordering a hsCRP blood lab). Potential ways to lower inflammation: weight loss (obesity is highly inflammatory), high EPA fish oil, addressing SIBO, IBD, intestinal permeability, plant-based Mediterranean diet, avoiding the standard SAD diet everyone eats in the West, exercise, treating insomnia, using certain supplements and medications. Minocycline likely helps anhedonia by directly inhibiting microglial cells in the brain.

Not mentioned in the video
-Agomelatine: seems to help anhedonia but sadly not available in USA
-Ketamine: appears to decrease anhedonia in depressed patients
-ECT: likely helps anhedonia:
-TMS: unclear

[Thereal_prettyinblack]

I run on autopilot for most of the time. Remembering what used to make me happy, I just mimic my old actions and rections- I used to paint watercolors, draw, read a now I have drawers of supplies and they are just catching dust. I can open a drawer, paint a watercolor and put things away just like I have sliced bread or paid a bill. No attachment, no reaction, no pleasure or displeasure. I used to call it 'dysthymia' but I think it is now much more sever than just dysthymia

[ganzergrey]

You are giving us a voice and it is so deeply appreciated (to the extent we can respectively appreciate things). Thank you

[valeriezushin]

Doctors are SO clueless about antidepressants and what they do to people.If you want to be a good psychiatrist you should join some groups of the people suffering from antidepressants, don’t go by a text book . Listen to the people who are actually experiencing the devastating effects. Surviving antidepressants is a good one to start with.

[JasonJason-ru]

What pulled me out was staying home, eating good, avoiding people, and exercising.

[wendylcs]

Wow, thanks for caring about this overlooked issue. I've been struggling with anhedonia for several years now, and it sucks so much. I don't feel sad or depressed, just totally disinterested in anything, no joy no matter what i try. It just makes me hate existing most of the time. Even before i got this way, there were only a small number of things that used to interest me and bring me joy or pleasure. And now those things are not available to me right now.

[cudiz]

I have almost slept 2 times watching this. Your voice is so calm

[hushmychild]

Congrats on your success so far! I hope you create more content like this with a lot of rich information on things like anhedonia. I’ve lived with it for over a decade with no progress with meds and therapy so far. Nearly 30 now, I was working towards graduate school towards PhD in Clinical Psych. Still looking for new ways to get back into life again.

[Twisted_utopia]

I don't know if you'll read this, but I appreciate this vid man. Thanks

[historianz]

Thank you so much for this video. I've had depression and been taking Paxil for 20 years. I noticed the Anhedonia symptoms maybe a couple years after starting the meds. I'm slowing reducing Paxil but no change yet in Anhedonia. My deepest hope is that once I'm off Paxil things start to rewire again.

[maryvardakis]

Thank you so much. This was very helpful to me and no doubt others. Please do more videos.

[marcoborge]

Very thankful for your sharing and support! Blessings

[lordiblees]

This was so helpful! I've been clutching at straws desperately to find something to cure my anhedonia. I've developed extreme sexual anhedonia out of nowhere and slightly less extreme general anhedonia. I'm not sure if it's a depression or symptom or just standalone anhedonia but it's ruined my life. I haven't been able to find much research specifically on sexual anhedonia (especially for a male) but your video gives me hope. Maybe if my general anhedonia can be treated, i'll start finding pleasure in orgasms again.

Thank you so much for talking about such an underresearched and under-recognized health problem in so much detail. I really appreciate it!

I hope you're able to make more videos on the subject and other issues in psychiatry. I'd gladly like to hear your thoughts more.

[leannajensen]

Thanks for not speeding through your information. Easier to absorb and think about. I've had anhedonia for too long. Ready to try a new med.

[skinnyrick]

Hey, I've seen your comments on inflammation in depression videos! I really appreciate you making a video specifically about anhedonia. If you have browsed through any forum related to anhedonia, you have probably noticed that most of us are desperate for explanations and treatment options. So much so that a lot of us have gotten pretty knowledgeable on a lot of these topics (no where near a professional level obviously). It's reassuring to hear professionals speak on these issues and gives us hope. I would love to see more videos on inflammation in depression. It is very interesting and also, like you said, very treatable. I also noticed in your description that you pointed out TMS. Was wondering if you have any knowledge on TMS for anhedonia. I've watched a decent amount of presentations on TMS and there seems to be good results for people with anhedonia, and some new targets to treat anhedonia specifically, like the orbitofrontal cortex. Again, thanks for the videos!

[Rosey_Squirrel]

I've had so much luck climbing out of my anhedonia. Something about food insecurity triggers mine. I've had several productive weeks, and I'm starting to see hope in places I didn't have energy for.

[robertceliberti]

I like your video You're going to be a great psychiatrist. You have a calming way of speaking.

[dillionare]

I'm currently undergoing neurofeedback for anhedonia. Also beginning Jackie Kelm's anhedonia program. Things to consider as well. Thank you for the video!

[jlward]

Really appreciated the video. Thanks it reinforced some of the actions I've been taking to improve my Anhedonia

[casuallevelexpert]

The concern about Wellbutrin is the PSSD that also isn’t talked about. Anti depressants are scary!

[DancesTonight]

THANK YOU! Perfect as is! Just do the videos don’t think about it! I enjoyed this one!