Exploring the science behind emotional numbness and the path toward renewal.

Most people experience brief periods of losing interest, but anhedonia persists as a distinct condition. People who endure it lose their ability to find pleasure in activities that once brought them joy, including music, food, social relationships, and hobbies, leaving them with a life devoid of color and excitement.

The core symptom of depression exists in anhedonia, but this condition appears in various psychiatric disorders, including trauma-related disorders and psychosis, and sometimes exists independently from other treatments.

Medical professionals define anhedonia through two main symptoms, which include decreased pleasure and decreased interest in activities. The motivation system includes three essential components: reward pursuit, pleasure experience, and learning from experience for future attempts. These systems that control motivation will stop functioning properly when disrupted, making it difficult to begin any activities.

What’s Going On in the Brain and Body?

Scientists used to study dopamine as the brain chemical that controls reward and motivational responses. But the current understanding of brain function extends beyond dopamine research. Currently, research using brain imaging and behavioral assessments shows that anhedonia develops through changes in neural pathways linking the prefrontal cortex to dopamine release systems, as well as glutamate and serotonin pathways. It’s not as simple as we once thought and is much more involved in multiple brain pathways.

Research is now focusing on understanding the role of inflammation in the body. New research shows that immune system activation affects the reward system by reducing dopamine levels and diminishing both effort and pleasure, potentially leading to anhedonic symptoms in some individuals.

The American Journal of Psychiatry published a review stating that inflammation-related anhedonia symptoms have been present all along. Yet clinicians failed to check for inflammatory factors, such as chronic diseases and infections, or to monitor elevated inflammatory markers when treating anhedonia. It seems so simple, yet it was never explored when someone came in and reported symptoms that directly pointed to anhedonia. Was it beyond the health care provider’s abilities and should they have made a referral?

Anhedonia represents more than the loss of enjoyment because people experience a deep sense of effort required to start activities. People also experience difficulty when they try to start walking, send texts, or prepare basic meals. The loss of social interest, known as social anhedonia, leads to functional problems in various psychiatric conditions. And we know that social interaction serves as a natural antidepressant that benefits people who experience depression.

What Helps

The treatment process begins with basic steps that lead to advanced medical care. People who experience overwhelming situations should perform small, deliberate actions. Behavioral Activation (BA) is a structured treatment approach that helps patients create specific, meaningful activities despite their lack of motivation and monitor their progress.

The treatment approach focuses on building the reward system through real-life experiences rather than forcing patients to continue their activities. Research indicates that Behavioral Activation (BA) helps patients with anhedonia and has the potential to restore reward network function.

This therapy stands out as a practical skill-based treatment that patients find simple to use in their daily lives, even when other strong treatments perform equally well in clinical trials. Remember, real-life situations are never duplicated in clinical trials. Part of the problem with them is that they are, in many ways, artificial.

Reward nutrition represents a set of basic elements that help people experience pleasure. And people can support their reward systems through daily practices, which include sleeping consistently, performing light exercise in the morning, taking short walks, spending time outside, and eating regular meals to maintain stable energy levels.

The treatments don’t solve the problem, but they reduce background interference, which weakens reward signals and enables patients to achieve better results from their therapy or medication. When did we ever think that maintaining a regular schedule, engaging in exercise, and going outside for a walk was going to have an effect on our brain’s neural pathways?

The treatment approach, however, must address all aspects of the condition. This combination of depression and anxiety with anhedonia means patients need to receive their standard treatment options. The majority of antidepressants prove effective for patients, but these medications don’t affect anhedonic symptoms directly.

The usual path for medical professionals has been to select bupropion and other dopaminergic or noradrenergic agents for treatment when patients don’t respond to standard therapy. But treating brain reward system dysfunction requires healthcare professionals to address underlying sleep apnea, metabolic problems, inflammatory conditions, and other medical conditions that affect the brain.

Rapid-acting Options

The fast-acting effects of ketamine and esketamine through nasal administration are reported to make them effective for treating persistent anhedonia symptoms. Studies have demonstrated that anhedonia symptoms improve within short periods of treatment initiation, even when patients show minimal improvement in their overall depression ratings.

The U.S. Food and Drug Administration approved esketamine for independent treatment of treatment-resistant depression in adults under medical supervision through a REMS program in January 2025. A qualified clinician should perform ketamine/esketamine decision-making to evaluate treatment advantages against potential side effects and operational requirements. But remember, whenever a new medication indication is given, it’s always prudent to go slow and watch for any side effects in patients.

The brain develops, as we’ve noted, better reward processing through activities that expand its reward capacity, including scheduled social activities, value-based community service, and creative activities at low risk levels and short learning sessions. It is truly interesting how these social activities have a physical benefit on patients experiencing anhedonia.

When to Seek More Help

A higher-level evaluation becomes necessary when someone can’t perform their duties at work or home, and their symptoms last for months, and they experience self-harm thoughts. Healthcare specialists can administer tests to identify brain conditions and develop individualized therapy plans and advanced treatment options. The correct treatment for anhedonia requires multiple attempts to find the right combination. Unfortunately, many patients become exasperated when they are tried on multiple therapies one after another and none work.

There is no doubt now, based on extensive research, that anhedonia is a genuine medical condition that affects brain function rather than a sign of laziness, weakness, or personal failure. The brain experiences a genuine, measurable disruption when it fails to properly value different life experiences. As I’ve asked, did we ever think that the brain was responsive to experiences that would activate neural networks? It is a truly significant advance in mental health.

The biological understanding of reward systems, learning processes, and inflammatory responses now enables healthcare providers to create individualized treatment plans tailored to each patient. Utilizing a multi-formulated treatment plan will enable patients to want things, try new experiences, and experience joy through the careful implementation of these supportive treatments. The question remains whether or not these healthcare professionals will have the time needed to prepare these plans adequately.

A better day is here for those who have suffered for so long and have their self-esteem battered by those who believe they are unwilling in their anhedonia. The secret, it seems, lies in how the brain is functioning, not the person’s unwillingness to function.