Advances in the Management of Major Depressive Disorder - Episode 8

Clinical Management of Anhedonia and Communication with Patients

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Dr Andrew Cutler and Dr Greg Mattingly review current understanding of anhedonia. They discuss how clinicians can better evaluate it by effectively and candidly communicating with patients about anhedonia.


Anhedonia, defined as loss of interest or pleasure, is a highly disabling residual symptom affecting up to 70% of depression patients. It has strong links to treatment non-response, recurrence, suicide risk, and functional impairment. There are anticipatory (motivation), consummatory (experience of pleasure), and cognitive (reward-based decision making) components.

Standard antidepressants like SSRIs downregulate dopamine, worsening anhedonia over time. The clinicians are excited about novel glutamatergic agents like dextromethorphan-bupropion that may directly improve anhedonia based on effects seen in clinical trials.

Rather than formal rating scales, they suggest practical ways of assessing anhedonia: asking about life engagement, looking forward to or enjoying activities, feeling meaning/purpose, intimacy/relationships sparking joy or anticipation. Compare current interests and relationships to baseline pre-depression state. Specific recreational interests, social interactions, or responsibilities can also demonstrate improved motivation and reward experience.

Symptom scores may decrease with treatment, but anhedonia persists, so assessing hedonic capacity beyond mood scores is critical. Studies show patients can be in “remission” symptomatically but still have significant anhedonia and life impairment. Getting patients to optimal functioning and wellness requires targeting negative and positive affect. Improving anhedonia is key to enabling true remission and recovery.

This summary was AI-generated and edited for clarity and readability.