Reader’s Question

I don’t know what’s wrong with me. I envy the people who enjoy food because I can never find such pleasure in eating. I find myself uninterested in most things. I don’t often feel sad or down, I just feel empty and unmotivated, and if I ever feel motivated to do something, it fades away in an instant. I used to enjoy going to the gym, and it used to feel great. That was five years ago. Now I can hardly get myself to a workout. Whenever I sit with friends or with new people I don’t feel happy about being around them; I don’t get that happy feeling or any feelings of satisfaction. I love math, physics and computer science, but when I find myself engaged in such activities I just can’t get myself focused on them because I find that I there’s no pleasure in doing the things I love the most. I don’t get any feelings of satisfaction or feel any relief. Every month, it hits me once or twice, lasting from days to weeks; I get this overwhelming feeling of emptiness. Sometimes I don’t even bother eating or drinking because I find no purpose in it. This doesn’t seem like depression. Is that possible?

Psychologist’s Reply

Much of what you describe is actually a major component of depression called anhedonia. Anhedonia is simply the inability to experience pleasure from activities normally found enjoyable or fun. Often it may come in the form of loss of the motivation to do the things you like to do or a lack of pleasure in those activities you normally enjoy, often called avolition. Many of my clients experience anhedonia as a significant part of their depression, sometimes even more intensely than just feeling depressed or blue. Many report it as chronic feelings of emptiness, not from boredom, but from feelings of hopelessness, feeling lonely or isolated. Most commonly I see anhedonia contribute to lower sex drive and being less social.

Although anhedonia is most commonly associated with depression, it can be present in schizophrenia, anxiety and personality disorders, albeit less frequently. Some researchers suggest that depression may shut down the brain’s pleasure center, making it difficult to feel good, basically limiting the amount of pleasure we can get from something. Others have suggested that anhedonia limits the amount of time we can feel good so that even if we do experience pleasure, it does not last long enough to matter.

Regardless of the cause, anhedonia is often very problematic and can derail recovery from depression by decreasing the desire to work, move forward and put effort towards recovery. Finding the energy to move forward can be difficult, especially when you don’t feel like doing it. However, it is needed to help in your recovery. Trying to keep up with as much of your normal routine as possible can make a huge difference. Anhedonia and depression can make us want to withdraw, stay in bed all day, and ignore relationships that we need, but fighting those urges can get you unstuck from the way you have been feeling. Sometimes it may just start with getting yourself out of bed. Then getting dressed. Then eating. Then beginning your next step. Take it in small increments to start out with. Coach yourself through each step before you begin to even think about the next. Simple exercise, even small amounts, has been found to help anhedonia significantly. Even small amounts of exercise will release chemicals in your brain that elevate mood and motivation. Taking a walk is a great way to get started. Get up, get moving. Medication is another option that benefits many. Fast acting antidepressants are being linked to restoring the brain’s ability to experience pleasure. Medication may come with some side effects, but the overall benefit often outweighs them.

One thing to be careful about is self-shaming or being self-critical about this. Many active and productive people experience anhedonia and tend to see it as a character flaw. They call themselves lazy, slow, pathetic, etc. I see this in those individuals who had extremely high levels of activity and production before the onset of their depression. We need to remember that this is a neurological and biochemical process in the brain. It is important for anyone in this situation to understand that it is your brain being impacted by the depression. It is not something you caused, and it is not a permanent change in who you are as a person. Criticizing yourself to get moving and go, shaming yourself, or “guilting” yourself to do better will likely only create a deeper depression. Adding low self-esteem to your depression is not going to help and will only prolong your trouble. To anyone in this position: go easy on yourself. Motivate with encouragement rather than shame and guilt. Recovery is a process. Allow yourself to be in that process without expectation about how long your recovery “should” take. In working with many people who are depressed, I have never seen anyone “yell and scream” at themselves back into feeling better. To anyone in this position, I would say: you can do this. You’ve got this.