By Vonetta Dotson, PhD (Associate Professor of Psychology and Gerontology, Georgia State University)
Many of us have had the experience of losing interest in some of the activities that used to excite us. This is to be expected as our lives change and we experience new things. However, some people have a more general decrease in their ability to experience pleasure in activities they used to find enjoyable. Psychologists refer to this as anhedonia.
Anhedonia can look different in different people. Some individuals have little motivation to put any effort into doing activities they used to enjoy. For example, someone who previously enjoyed gardening now no longer has interest in the pursuit. Other individuals might have the motivation to get started, but they find that they are getting little or no pleasure from the activity. To use the gardening example, the individual might continue to garden but no longer find it enjoyable or fulfilling. In both cases, the person is not experiencing pleasure or a sense of reward from their activities.
Anhedonia is an important, but often overlooked, mental health concern in older adults. Research has shown that anhedonia increases with age; in fact, as many as 1/3 of older adults experience symptoms of anhedonia1,2,3. Even though anhedonia is common in older adults, it is not an inevitable part of aging!
Here are some important facts to consider if you think you or someone you know has symptoms of anhedonia:
1. Anhedonia might be the only symptom, or it can be part of another disorder
Anhedonia is a key feature of psychological disorders such as depression and schizophrenia, as well as neurological disorders such as Parkinson’s disease4,5. Older adults with depression are more likely to have symptoms of anhedonia than the sad mood that comes to mind when we think of depression. However, anhedonia can also occur in otherwise healthy older adults.
2. Anhedonia increases the risk for negative outcomes
Recent studies have shown that individuals with anhedonia are at risk for cognitive deficits, disability, and poor clinical outcomes. Anhedonia is associated with deficits in executive functions—a set of complex mental skills that help us to control and coordinate our behavior6. People with anhedonia are more likely to have difficulty performing everyday activities such as managing their schedule and medications, driving, and cooking7. In depression, people with more severe symptoms of anhedonia tend to respond less to depression treatment and have more persistent depressive symptoms8.
3. Anhedonia can be treated
Antidepressant medication is currently the most common treatment for anhedonia, but it might not be the best treatment. Recent studies have shown that these symptoms are less responsive to antidepressant medication compared to other symptoms of depression9.
Talk therapy can be an alternative or complement to pharmacological treatment. Psychotherapy has been shown to effectively treat mood symptoms such as anhedonia in many older adults10. Cognitive behavioral therapy—CBT for short—is a type of short-term psychotherapy that focuses on identifying and changing patterns of behavior and thoughts that impact emotions and beliefs. For example, CBT might focus on behavioral activation, which would involve helping the individual make behavioral choices to become more active and engaged with meaningful activities. The therapist might encourage the client to engage in the activities even when they don’t feel motivated, with the idea that they might experience pleasure from the activity once they get started. By increasing access to situations that are positively reinforcing, behavioral activation can improve mood and functioning.
Resources to find help: Losing interest and motivation is not inevitable as we grow older!
Stay active, socially connected, and engaged at every age to combat anhedonia and other mood symptoms.
If you need professional assistance, visit the APA’s Psychology Help Center for information about how psychologists can help you manage mood symptoms such as anhedonia, and other issues such as depression and anxiety.
Learn more about Older Adults’ Health and Age-Related Changes by reading the APA Committee on Aging’s publication on that topic.
References:
Lampe, I. K., Kahn, R. S., & Heeren, T. J. (2001). Apathy, anhedonia, and psychomotor retardation in elderly psychiatric patients and healthy elderly individuals. Journal of Geriatric Psychiatry and Neurology, 14(1), 11-16. doi: 10.1177/089198870101400104
Ritchie, C. S., Hearld, K. R., Gross, A., Allman, R., Sawyer, P., Sheppard, K., . . . Roth, D. L. (2013). Measuring symptoms in community-dwelling older adults: the psychometric properties of a brief symptom screen. Medical Care, 51(10), 949-955. doi:10.1097/MLR.0b013e3182a53d1f
Sharpley, C. F., Hussain, R., Wark, S. G., Bitsika, V., McEvoy, M. A., & Attia, J. R. (2017). Prevalence of depressed mood versus anhedonia in older persons: implications for clinical practice. Asia Pacific Journal of Counselling and Psychotherapy, 8(1), 3-14. doi:10.1080/21507686.2016.1249382
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
Lemke, M. R., Brecht, H. M., Koester, J., Kraus, P. H., & Reichmann, H. (2005). Anhedonia, depression, and motor functioning in Parkinson’s disease during treatment with pramipexole. Journal of Neuropsychiatry and Clinical Neurosciences, 17(2), 214-220. doi:10.1176/appi.neuropsych.17.2.214
Gong, L., He, C., Zhang, H., Zhang, H., Zhang, Z., & Xie, C. (2018). Disrupted reward and cognitive control networks contribute to anhedonia in depression. Journal of Psychiatric Research, 103, 61-68. doi:https://doi.org/10.1016/j.jpsychires.2018.05.010
Covinsky, K. E., Cenzer, I. S., Yaffe, K., O’Brien, S., & Blazer, D. G. (2013). Dysphoria and Anhedonia as Risk Factors for Disability or Death in Older Persons: Implications for the Assessment of Geriatric Depression. American Journal of Geriatric Psychiatry. doi:10.1016/j.jagp.2012.12.001
Mojtabai, R., & Olfson, M. (2004). Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. Psychological Medicine, 34(4), 623-634. doi:10.1017/S0033291703001764
Dunlop, B. W., & Nemeroff, C. B. (2007). The role of dopamine in the pathophysiology of depression. Archives of General Psychiatry, 64(3), 327-337. doi:10.1001/archpsyc.64.3.327
Renn, B. N., & Arean, P. A. (2017). Psychosocial Treatment Options for Major Depressive Disorder in Older Adults. Current Treatment Options in Psychiatry, 4(1), 1-12. doi:10.1007/s40501-017-0100-6
Biography:
Vonetta Dotson, PhD, is an Associate Professor in the Departments of Psychology and Gerontology at Georgia State University. She completed her doctoral training in Clinical and Health Psychology at the University of Florida with a specialization in neuropsychology and a certificate in gerontology. She completed her postdoctoral training at the National Institute on Aging Intramural Research Program. Her research focuses on the intersection of mood disorders with cognitive and brain aging. She was awarded an R03 by the National Institute of Mental Health for her work on age differences in the neurobiology of anhedonia. She is currently a member of APA’s Committee on Aging.
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