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Anhedonia: Current and future treatments

Summary

Anhedonia is the inability to feel pleasure from activities, which is a significant problem affecting many people with depression and other psychiatric conditions. This review examined many different treatments for anhedonia including medications, brain stimulation techniques, and psychological therapies. The research shows that newer medications like vortioxetine and ketamine work better for anhedonia than older antidepressants, and combining multiple approaches including therapy and lifestyle changes gives the best results.

Background

Anhedonia is a transdiagnostic domain characterized by diminished ability to desire and experience pleasure from activities, increasingly recognized as an independent disorder domain across multiple psychiatric conditions including major depression, schizophrenia, and substance use disorders. The condition independently predicts poorer outcomes, reduced quality of life, and higher rates of relapse. Anhedonia has been linked to poorer treatment outcomes and increased risk of suicide, emphasizing the need for targeted interventions.

Objective

This narrative review aims to integrate and examine a wide array of representative studies exploring the treatment of anhedonia, spanning from pharmacological interventions, neuromodulation, psychotherapy, to lifestyle modifications. The review describes interventions targeting anhedonia across pharmacological, neuromodulatory, behavioral, and lifestyle-based approaches with the goal of understanding which treatments are most effective for this symptom domain.

Results

Multiple treatment modalities showed promise for treating anhedonia: Drugs such as vortioxetine, agomelatine, bupropion, ketamine, and brexpiprazole demonstrate promising anti-anhedonic effects, while traditional antidepressants like SSRIs and SNRIs are less effective. Neuromodulation techniques including rTMS, tDCS, iTBS, and taVNS proved effective at improving anhedonia. Psychotherapeutic interventions including behavioral activation, mindfulness-based strategies, and savoring techniques help re-engage patients with pleasurable activities and enhance positive affect. Innovative treatments such as aticaprant and psilocybin showed promising results.

Conclusion

Substantial evidence suggests that improving anhedonia leads to better psychosocial functioning, quality of life, and sustained remission. The reviewed evidence underscores the importance of routine assessment of anhedonia and the integration of symptom-specific strategies. Tailoring interventions to address individual patterns of reward disruption may optimize outcomes for patients with anhedonia, with most improvement occurring through comprehensive approaches combining pharmacological and non-pharmacological treatments.
  • Published in:Psychiatry and Clinical Neurosciences Reports,
  • Study Type:Narrative Review,
  • Source: PMID: 40129874, DOI: 10.1002/pcn5.70088
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