Anhedonia: Psychotherapy & SSRIs. The truth

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One thing schizophrenics and depressed patients know is that anhedonia is not caused by dysfunctional beliefs…If simple talk therapy, cognitive exercises and behavioural activation could improve our ability to experience pleasure, we wouldn’t be hearing about so many treatment-resistant patients. Moreover, the research shows that anhedonia in both these conditions is mainly caused by a dopamine dysfunction in the brain reward system, which is not addressed by SSRIs.

“Psychotherapy (CBT) for negative symptoms of schizophrenia”

“Grant et al. (2012) used cognitive therapy (CT) to correct dysfunctional beliefs about pleasure, cognitive abilities, performance and social functioning. Techniques included goal-setting, behavioral experiments, activity scheduling, and more. Several accommodations were used to work around neurocognitive impairments. CT was found to be superior in reducing avolition/apathy and improving levels of functioning. However, other negative symptoms did not improve significantly, such as affective flattening, alogia, and anhedonia- asociality.”

“CBT-n seemed effective in reducing negative symptoms. The changes were partially explained by a reduction in dysfunctional beliefs about cognitive abilities, performance, emotional experience, self-stigma, and social exclusion.”

Psychotherapy for anhedonia in depression

"Psychotherapy may be less appropriate for patients with melancholia (563), particularly if the symptoms prevent engagement with the therapist (e.g., lack of interest in activities).

Melancholic features describe characteristic somatic symptoms, such as the loss of interest or pleasure in all, or almost all, activities or a lack of reactivity to usually plea- surable stimuli."

SSRIs for anhedonia in depression

"When considered from the perspective of the tripartite model, these results suggest that SSRIs reduce levels of general distress and anxious arousal but have limited effects on the anhedonia dimension, perhaps even worsening these symptoms somewhat.

[…] suggest that an SSRI would not be the medication of choice if a primary goal was the reversal of anhedonia and an increase in positive affect. In fact, the inhibition of both positive and negative emotions by serotonin could explain the “flatness” of mood that some patients experience while taking SSRIs."

http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.52.11.1469#

SSRIs for negative symptoms of schizophrenia

“SSRI augmentation does not improve the negative symptoms of schizophrenia.”

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Possible solutions to anhedonia include: rTMS, Deep TMS, iTBS, possibly tDCS and DBS (of the nucleus accumbens/ventral striatum). Some lucky people may respond to certain antipsychotics: I would try abilify, rexulti, vraylar, seroquel, latuda, maybe clozapine if really desperate…and some may also respond to Wellbutrin. Besides those I can’t think of any other solutions :confused: Maybe sarcosine, or even minocycline

Eventually there may be min-101 which supposedly helped with anhedonia in the phase II trial.

If someone was helped by a SSRI, SNRI, TCA, or MAOI, or some atypical antidepressants like mirtazapine, nefazodone, trazodone, vilazodone (Viibryd), and vortioxetine (Brintellix) for INABILITY TO EXPERIENCE PLEASURE/JOY now is the time to say it…otherwise I wouldn’t waste much time trying them…

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I would try rTMS but it’s not available in my area and it would probably be too expensive anyway.
I tried tDCS. It did nothing for my negatives.

I don’t have dysfunctional beliefs. I am a pretty balanced individual who used to work in a competitive environment, was doing sports and eating healthy. But schizophrenia f****d me up good.

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I experience joy and pleasure now. Took 6 years.

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It took me about a year to start feeling pleasure again, it came back after changing medications from Zyprexa to Seroquel.

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Was struggling with this badly a couple years ago. It improved on its own by going out and doing things regularly and focusing on my hobbies and work. I’m on zyprexa and chlomipramine.

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Thank you for this post.

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SSRis never helped me on my negative symptoms of schizophrenia. My doc was saying that my sz is mostly with negative symptoms. and its hell, yes…
I take Zyprexa who helps me a bit to be on my feet and not in the bed taking the information from the tv too personally but I am still unhappy wow… And two pdocs told me that psychotherapy wont help me cause i remain unmotivated by activities. I just now try to be more active by my own but i still do very few things…

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Same here Andrey…

In your case you did also try SSRIs, correct?

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@insidemind Was it vraylar that helped you with anhedonia after all those years? Or was it the passage of time?

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Of course. I tried Mirtazapine (Remeron), Venlafaxine (Effexor), Duloxetine (Cymbalta) and Clomipramine (Anafranil).
I also tried Sarcosine and Pregnenolone.
I also tried tDCS.

In terms of AP, I tried Amisulpride (Solian), Risperidone (Risperdal) and Aripiprazole (Abilify), the latter I’m still on.

Nothing helps me…

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Passage of time. I think cogentin helped.

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I get anhedonia within a week of starting risperidone :frowning:

Off meds I don’t have the anhedonia problem. I will try reducing my dosage with doctor’s help to see how that impacts anhedonia.

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Insidemind says passage of time helped him, but also told me that his anhedonia did not affect his ability to enjoy listening to music. In my case I can’t even enjoy music…and according to this scientific study, in the act of enjoying music there is dopamine that’s released inside the nucleus accumbens.

Therefore, anhedonia has different degrees of severity. The dopaminergic reward system is affected to different extents in schizophrenia…In my opinion, the inability to enjoy music reflects the main problem inside the brain, in terms of anhedonia…Lucky are those that can still enjoy music. I miss it so much

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I can’t enjoy music either. So sad…

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Anybody that tells me that they are honest I figure is lying. Anybody that says they have The Truth I assume is misguided.

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Here’s a joke about it from the onion.

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@Szsurvivor, may I know how old you are?

I’ve noticed that a large chunk of those diagnosed with severe negatives have had a late onset. I was 30. I know of two other people whose illness started in their 40s. So how about you?

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I am currently 25. Been suffering from anhedonia since I was 23 1/2, after about 9months of untreated psychosis. I did not have negative symptoms while being psychotic. Psychosis went away and anhedonia settled in.

Same thing happened when I was 19, except that anhedonia went away after 1month.

In my case, to go into details, the first time my psychotic episode was caused by marijuana. The second time by magic mushrooms.

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(Here’s one last link that discusses, among other things, the fact that Behavioral Activation may help anticipatory/motivational aspect of anhedonia, more so than the consummatory aspect anhedonia.)

''Behavioral activation (BA) provides a potential example of a specific psychotherapeutic technique that might be particularly appropriate in cases with motivational anhedonia. Initially developed as a component of Cognitive Behavioral Therapy (CBT), Behavioral Activation (BA) differs primarily in its conceptualization of patient cognitions as a ruminative behavior (Dimidjian et al., 2006). The goal of treatment is to help the patient identify when they are engaging in rewarding and non-rewarding behaviors, and to help the patient make behavioral choices that are likely to increase exposure to positively reinforcing experiences.

[…] Additionally, only a small number of studies have sought to dissociate anticipatory/motivational and consummatory aspects of reward processing’’