Anhedonia in depression: losing interest and enjoyment

Anhedonia is the loss of interest or pleasure in activities that used to be enjoyable. People describe it in different ways: food tastes of nothing, music leaves them flat, time with friends feels like an obligation, hobbies are abandoned without any sense of why.

The NHS does not use the word anhedonia on its depression pages, but it lists exactly these experiences. The psychological symptoms include having no motivation or interest in things and not getting any enjoyment out of life, and the social symptoms include neglecting your hobbies and interests and taking part in fewer social activities.

It is important to separate anhedonia from tiredness or laziness. It is a symptom, not a choice, and the NHS is explicit that depression is not a sign of weakness or something you can snap out of by pulling yourself together.

The NHS says the symptoms of depression are complex and vary widely between people. If you are depressed you may feel sad, hopeless and lose interest in things you used to enjoy, and the symptoms persist for weeks or months and are bad enough to interfere with your daily life.

The NHS advises seeing a GP if you have symptoms of depression for most of the day, every day, for more than 2 weeks, noting that a low mood may improve after a short time. It stresses that many people wait a long time before seeking help and that it is best not to delay.

If you are having suicidal thoughts or thoughts of harming yourself, which the NHS lists among the psychological symptoms, seek help urgently from your GP, NHS 111, or call 999 or go to A&E if you are in immediate danger. You do not need to cope with this alone.

It can be hard to tell grief from depression. The NHS says grief is a natural response to loss and symptoms usually improve with time, while depression is an illness; feelings such as hopelessness, guilt and suicidal thoughts are rare in grief and suggest depression.

The NHS says there is sometimes a trigger for depression. Life-changing events such as bereavement, losing your job or giving birth can bring it on, and people with a family history of depression are more likely to experience it. You can also become depressed for no obvious reason.

The NHS also describes related conditions where depression is one of the symptoms: postnatal depression, bipolar disorder, seasonal affective disorder and premenstrual dysphoric disorder. If a loss of enjoyment follows a pattern, for example in winter or before periods, mention it to your GP.

The NHS says doctors describe depression in adults as either less severe (mild) or more severe (moderate or severe), based on the symptoms, how often they occur and how bad they are, how long the depression lasts and the impact on daily life. You will usually be asked to answer a set of questions to help assess how severe it is.

The assessment is also a chance to describe in your own words what has changed for you, such as which activities you have stopped and for how long.

NICE guideline NG222 covers identifying, treating and managing depression in adults, including first episodes, further-line treatment and relapse prevention. The NHS summary is that treatment usually involves a combination of self-help, talking therapies and medicines, based on severity.

Behavioural activation is particularly relevant when enjoyment has gone. The NHS describes it as focusing on links between your activities and your mood and making practical changes to behaviour, rather than on thoughts and feelings, and says it can be useful if depression has led you to withdraw from social activities.

The NHS also suggests lifestyle changes such as getting more exercise, cutting down on alcohol, giving up smoking and eating healthily, as well as reading a self-help book or joining a support group. Sharing experiences with others in a similar situation can be very supportive.

On the NHS, you can see a GP or self-refer to an NHS talking therapies service. The NHS notes that waiting times for talking therapies can vary, so it is worth asking what to expect and what support is available while you wait.

Some people choose private counselling or psychiatry for faster access or a particular approach. The main treatments, CBT, behavioural activation and medicine, are the same in both settings. Whichever route you take, tell your GP so that medicines and monitoring stay coordinated.