When people think depression - they think the standard: Low Mood. Low Energy. Low Appetite. Low Happiness. We understand it (or we think we do); and rightly so. Globally 300-400 million people live with depressive disorders. As a society (at least the one I live in), we now talk about it. We share stories and cupcakes; a shoulder to cry and a wry side eye. Yet despite being aficionados in the disorder that does not wish us to excel in much of anything, there's plenty of unknowns. The irony - a disease that can make one feel so alone, has further levels that, unless one has experienced it first hand, feels even more alone (If not crazy). I introduce - anhedonia.
Anhedonia is a key symptom of depression and comparable psychiatric disorders. It doesn't pick a lane, affecting change in striatal and prefrontal areas of the brain - with dopamine the most involved neurotransmitter. It's thought to have a significant genetic component, just like depression, yet doesn't behave in the same way. For a start - SSRI's have delivered a limited benefit on anhedonia. More worringly, the symptoms of anhedonia can often be a blocker to curing anhedonia itself - creating a feedback loop of paradoxial recovery - The energy required to fix the anhedonia is greater than the energy remaining after the anhedonia has called home.
Anhedonia is a cruel joke. We all experience sadness and loss and grief at stages in our life. And these emotions are often linked to tangible, real life events and experiences. Things we can analyse; or improve; or learn from. We can use coping mechanisms to better ourselves in the short term - and also to better ourselves for the next challenge life throws our way. But what happens when the coping mechanism's don't work? And what happens if we can't pinpoint why we are feeling a certain way?
CBT - change thought process. How does one change thought process without realising why they're feeling a certain way?
In turn, anhedonia creates a monster. A playing field develops - eternally broken. However work must be done to minimise the risk of worsening said playing field. And the question emerges - Is the entirety of adult life just coping; and if so; what is the point? If one's goal of life is to wake up, work, earn money, pay doctors, to try and improve symptoms, so that one can continue to go to work, to earn money, to pay doctors - it does not generate much satisfaction. The dopamine levels continue to drop.
Some people say they love life, and all the power to them. As a middle-aged adult - currently at a stage in life that, historically, I should probably have a family and structure in toe - I can say that I have never felt this feeling. I have never felt the feeling of love or happiness that wasn't conditional or attatched to an event or outcome or incident. I have not felt the feeling of happiness just because I was feeling happy. One feels broken. One feels angry. One does not feel like a healthy, normal person. One feels empty. One feels alone. One continues asking "What is the point? When will this end?".
When one tries to be a 'normal' person with 'normal, healthy' habits, this often exerts more energy than is left, creating burnout and executive dysfunction. Shock horror - this often worsens the symptoms of anhedonia. Picture this. You're sitting on the couch, lonely. You feel like your friendship group is close to non-existent and you could be described as a hermit at best. You ponder the concept of meeting up with one friend for an hour or two - but the dread of appearing decent and functioning and preparing onesself to walk out the door is exhausting. You re-grade your attempts - What if I reached out via text? The words do not come to mind - or if they do - a quick response leaves you struggling to find additional words to bat the ball back. It becomes another job - unpaid in both tangible financials and tangible dopamine. It creates a paradox:
I feel lonely and that makes me scared and upset. If I reach out to my friend, I cannot find words to converse, and the conversation makes me feel even more tired and upset. Ergo, if I pull back on conversing, I will not feel poorly. Yet pulling back on conversing was why I was feeling poorly in the first place. It's a cruel joke.