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Question:

I have psychotic syndrome and I suffer from anhedonia. I have had anhedonia for a year.I lost the joy of everything! Is there any treatment?

Answered by: L. Fredrick Jarskog

Anhedonia is a term used to describe the absence of pleasure or joy. It is often used to describe a person who no longer enjoys one or more (or all) activities that previously were enjoyable and fulfilling. Anhedonia can be used to describe symptoms related both to psychotic disorders (such as schizophrenia) and mood disorders (such as depression). When anhedonia is used in relation to a psychotic disorder, it usually occurs in the setting of other related symptoms such as social withdrawal, lack of motivation, and flat affect (reduced expression of emotion). Collectively, these symptoms are referred to as "negative symptoms" in psychiatry. It does not mean that these are bad symptoms or that the person is somehow "negative" or bad, it is just the somewhat unfortunate terminology that is used. There are several possible causes of anhedonia in psychotic disorders. One possibility is that the anhedonia is occurring in the context of a major depression. If this is the case, an antidepressant medication together with psychotherapy is likely to provide benefit since depression is usually readily treatable. Another possibility is that the antipsychotic medication that is used to treat the psychosis is causing anhedonia. In this case, psychiatrists will call this a "secondary negative symptom." This represents a side-effect of some antipsychotic medications; the older generation medications such as Haldol and Prolixin are somewhat more likely to cause this problem than the newer antipsychotics (such as Abilify, Zyprexa, Risperidone, Clozapine), although anhedonia can occur from any antipsychotic. A switch in antipsychotic medication can sometimes be helpful.

Finally, anhedonia sometimes represents a core symptom of schizophrenia and other psychotic disorders. In this case, it is called a "primary negative symptom." Unfortunately, primary negative symptoms are much more difficult to treat. Studies are currently underway to try to understand the cause of primary negative symptoms. We have one such study ongoing in the Lieber Schizophrenia Research Clinic. New treatments are also being tested for negative symptoms, including anhedonia. Antipsychotics are generally not effective, nor are antidepressants. You should discuss these different distinctions with your psychiatrist. These are not easy distinctions to make but it is important to patiently address each of the possibilities in order to give yourself the best chance of feeling better again.