Bill Doskoch: Media, BPS*, Film, Minutiae

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Anhedonia is Greek for “without pleasure,” and it’s a component of depression that doesn’t have to co-exist with sadness.

By Michael B. Friedman, L.M.S.W., and Dr. Kenneth G. Terkelsen, writing at, posted Aug. 17:

… Identifying depressive disorders is not as easy as it sounds, in part because people can have a depressive disorder without being sad (4).

This seems very strange because of the difference between “depression” as a psychiatric diagnosis and as an ordinary English word. Obviously, in ordinary English being “depressed” means being very sad. But as a psychiatric diagnosis, “depression” refers to a particular combination of symptoms. To have a diagnosable “major depressive disorder” (sometimes called “clinical depression”), you must have at least one of two particular symptoms — called “cardinal” symptoms. Deep sadness (“depressed mood”) is one of the two cardinal symptoms. The other is called “anhedonia” (Greek for “without pleasure”), which means not taking pleasure in pretty much anything, even in things that used to give you pleasure — your work, your hobbies, your grandchildren, your friends, etc.

So if you have become bored with life, if you mostly sit around doing nothing unless you absolutely have to, if you find it difficult to rouse yourself enough to do even what you absolutely have to do — you may have a depressive disorder.

Anhedonia, even in combination with profound sadness, is not enough for a diagnosis of major depressive disorder. There must be at least five symptoms in all. In addition to the two cardinal symptoms, these could include: sleep problems, having little energy, eating too much or too little, difficulty concentrating, moving or speaking noticeably slowly or being fidgety and restless, feeling that you are a failure, or thinking that you would be better off dead (5). People with major depressive disorder may also experience distressing ruminations, be irritable, or rely on drugs or alcohol to dull painful feelings (6).

I provide the full checklist of depressive symptoms in this post from Feb. 7, 2012. I also dealt with the semantics of depression in a Feb. 27, 2012 post.  Friedman and Terkelsen’s article add much-needed context to that latter post.

Here are some additional thoughts from the duo on why anhedonia is particularly problematic:

The problem, of course, is that some people with depressive disorders — especially those who experience anhedonia — just can’t get themselves going. They are caught in a vicious cycle: The more isolated and inactive they are, the more depressed they are, and the more depressed they are, the more isolated and inactive they become. Formal interventions including outreach to encourage people to get off their couches, go for therapy, take their medications, or take a walk may well be essential for people caught in this vicious cycle (14). And sometimes, just getting a call from a friend saying, “Let’s take a walk” is what gets a person with anhedonia going.

I thought this was all worth mentioning because I notice a lot more flatness to my mood, rather than sadness, as I try to recover from Major Depressive Disorder.

If you run into me on the street, I doubt you would walk away afterwards saying “Bill seems so sad.” You might think I seem really subdued or something similar. But you wouldn’t walk away necessarily thinking I suffer from depression.

That’s why the HuffPo article caught my eye, and why I thought it deserved amplification. Appearances can be deceiving.

Sun, August 19 2012 » * Big Picture Stuff, Main Page, Minutiae