Anhedonia in Depressive Disorder: A Narrative Review

Abstract

Since the introduction of DSM-III anhedonia has become a core depressive criterion and is defined as the loss of interest or pleasure. Although the origin of the word goes back to the end of the 19th century and numerous anhedonic symptoms are described in classic texts on depression, this centrality in the diagnosis of depression is only recent. Anhedonia is best described as a symptom complex with unclear boundaries cutting across the tripartite model of the mind (affect, volition, and cognition). Popular concepts of anhedonia pertain to the pleasure cycle and positive affectivity. These concepts partially overlap and are often mixed up, but clearly stem from different theoretical backgrounds: the affective science of reward processing versus more general, dimensional modelling of affect. The former concept seems more suitable to understand anhedonic emotions, the latter more suitable to understand anhedonic mood or trait. This narrative review covers the history of “anhedonia,” the different anhedonic phenomena, and psychopathological concepts. An attempt is made to go beyond a merely descriptive psychopathology. Neurobiological and psychological insights shed a light on how symptoms are made and interconnected; these insights possibly call for a new psychopathological language.