Top

Published in:

Open Access 01-04-2020 | Affective Disorder | Original Contribution

Understanding anhedonia: a qualitative study exploring loss of interest and pleasure in adolescent depression

Authors: Rebecca Watson, Kate Harvey, Ciara McCabe, Shirley Reynolds

Published in: European Child & Adolescent Psychiatry | Issue 4/2020

Abstract

Anhedonia (or loss of interest and pleasure) is a core symptom of depression and may predict poor treatment outcome. However, little is known about the subjective experience of anhedonia, and it is rarely targeted in psychological treatment for depression. The aim of this study is to examine how young people experience anhedonia in the context of depression. Semi-structured interviews were conducted with 34 adolescents with a primary diagnosis of depression (N = 12) or elevated depressive symptoms (N = 22). Thematic analysis was used to identify important aspects of adolescents’ experiences. Four main themes were identified: (1) experiencing a loss of joy and a flattening of emotion; (2) struggling with motivation and active engagement; (3) losing a sense of connection and belonging; and (4) questioning sense of self, purpose, and the bigger picture. The results challenge the framing of anhedonia as simply the loss of interest and pleasure. Adolescents reported a range of experiences that mapped closely onto the cluster of negative symptoms associated with schizophrenia and were similar to the sense of ‘apathy’ characteristic in Parkinson’s disease. This highlights the potential benefit of taking a trans-diagnostic approach to understanding and treating reward deficits associated with mental health problems.

Available only for authorised users

American Psychological Association (2015) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychological Association, Washington, DC (APA 2013)

Thapar A, Collishaw S, Pine DS, Thapar AK (2012) Depression in adolescence. Lancet 379:1056–1067. https://doi.org/10.1016/S0140-6736(11)60871-4 CrossRefPubMedPubMedCentral

Orchard F, Pass L, Marshall T, Reynolds S (2016) Clinical characteristics of adolescents referred for treatment of depressive disorders. Child Adolesc Mental Health 22:61–68. https://doi.org/10.1111/camh.12178 CrossRef

Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J et al (2017) Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial. Lancet Psychiatry 4(2):109–119. https://doi.org/10.1016/S2215-0366(16)30378-9 CrossRefPubMedPubMedCentral

McMakin DL, Olino TM, Porta G, Dietz LJ, Emslie G, Clarke G et al (2012) Anhedonia predicts poorer recovery among youth with selective serotonin reuptake inhibitor treatment resistant depression. J Am Acad Child Adolesc Psychiatry 51:404–411. https://doi.org/10.1016/j.jaac.2012.01.011 CrossRefPubMedPubMedCentral

Auerbach RP, Millner AJ, Stewart JG, Esposito EC (2015) Identifying differences between depressed adolescent suicide ideators and attempters. J Affect Disord 186:127–133. https://doi.org/10.1016/j.jad.2015.06.031 CrossRefPubMedPubMedCentral

Berridge KC, Robinson TE (2003) Parsing reward. Trends Neurosci 26(9):507–513. https://doi.org/10.1016/S0166-2236(03)00233-9 CrossRefPubMed

Berridge KC, Kringelbach ML (2008) Affective neuroscience of pleasure: reward in humans and animals. Psychopharmacology 199(3):457–480. https://doi.org/10.1007/s00213-008-1099-6 CrossRefPubMedPubMedCentral

Dichter GS, Smoski MJ, Kampov-Polevoy AB, Gallop R, Garbutt JC (2010) Unipolar depression does not moderate responses to the sweet taste test. Depress Anxiety 27:859–863. https://doi.org/10.1002/da.20690 CrossRefPubMedPubMedCentral

10.

Sherdell L, Waugh CE, Gotlib IH (2012) Anticipatory pleasure predicts motivation for reward in major depression. J Abnorm Psychol 121(1):51–60. https://doi.org/10.1037/a0024945 CrossRefPubMed

11.

McCabe C, Cowen PJ, Harmer CJ (2009) Neural representation of reward in recovered depressed patients. Psychopharmacology 205(4):667–677. https://doi.org/10.1007/s00213-009-1573-9 CrossRefPubMedPubMedCentral

12.

McCabe C, Woffindale C, Harmer CJ, Cowen PJ (2012) Neural processing of reward and punishment in young people at increased familial risk of depression. Biol Psychiatry 72(7):588–594. https://doi.org/10.1016/j.biopsych.2012.04.034 CrossRefPubMed

13.

Rzepa E, Fisk J, McCabe C (2017) Blunted neural response to anticipation, effort and consummation of reward and aversion in adolescents with depression symptomatology. J Psychopharmacol 31:303–311. https://doi.org/10.1177/0269881116681416 CrossRefPubMed

14.

Zhang WN, Chang SH, Guo LY, Zhang KL, Wang J (2013) The neural correlates of reward-related processing in major depressive disorder: a meta-analysis of functional magnetic resonance imaging studies. J Affect Disord 151(2):531–539. https://doi.org/10.1016/j.jad.2013.06.039 CrossRefPubMed

15.

Rizvi SJ, Pizzagalli DA, Sproule BA, Kennedy SH (2016) Assessing anhedonia in depression: Potentials and pitfalls. Neurosci Biobehav Rev 65:21–35. https://doi.org/10.1016/j.neubiorev.2016.03.004 CrossRefPubMedPubMedCentral

16.

Pizzagalli DA, Iosifescu D, Hallett LA, Ratner KG, Fava M (2008) Reduced hedonic capacity in major depressive disorder: evidence from a probabilistic reward task. J Psychiatr Res 43(1):76–87. https://doi.org/10.1016/j.jpsychires.2008.03.001 CrossRefPubMedPubMedCentral

17.

Vrieze E, Pizzagalli DA, Demyttenaere K, Hompes T, Sienaert P, de Boer P et al (2013) Reduced reward learning predicts outcome in major depressive disorder. Biol Psychiatry 73(7):639–645. https://doi.org/10.1016/j.biopsych.2012.10.014 CrossRefPubMed

18.

Kaufman J, Birmaher B, Brent D, Rao UMA, Flynn C, Moreci P et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36(7):980–988. https://doi.org/10.1097/00004583-199707000-00021 CrossRefPubMed

19.

Snaith RP, Hamilton M, Morley S, Humayan A, Hargreaves D, Trigwell P (1995) A scale for the assessment of hedonic tone the Snaith-Hamilton Pleasure Scale. Br J Psychiatry 167(1):99–103. https://doi.org/10.1192/bjp.167.1.99 CrossRefPubMed

20.

Gard DE, Gard MG, Kring AM, John OP (2006) Anticipatory and consummatory components of the experience of pleasure: a scale development study. J Res Pers 40(6):1086–1102. https://doi.org/10.1016/j.jrp.2005.11.001 CrossRef

21.

Gooding DC, Pflum MJ (2014) Further validation of the ACIPS as a measure of social hedonic response. Psychiatry Res 215(3):771–777. https://doi.org/10.1016/j.psychres.2013.11.009 CrossRefPubMed

22.

Gooding DC, Pflum MJ, Fonseca-Pedero E, Paino M (2016) Assessing social anhedonia in adolescence: the ACIPS-A in a community sample. Eur Psychiatry 37:49–55. https://doi.org/10.1016/j.eurpsy.2016.05.012 CrossRefPubMed

23.

Rizvi SJ, Quilty LC, Sproule BA, Cyriac A, Michael Bagby R, Kennedy SH (2015) Development and validation of the Dimensional Anhedonia Rating Scale (DARS) in a community sample and individuals with major depression. Psychiatry Res 229:109–119. https://doi.org/10.1016/j.psychres.2015.07.062 CrossRefPubMed

24.

McCann TV, Lubman DI, Clark E (2012) The experience of young people with depression: a qualitative study. J Psychiatr Ment Health Nurs 19(4):334–340. https://doi.org/10.1111/j.13652850.2011.01783.x CrossRefPubMed

25.

Midgely N, Parkinson S, Holmes J, Stapley E, Eatough V, Target M (2015) Beyond a diagnosis: the experience of depression among clinically-referred adolescents. J Adolesc 44:269–279. https://doi.org/10.1016/j.adolescence.2015.08.007 CrossRef

26.

Harper D, Thompson AR (eds) (2011) Qualitative research methods in mental health and psychotherapy: a guide for students and practitioners. Wiley, Hoboken

27.

Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19(6):349–357. https://doi.org/10.1093/intqhc/mzm042 CrossRefPubMed

28.

GOV.UK (2018) Find and compare schools in England. https://www.gov.uk/school-performance-tables. Accessed 7 Oct 2018

29.

Angold A, Costello EJ, Pickles A (1987) The development of a questionnaire for use in epidemiological studies of depression in children and adolescents. Medical Research Council Child Psychiatry Unit, London

30.

Messer SC, Angold A, Costello EJ, Loeber R (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents: factor composition and structure across development. Int J Methods Psychiatr Res 5(4):251–262

31.

NICE (2017) Depression in children and young people: identification and management. https://www.nice.org.uk/guidance/cg28. Accessed 3 May 2018

32.

Wood A, Kroll L, Moore A, Harrington R (1995) Properties of the mood and feelings questionnaire in adolescent psychiatric outpatients: a research note. J Child Psychol Psychiatry 36(2):327–334. https://doi.org/10.1111/j.1469-7610.1995.tb01828.x CrossRefPubMed

33.

Angold A, Costello EJ, Messer SC, Pickles A, Winder F, Silver D (1995) The development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res 5:237–249

34.

Brown, T. A., Barlow, D. H., & DiNardo, P. A. (1994). Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV): Client Interview Schedule/. Graywind Publications Incorporated.

35.

Guba EG, Lincoln YS (1994) Competing paradigms in qualitative research. Handb Qual Res 2:105–117

36.

Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101. https://doi.org/10.1191/1478088706qp063oa CrossRef

37.

Saldaña J (2015) The coding manual for qualitative researchers. Sage, London

38.

Millan MJ, Fone K, Steckler T, Horan WP (2014) Negative symptoms of schizophrenia: clinical characteristics, pathophysiological substrates, experimental models and prospects for improved treatment. Eur Neuropsychopharmacol 24(5):645–692. https://doi.org/10.1016/j.euroneuro.2014.03.008 CrossRefPubMed

39.

Gee B, Hodgekins J, Lavis A, Notley C, Birchwood M, Everard L et al (2018) Lived experiences of negative symptoms in first‐episode psychosis: a qualitative secondary analysis. Early Interv Psychiatry. https://doi.org/10.1111/eip.12558 CrossRefPubMed

40.

McCabe C (2018) Linking anhedonia symptoms with behavioural and neural reward responses in adolescent depression. Curr Opin Behav Sci 22:143–151. https://doi.org/10.1016/j.cobeha.2018.07.001 CrossRef

41.

George M, Maheshwari S, Chandran S, Manohar JS, Rao TS (2017) Understanding the schizophrenia prodrome. Indian J Psychiatry 59(4):505PubMedPubMedCentral

42.

McGorry PD, McFarlane C, Patton GC, Bell R, Hibbert ME, Jackson HJ, Bowes G (1995) The prevalence of prodromal features of schizophrenia in adolescence: a preliminary survey. Acta Psychiatr Scand 92(4):241–249CrossRefPubMed

43.

Cuthbert BN (2015) Research Domain Criteria: toward future psychiatric nosologies. Dialogues in clinical neuroscience 17(1):89–97PubMedPubMedCentral

44.

Husain M, Roiser JP (2018) Neuroscience of apathy and anhedonia: a transdiagnostic approach. Nat Rev Neurosci 19:470–484. https://doi.org/10.1038/s41583-018-0029-9 CrossRefPubMed

45.

Pile V, Smith P, Leamy M, Blackwell SE, Meiser-Stedman R, Stringer D et al (2018) A brief early intervention for adolescent depression that targets emotional mental images and memories: protocol for a feasibility randomised controlled trial (IMAGINE trial). Pilot Feasibility Stud 4(1):97. https://doi.org/10.1186/s40814-018-0287-3 CrossRefPubMedPubMedCentral

Title: Understanding anhedonia: a qualitative study exploring loss of interest and pleasure in adolescent depression
Authors: Rebecca Watson
Kate Harvey
Ciara McCabe
Shirley Reynolds
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Affective Disorder
Affective Disorder
Published in: European Child & Adolescent Psychiatry / Issue 4/2020
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-019-01364-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Understanding anhedonia: a qualitative study exploring loss of interest and pleasure in adolescent depression

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2020

Negative impact of maternal antenatal depressive symptoms on neonate’s behavioral characteristics

A systematic review of interventions for treatment resistant major depressive disorder in adolescents

Clinical high risk for psychosis model in children and adolescents: a joint position statement of ESCAP Clinical Division and Research Academy

Child mental health and resilience in the context of socioeconomic disadvantage: results from the Born in Bradford cohort study

Affective lability in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia

Systematic literature review and meta-analysis of the relationship between adherence, competence and outcome in psychotherapy for children and adolescents