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Why Does Depression Make it Difficult to Function?

And why it's OK to admit you're not OK.

Image by paolomartinezphotography/ Getty Images

By Renee Fabian 

Sometimes depression can sneak up on us, seeping into our lives without detection until it hits hard weeks, months, or even years later. Other times it shows up suddenly, like a heavy, wet blanket that has been thrown on top of us.

Either way, one of depression’s hallmark features is our loss of interest in seemingly everything, whether it’s a favorite pastime or the people closest to you — it can make getting out of bed at all nearly impossible. The world, which once seemed round, flattens out. We’re no longer having any fun and sometimes it’s downright hard to function.

The culprit? In the case of clinical depression, usually it’s a symptom referred to as anhedonia.

Defining Anhedonia

Anhedonia is defined as a loss of interest or pleasure. Activities we used to enjoy, such as hanging out with friends, eating a good meal, playing board games, watching our favorite TV show, or even having sex are no longer pleasurable. We may feel “flat or empty,” and as a result, have zero motivation to do anything.

“Anhedonia feels like an endless dribble of dirty dishwater. It feels like a constant gray fog. It’s the experience of the word ‘bleh.’ It’s nothing,” Natasha Tracy writes on her blog. “I still have feelings, I guess, but they are so undifferentiated as they are unpunctuated by pleasure, they all feel the same. They all don’t ‘feel.’”

To help lift us out of the gray, people in our lives often invite us to go out and exercise or socialize to feel better. Due to anhedonia’s effect on our internal reward systems, it’s not always possible to act on these well-meaning offers. We simply don’t have control over our loss of interest, and unfortunately, not being able to engage in pleasurable activities creates a feedback loop.

“It can become a vicious cycle, since anything you could do to improve your mood no longer seems to help, and may sometimes even worsen it since you notice the difference and lack of benefit,” says Dr. Jean Kim, clinical assistant professor of psychiatry at George Washington University. “Anhedonia can be one of the most serious signs of depression.”

Diagnosing Clinical Depression

Anhedonia is a symptom of several mental illnesses and neuropsychiatric disorders, including schizophrenia, substance use disorders, some eating/feeding disorders, and even Parkinson’s disease.

Most commonly though, it’s associated with depression. According to the Diagnostic and Statistical Manual of Mental Disorders, which is used to diagnose mental illness, anhedonia is indeed one of two “must-have” symptoms in order to determine clinical depression.

“[Anhedonia is] actually one of the key points that distinguish feeling sad or low or having the blues…from a diagnosable disorder,” says Dr. Simon Rego, chief psychologist at Montefiore Medical Center and associate professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine in New York. “It makes it very difficult to function in either your social life, your work or school life, or in your home, family life.”

Why Andheonia Makes It Hard To Function

As for why anhedonia makes it hard to function, we need to look at the brain’s reward system. Though, exactly how anhedonia works or where the process goes awry is still a complicated question researchers haven’t quite figured out the answer to.

In brief, as Science Alert describes, “pleasure is the feeling we get that drives us to seek out a stimulus.” As we find pleasure, our brain’s neurochemistry activates a complex system that drives us to repeat what makes us feel good. For example, we discover that cookies taste awesome, so we go back to the cookie jar over and over.”

“This process is controlled by two main areas of the brain, one that regulates our neurochemistry — the cortico-ventral basal gangli — and another “part of the brain called the medial prefrontal cortex (mPFC) [that] acts as a traffic cop for pleasurable acts, allowing oh-so-good dopamine levels to rise…and eliciting a pleasant sensation.”

When we lose interest in activities, several facets of this process may be disrupted. Some recent research suggests that our mPFC “traffic cop” has essentially taken a vacation and decreases its activity level. Other theories point to an imbalance in neurotransmitters, particularly dopamine, one of the “feel good” chemicals in our brain. Additional research identifies that “GABA (an inhibitory neurotransmitter), glutamate (an excitatory neurotransmitter), serotonin, and opioids may also play their part” in the process.

Long story short, MedicalNewsToday perhaps sums up anhedonia more colloquially: “Something [is] amiss as far as motivation, anticipation, and reward are concerned. For people with anhedonia, the reward process has come unhinged.”

Getting Help for Loss of Interest

If any of this sounds familiar and you’ve lost of interest in previously enjoyed activities, reach out for help. Clinical depression with anhedonia, if left untreated, can have serious consequences that make it difficult to function in our social, work, and school lives. Know this isn’t your fault — depression is an illness.

“You can’t get your blood drawn and they say, ‘Oh, this marker is out of range. That’s why you have depression.’ So it’s easy then to dismiss it or minimize it as all in your head or stigmatize it….All that is simply untrue,” says Simon Rego. “It’s important to recognize it’s a real medical condition and…it’s really important, especially if it’s persisting for at least a couple of weeks, to reach out and get help from a professional.”

A mental health professional — or your family doctor if that’s more comfortable — can address your depression symptoms. If you’re having trouble reaching out for support, ask a loved one if they will help you search for a service provider, make the call, or even take you to your first appointment. Though we may not know everything about what causes depression, it can absolutely be treated.

“Depression, once diagnosed, can be treated with psychotherapy to address life stressors, patterns, and behaviors, and sometimes medication to address the underlying neurobiology in your brain that is triggering depressive symptoms,” says Dr. Jean Kim. “Other helpful ways to manage depressive moods (usually in their milder stages) include reaching out to your support network, exercise, and decreasing life stressors whenever possible.”

Rego also recommends making sure we take care of the basics. “Keep yourself in a daily rhythm where you try to maintain as best you can a constant wake time, a good bedtime, and try to keep yourself engaged in things, even if they don’t seem pleasurable,” he says.

If You’re In Crisis

Some evidence suggests there is a strong link between anhedonia and an increased risk of suicide. If you are having thoughts of killing or harming yourself, it’s an emergency. Reach out to a loved one, call 911, go to the emergency room, or call the National Suicide Prevention Lifeline for immediate help. Your life matters, it can get better, and you’re needed here, alive.

There’s Hope

Anhedonia, by definition, takes away the very activities that make life worth living, which can even impair our ability to function on a daily basis. With the support of loved ones and a therapist or psychiatrist as needed, as well as fighting against that loss of interest with self-care and self-love wherever possible, there’s absolutely hope. You won’t feel this way forever.

If you need a little inspiration in the meantime, try the wise words of poet Aberjhani:

“Even when muddy your wings sparkle bright wonders that heal broken worlds.”

Originally published at www.talkspace.com

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