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September 01, 2020
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Inability to experience pleasure varies across psychiatric disorders

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Anhedonia severity differed across various disorders, according to results of a systematic review and meta-analysis published in JAMA Network Open.

“Anhedonia is a reduced ability to experience pleasure that occurs in many different psychiatric and neurological conditions, including major depressive disorder, schizophrenia, substance use disorders, Parkinson’s disease and chronic pain,” Martin Trøstheim, MS, of the department of psychology at University of Oslo in Norway, told Healio Psychiatry. “We wanted to compare the severity of anhedonia between these conditions because it has rarely been done in previous clinical research. We also noted a lack of reliable reference values for what constitutes healthy capacity for pleasure. Without such reference values, it becomes difficult to evaluate and compare anhedonia symptom severity.”

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In the current study, Trøstheim and colleagues aimed to establish and compare reference values for anhedonia levels among adults with and without mental illness. They searched four databases for articles published between January 1995 and July 2, 2019, that cited the scale development report of the Snaith-Hamilton Pleasure Scale (SHAPS), which is a widely used questionnaire for assessing anhedonia. They included studies of healthy patients and those with a verified diagnosis who were assessed via the complete 14-item SHAPS at baseline or in a no-treatment condition. Main outcomes and measures included self-reported anhedonia according to two different formats of the SHAPS, which ranged from 0 to 14 or 14 to 56 points, with higher values on both scales being linked to greater anhedonia symptoms.

Martin Trøstheim

The investigators analyzed 168 articles featuring 16,494 participants and found that those with current major depressive disorder, schizophrenia, substance use disorder, Parkinson’s disease and chronic pain exhibited higher scores on the SHAPS vs. healthy participants. For the patient groups, individuals with current MDD had considerably higher scores vs. all other groups. Those with remitted MDD had scores within the healthy range. The researchers observed that this pattern replicated across SHAPS scoring methods and was consistent across effect size and point estimate analyses.

“Anhedonia is a difficult symptom to treat, but new pharmacological and psychological treatments are in development,” Trøstheim told Healio Psychiatry. “With this comprehensive data summary, we have provided a tool for researchers and clinicians to evaluate the efficacy of current and future candidate treatments for anhedonia. For instance, the estimates we have provided for healthy hedonic capacity will allow clinicians to judge to what extent a patient’s anhedonia symptoms are improving and whether the patient has reached full symptom remission.”