“Nothing is fun anymore. You don’t go out because you just think, what’s the point?”
This article is part of That Feeling When—a partnership between VICE Australia and youth mental health initiative headspace.
Sadness is a common emotion that people often deal with – but when it’s lingering and you notice that you are pulling back from doing things you’d normally do, and it’s impacting your daily life, this may be depression.
Depression is different for everyone, which means the journey is different for everyone, but importantly, most people do recover. This recovery depends on the severity of symptoms, but typically starts with self-care strategies , connecting with family and friends and progresses to talking therapies, before anti-depressant medicine is seen as appropriate.
Seeking help early is hugely beneficial in the long-run. If people are able to maintain engagement with family, friends, school, work, and study (even with some ongoing mental health challenges) it significantly improves their long-term outcome. Finding the right support can take time and patience, but it’s important to keep working at it until you find someone or something that works for you.
Vikki Ryall, Head of Clinical Practice at headspace, the National Youth Mental Health Foundation
Which is worse: feeling profoundly sad, or feeling nothing at all? It’s a difficult question that depression sufferers can grapple with daily. Because while we may think of depression in the mopey Eeyore sense, its symptoms can often be characterised by a lack of emotion rather than an abundance of it. Some people who experience depression lose interest in anything that once gave them pleasure, and life becomes hideously banal.
“It’s such a slow, numbing effect that you don’t notice it at first,” says Sarah*, who has lived with mania and depression all her life. “You don’t think ‘I’m not happy,’ and you just don’t really feel anything but boredom or ennui. Nothing is fun anymore … you don’t go out to movies, parties, all that, because you just think, what’s the point?”
This reduced ability to experience pleasure is called anhedonia (literally “without pleasure” in Greek), and it is a core symptom of depressive illness, alongside low energy and low mood. “About 90 percent of people with depression will experience anhedonia, explains psychiatry researcher Dr Christopher Davey, from Orygen, the National Centre of Excellence in Youth Mental Health. “They describe not feeling their usual affection for people close to them, and finding it hard to enjoy activities that they usually enjoy.”
It’s important to distinguish between anhedonia and the numbing effect some people experience on antidepressants. The former is a symptom of depression, and the latter is a side effect of using some antidepressant medications. Neither are pleasant, but anhedonia is much more harmful and riskier where suicide ideation is concerned.
Although cautious about the risk of re-experiencing anhedonia, Sarah is currently reducing her antidepressant intake with positive results. She emphasises how important it is for those experiencing depression to talk regularly with their doctor about how medications are affecting them. “I spent the last six months reducing some of my medication. I worked through it with my doctor and weaned off really slowly. Meds always work differently for everyone, so it would be pointless to say reduce this pill or that pill.”
Dr Davey says the root cause of anhedonia, like the root cause of depression, “is incompletely understood.” More research is needed to fully understand the cause and progression of anhedonia. One theory researchers are exploring relates to the brain’s “reward system”. Some patients who suffer from anhedonia appear to receive no dopamine hit from experiences that are usually pleasurable: sex, food, music, social events. Other research investigates the contributions that social, cognitive, emotional and behavioural factors have on the experience of anhedonia.
Sarah describes her libido going “out the window” and fun outings with friends turning into mundane chores. “You could be at the park on a nice sunny day, with people everywhere enjoying the sunshine, and you just look at it all and think ‘Why isn’t this fun?'”
In its worst cases, Davey says, anhedonia leads to “a complete loss of hope,” which can exacerbate suicidal thoughts. Simply put, some people experiencing prolonged bouts of anhedonia become so bored and alienated that they consider self-harm. It’s different to feeling extreme melancholy or mania: you’re flat-lining emotionally, and that can be extremely disorientating. “The scary thing [about anhedonia] is you think you’re going to feel like this forever,” Sarah says. “I can see why people might want to do risky things, just so that they feel something.”
If medical researchers can learn how to effectively manage anhedonia, they’ll be several steps closer to curing depression altogether. Anhedonia is also a symptom of schizophrenia, and a recent University of Cambridge study suggests this link might help researchers develop better treatments for both conditions. Currently, medication and psychotherapy offer the best treatment options. But Davey says that while both can be effective, “much more clinical research is needed” around anhedonia and depression more broadly.
Sarah is unequivocal in saying that living with anhedonia is brutal, like “walking around in a grey fog” that never lifts. Still, over time and in consultation with her doctor she has developed her own ways of coping that might work for other people, too. “I think it’s good to remember that anhedonia isn’t an illness in itself,” she says. “It’s a symptom. But it is a real thing, it’s not just you being a dick, and it won’t last forever.”