Evolution of anhedonia in adolescent depression: An interpretative phenomenological analysis study

Abstract

Introduction

Anhedonia is a symptom complex currently linked to dysfunctional reward processing. Phenomenological studies capture anhedonia as a loss of hedonic and eudemonic pleasure. However, there is a lack of integration between neurobiological understanding and clinical phenomenology. This study used a qualitative method to explore the interplay of sociocultural contexts and individual factors associated with the evolution of dysfunctional reward processing in adolescents with depression and anhedonia.

Methods

Ten female adolescents with a current or prior diagnosis of major depressive disorder were recruited from a public tertiary care child and adolescent psychiatry service. In-depth interviews were conducted, voice recorded, and transcribed verbatim. The transcripts were analyzed using Interpretative Phenomenological Analysis (IPA).

Findings

The adolescents hailed from urban families. Educational stress and relational difficulties figured prominently. Amotivation was the most important subdomain of anhedonia affected. An integrated framework for understanding the evolution of anhedonia is presented. Five main patterns of dysfunctional reward processing emerged in our study: an overworked system, erroneous reward valuation, reward-effort imbalance, and diversion of the reward processing system for self-preservation.

Conclusion

There is a necessity to build robust theoretical models of the evolution of anhedonia, hence finding homogenous sub-groups, paving the way for person-centric interventions for anhedonia.

Plain language summary

Why was the study done? Adolescents suffering from depression lack interest in pleasurable activities along with sad moods and negative thoughts. It becomes very difficult to motivate adolescents to do meaningful and or pleasurable activities during or after other symptoms of depression have been reduced with medicines or therapy. The study was done to understand how and why the lack of interest comes about, and the different components of this symptom, so that it can help in understanding the symptom and finding new treatment strategies. What did the researchers do? The research team did an in-depth interview with ten adolescents suffering from depression who had lost interest in pleasurable activities to understand their lived experiences. Their experiences were recorded and analyzed in detail. A theoretical model of the symptom was derived in terms of brain pathways for reward. What did the researchers find? The lack of motivation rather than the lack of pleasure in doing activities was seen. The adolescents’ own proclivities along with the environment influenced (that is, family, peers, school, and society) what activities they found pleasure in. Their motivation was initially due to societal pressures, however, with time they were truly motivated from within to do these activities. This true inner motivation was lost when there was academic stress or difficult relationships with family or peers. When motivation was lost, it reduced their confidence in themselves, and over time they stopped doing any meaningful activities.