Relationship Between Anhedonic Depression and Alcohol

In Friends, Lovers, and the Big Terrible Thing, actor Matthew Perry described anhedonia this way: “The key to the problem, I would come to understand, was this: I lacked both spiritual guidelines, and an ability to enjoy anything. But at the same time, I was also an excitement addict … I didn't know this at the time, of course, but if I was not in the act of searching for excitement, being excited, or drunk, I was incapable of enjoying anything.”

Anhedonia — the inability to feel pleasure — can show up at a particularly difficult time in our lives, or it can be a constant companion. In times like these, it may seem attractive to reach for quick fixes that don’t require a lot of energy — things like eating junk food, overspending, using drugs, or drinking alcohol. But these are only band-aids, and they can make depression’s vicious cycle even harder to break.

So what is the relationship between anhedonic depression and alcohol in particular? And is there a cure for anhedonia? If you’re wondering how to get rid of anhedonia or struggling to find recovery after flatlining emotionally, let’s see what science has to say.

What Is Anhedonia and What Causes It?

At the most basic level, anhedonia is the inability to feel joy. It can have several underlying causes ranging from temporary emotional imbalances to structural neurological changes or fundamental shifts in neurochemistry. Ultimately, it all boils down to the brain — specifically, to the levels of “feel-good” neurotransmitters like dopamine.

Dopamine is the main driver of the brain’s reward circuit — it’s that boost of pleasure and motivation we get from doing something that feels inherently good, like eating a great meal, having a heart-to-heart conversation with a friend, or spending time with someone we love. The reward system evolved as a way to keep us alive by promoting behaviors that benefit our safety and health.

When our dopamine levels tank, we feel it. Anhedonia — the result of a drop in dopamine — manifests itself as the inability to find pleasure or feel motivated by things that used to capture our attention and bring us joy.

Anhedonia can manifest in two main ways: physical and social. 

• Physically, it might be harder to feel the pleasure of touch or sensory experiences we used to enjoy — the taste of cinnamon toast, the smell of eucalyptus bath soap, the feeling of a cool September breeze on our skin. 
• Socially, it shows up as a reduced desire to engage with others — we start canceling plans and ignoring texts, letting weeks go by before responding to a Facebook message or email from a friend. Talking to loved ones and friends suddenly feels like a chore we don’t have enough energy to face.

Anhedonia affects the way we see the world, which can seem colorless and lacking in the usual “flavor” of life. It’s a slippery concept, because in a way it describes a painful lack of feeling — kind of like air without oxygen.

What Is Anhedonic Depression?

In some ways, anhedonia is worse than depression — partly because it’s so difficult to describe. As David Foster Wallace put it in his novel  Infinite Jest, “When people call it depression I always get pissed off because I always think depression sounds like you just get like really sad, you get quiet and melancholy and just like sit quietly by the window sighing or just lying around … Well this — isn’t a state. This is a feeling … It’s like horror more than sadness … Everything you see gets ugly … And everything sounds harsh, spiny and harsh-sounding, like every sound you hear all of a sudden has teeth.”

Anhedonia can be difficult to separate from depression, since the two often come together in the form of “anhedonic depression.” Needless to say, the combination of the two can be especially challenging to treat. 

How Is Anhedonic Depression Treated?

Depression is often treated with selective serotonin reuptake inhibitors, or SSRIs, which restore the levels of serotonin — a neurotransmitter involved in mood regulation. Deficit or dysfunction of serotonin tends to lead to classic symptoms of clinical depression like low mood, fatigue, sleep difficulties, weight fluctuations, and trouble concentrating.

In anhedonic depression, however, the picture is a bit more complex. In addition to low serotonin levels, the levels of dopamine are also low. Since raising serotonin levels can actually lead to lower dopamine levels, we run into a dilemma: SSRIs could potentially make the anhedonic part of anhedonic depression worse. 

When anhedonia is part of depression, doctors typically combine SSRIs with another medication or turn to atypical antidepressants. Common medical treatments for anhedonia include serotonin-norepinephrine reuptake inhibitors (SNRIs), which act on serotonin and the stimulating neurotransmitter norepinephrine, or norepinephrine-dopamine reuptake inhibitors (NDRIs), which specifically target the reward pathway.

Treating anhedonia also typically involves therapy, lifestyle changes, and mindfulness practices under the supervision of a psychiatrist or trained therapist.

Why Does Anhedonic Depression Develop?

As it often happens, nobody knows for sure — scientists have suggested that it’s most likely a mixture of genetics and environmental factors. However, there are a few known risk factors:

• Post-traumatic stress disorder (PTSD), which can cause fundamental changes in how our brain processes stimuli.
• Eating disorders, which involve intentionally manipulating our reward system using food.
• Chronic illness, although this relationship can be complex based on the illness.


Alcohol’s Role in Anhedonia

What is alcohol’s role in all this? Once again, it comes back to dopamine. Alcohol — like many addictive substances — artificially boosts the levels of dopamine in the brain. As a result, for a brief time social experiences appear more fulfilling, conversations seem “deep,” everyone (including ourselves) seems “funny,” mundane tasks don’t feel like a drag, and life feels a bit more exciting. This is, of course, only a brief biochemical illusion, but it can be hard to resist — especially if we are feeling drained by anhedonic depression, which can make the world and everything in it appear colorless and dull. 

At the same time, by acting as a depressant, alcohol dulls our senses and slows down brain activity. We may no longer notice or think about our anhedonic symptoms, making it appear that our depression has temporarily lifted.

When the Illusion Fades Away

Unfortunately, when the illusion created by alcohol starts to fade away, we are left in a state of worse anhedonic depression than before. Artificially boosting dopamine levels for long periods of time creates a “new normal” in the brain. It gets used to the constant supply of “feel-good” neurochemicals and presses the pause button on their natural production.

Worse still, to counteract the artificial boost that dopamine provides, the brain releases a chemical called dynorphin to balance things out. The effects of dynorphin cancel out those of the “happy” neurotransmitters (and then some). The result? We’re left feeling more emotionally unbalanced, anxious, and depressed than before.

Alcohol Takes Its Toll

Over time, as the brain adjusts to the new chemistry and the body adjusts to the presence of alcohol, our tolerance rises, and we need more to achieve the same effect. This is a clear path to dependence — the state in which we need a certain level of alcohol simply to feel normal. If we suddenly stop, withdrawal sets in, leading to symptoms that range from nausea, insomnia, uncomfortable shakes, headaches, and fatigue to potentially life-threatening seizures and delirium tremens.

All of this leads to a host of problems that affect our health. In addition to physical health problems like liver damage and cardiovascular issues, alcohol can do a number on our mental health, worsening the anxiety and depression that it originally promised to relieve.

Breaking the Cycle: How To Deal With Anhedonia

So how do we break out of this cycle? Is there a cure for anhedonia? If you’re wondering how to treat anhedonia — especially anhedonia after addiction, there are a few ways that have been proven to work.

1. Get creative. Stimulating creativity is one of the best ways to break out of the anhedonic trap and get dopamine flowing again. Studies have linked creative activities with dopamine release, and many artists will confirm this feeling. It doesn’t have to be anything grand — try planting a garden, writing a journal page every morning, creating a photo collage, or trying a new recipe. Those little sparks that happen when you look at daily life from a creative perspective eventually flood out the empty gray feelings of anhedonia.  
2. Get professional advice. The right therapist can help you untangle the way anhedonic depression is affecting your life and how alcohol might be playing a role. Techniques like cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) can be particularly useful when it comes to sorting out thought patterns and behaviors that might be keeping the vicious cycle going.
3. Get moving. Physical activity can work wonders for the mind. Exercise is a natural way to release feel-good endorphins and one of the best ways to naturally rebalance both dopamine and serotonin in the brain without compromising either. Once again, it doesn’t have to be complicated or demanding — take a stroll through the neighborhood, dance to a song you used to enjoy, try a yoga workout you found on YouTube. Whatever type of movement brings you joy and gets you energized will naturally boost your mood and provide a powerful buffer against anhedonia and alcohol cravings alike.
4. Get social. Even if you don’t feel like it at first, social interactions can work wonders when it comes to restoring the natural levels of feel-good neurotransmitters like dopamine. So talk to friends and family members, rekindle old friendships, and create new ones. Find supportive communities in person and online — and remember that Reframe is here to help and has a thriving community of people on a similar journey just a click away!

Conclusion

Anhedonic depression is a self-fulfilling cycle that can be hard to break. When we feel down, sometimes we will do anything to feel better (including unhealthy things), and sometimes we don’t want to do anything. When we feel this way, it’s important to remember that there is hope. There’s no one way to deal with anhedonia, but there are many approaches that can give us our life back.

Be mindful of the instinct to go for quick fixes like alcohol, which can worsen anhedonia symptoms. With a commitment to self-care, a strong support system, and knowledge about the causes and treatments of anhedonia, we can overcome this time in our life. Consider joining Reframe and exploring the broad factors behind anhedonia and how improving your relationship with alcohol can also improve your mental health.