A newly published research review is spotlighting an often overlooked—and intensely difficult—symptom at the heart of depression: anhedonia, the loss of interest or pleasure in once-enjoyable activities. This critical symptom, psychiatrists say, not only makes depression harder to treat but also increases the risk of chronic suffering. Recent scientific efforts unravel the complex roots and persistence of anhedonia, suggesting new ways forward for both patients and health professionals, including targeted therapies and hope for personalised interventions (WebMD).
For Thai readers, the significance of these findings is substantial. Depression is already underdiagnosed across Southeast Asia, with many individuals suffering silently due to social stigma or lack of awareness (WHO). Understanding the nuances of anhedonia could help Thai mental health workers, families, and patients recognise depression beyond low mood and better tailor interventions to those most at risk.
Anhedonia sits at the core of clinical depression. Alongside persistent sadness, it represents a foundational symptom making everyday life bleak and effortful. According to a resident psychiatrist at Mayo Clinic, “We see it all the time in our clinics, where patients are significantly struggling with the lack of motivation and the lack of experiencing pleasurable activities that they used to enjoy.” Research shows up to 70% of those with clinical depression experience some degree of anhedonia, and its presence is linked to worse treatment outcomes and risk of relapse.
But anhedonia isn’t unique to depression. It can also be found in people suffering from substance use disorders, eating disorders, Alzheimer’s, Parkinson’s, epilepsy, stroke, and chronic pain. For example, the WebMD article cites research estimating 35% of people with epilepsy, nearly 20% of those who’ve suffered strokes, and 25% of people with chronic pain encounter this symptom—illustrating the broad impact of reward processing failures in the brain. In both Thai and international context, these figures highlight a common thread among diverse diseases, uniting seemingly unrelated disorders under the biology of pleasure and reward.
Unlike fleeting boredom or fatigue, anhedonia is rooted in the malfunctioning of the brain’s reward circuitry. Psychologist and brain researcher at Weill Cornell Medicine explains: “People with anhedonia have differences on a neural level—meaning the symptom is linked to changes in the way neurons (brain cells) communicate using electrical and chemical signals.” Brain imaging studies confirm that for people with depression, regions involved in anticipating and enjoying positive experiences simply do not respond as robustly as in those without depression. In laboratory settings, individuals with anhedonia show less electrical activity in their brains in response to tangible rewards—even simple cash gains.
Crucially, researchers outline two main forms of anhedonia: anticipatory (difficulty looking forward to enjoyable activities) and consummatory (a lack of pleasure during the activity itself). For many, the drive to participate is numbed before pleasure can even be experienced; for others, even immersion brings no joy. As the psychologist points out, “You could have no problem actually enjoying things…but you may have a lot of trouble with the anticipatory piece or the motivational piece.” This understanding is vital for Thai families who may misinterpret a loved one’s withdrawal as laziness or disinterest, rather than as a legitimate symptom requiring clinical attention.
In Thailand, social expectations for group participation in communal life—be it family gatherings, temple festivities, or work events—can further stigmatise those who opt out due to anhedonia. Traditional beliefs may pathologise introversion or attribute withdrawal to supernatural causes or spirit disturbances, delaying necessary psychiatric care (Royal College of Psychiatrists of Thailand). Knowledge that such symptoms reflect neurobiological changes, instead of personality flaws or weak will, is crucial for progress in social attitudes and policies.
What can be done? Current pharmacological treatments for depression, particularly standard antidepressants, often struggle to address anhedonia directly. The WebMD report notes, “Antidepressants tend not to work as well for anhedonia, particularly for the most severe cases.” However, emerging treatments bring cautious optimism. The review highlights experimental therapies such as ketamine infusions (which can rapidly reduce anhedonia symptoms), transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT), specifically targeting the brain’s reward processing systems. Importantly, these approaches may not be widely available in Thai provinces but are increasingly accessible through major psychiatric hospitals in Bangkok and Chiang Mai, where advanced treatments are slowly being introduced (Ministry of Public Health).
Similarly, new forms of psychotherapy—like behavioral activation and “positive affect” therapy—offer patients practical tools. Behavioral activation encourages structured routines with goal-driven activities, even if initial motivation is low, aiming to create repeated opportunities for pleasure. According to experts, “Behavioral activation gives patients more opportunities to be exposed to these rewarding outcomes, which may help to strengthen some of these connections in the brain that help people respond in a healthy way to rewarding experiences.” Positive affect therapy, meanwhile, focuses on nurturing positive emotions, purpose, and social connection, all of which may counteract the cycle of withdrawal and numbness.
Thai cultural practices, notably communal worship, temple volunteering, and ritual arts, could potentially be woven into behavioral activation therapies, offering tailored, culturally resonant engagement for Thai patients. The Buddhist focus on mindfulness—now used worldwide as a therapeutic tool—can also support positive affect and the slow, patient rediscovery of joy in everyday tasks (Journal of Religion and Health). However, it is essential that therapists and families understand the difference between helpful encouragement and forcing participation which may deepen shame or alienation.
Societal change is also needed. For years, Thailand has grappled with both high suicide rates and barriers to mental healthcare, particularly in rural areas and among youth (WHO Southeast Asia suicide data). Anhedonia is now recognised as a powerful predictor of suicide risk—meaning earlier recognition and targeted intervention could be lifesaving. The WebMD article cites an expert in translational depression research as warning, “People need to take anhedonia very seriously because it can have very negative consequences, including a heightened risk of suicide.”
Looking to the future, research is underway to develop brain biomarkers—laboratory tests that may predict which medication or therapy will work for a specific individual. This “personalised psychiatry” approach, though still experimental, promises to move beyond trial-and-error prescription patterns and reduce suffering tied to anhedonia (Nature Reviews Neuroscience). While these innovations are largely based in Western research centers, growing collaborative efforts with Thai researchers and public health officials could soon make such approaches available locally. The Mental Health Department and leading universities in Thailand have begun collecting more nuanced data on depression subtypes through ongoing national mental health surveys and clinical research networks.
Historically, Thai approaches to mental suffering have blended Buddhist mindfulness, familial care, and herbal remedies. While these remain important resources, increasing evidence points to the need for integrated, science-based diagnosis and treatment. Only by recognising symptoms like anhedonia not as spiritual deficits but as treatable clinical challenges can the stigma be reduced and outcomes improved for millions in Thailand.
What does this mean for Thai readers today? Firstly, anyone who finds themselves persistently unmoved by previous sources of joy—music, food, friendship, or work—should consider seeking help from a mental health professional rather than solely waiting for the feeling to pass. Family and friends should respond to withdrawal with empathy and curiosity, not blame or criticism. And for healthcare providers, the message from the latest research is clear: look beyond sadness, ask about pleasure, and adjust treatment plans when anhedonia is present. For those seeking therapy, inquire whether the clinic offers treatments like behavioral activation or new approaches addressing reward systems directly. Increased awareness and compassion around this overlooked symptom could help ensure more Thais find lasting recovery, not just temporary relief.
For resources, readers can turn to the national mental health hotline (สายด่วนสุขภาพจิต 1323), community clinics, university hospital psychiatry departments, or reputable online sources such as the Department of Mental Health (dmh.go.th) and MOPH. In sum: understanding and confronting anhedonia—within families, communities, and clinics—holds the key to unlocking fuller, more sustained healing for those with depression in Thailand.