What is Anhedonia? (No Feelings, Emotional Flatlining)
What is Anhedonia?
The clinical definition of anhedonia (see below) is a loss of interest in activities that used to be enjoyable, and a reduced capacity to feel pleasure. The Diagnostic Manual of the American Psychiatric Association (DSM-5) lists it as a symptom of depression, so there is a lot of overlap in depression symptoms.
Anhedonia can be thought of as a “squeezing” of the neural pathways in the reward center of the brain which reduces the flow of good-feeling neurotransmitters. Less get through than normal, so you feel less motivated, less happy, less interested in things such as food, music, intimacy, or anything you used to enjoy. Examples of having anhedonia can inclue:
- Losing interest in hobbies or activities you used to like.
- Not wanting to spend as much time with friends and family, and not enjoying it much when you do.
- Feeling more sad, lonely, or depressed in general.
- Feeling like something’s missing, something’s wrong, life isn’t stimulating anymore.
- Feeling sort of flat, or dull, and not looking forward to things.
What is Emotional Flatlining?*
Emotional Flatlining is a physical inability to experience positive emotions. It is not a reduction of emotion, it’s the complete absence of it. It is not recongized in the DSM-5 as a distinct condition, but it is. *
Emotional Flatlining can be though of as cutting-off or kinking of the neural pathway “hose” which stops the flow of good-feeling neurotransmitters in the reward circuits of the brain. Nothing flows. In some cases the threat-response mechanisms continue to work, so there can still be negative feelings. It is a distinct condition from the DSM-5 depression-type of anhedonia that may or may not co-exist alongside it. There is no ability at all to feel any positive emotion such as joy, happiness, gratitude, caring, and other positive feelings. You become numb to everything except bad feelings in some cases. Zombie-like. Totally flat.
It is hard to explain the difference between the two, so I’m giving more examples. Below is what it’s like to have Emotional Flatlining, and unlike anhedonia where you might have some of the symptoms, you typically have all of these with Emotional Flatlining:
- Not caring if someone you love gets diagnosed with cancer, or even you do.
- Holding your baby and feeling no love or connection at all. The same feeling you get from holding a napkin – nothing.
- Not being able to grieve the loss of someone you love.
- Find yourself sitting on the couch just staring off into space.
- Hearing your favorite song and feeling completely numb
- Can’t enjoy video games, watching TV, puzzles, or doing anything at all.
- Having no desire for, or enjoyment of intimacy even if you can perform physically
- You could win the lottery and would still feel dead flat.
- Faking emotions with other people, such as pretending to care when you don’t.
- Feeling totally flat during special moments such as getting married or watching your favorite sports team win a major championship.
- Having memory issues, trouble concentrating, focusing, and other cognitive difficulties.
- Feeling like your life is pointless. There is no reason to live when you can’t enjoy anything.
*Emotional Flatlining is the term I (Jackie Kelm) created to describe what it is after getting it, overcoming it, and helping many others overcome it as well. I am not a medical doctor, this is not medical advice: These are my opinions.
Clinical Anhedonia Definition
“Anhedonia, a term first used by Ribot in 1896, is a diminished capacity to experience pleasure. It describes the lack of interest and the withdrawal from all usual pleasant activities. Chapman et al. defined two different types of hedonic deficit: physical anhedonia and social anhedonia. Physical anhedonia represents an inability to feel physical pleasures (such as eating, touching and sex). Social anhedonia describes an incapacity to experience interpersonal pleasure (such as being and talking to others).” Source
Types of Anhedonia
Anhedonia definitions include different types, such as social and physical described above, sexual, musical, appetitive or motivational, consummatory, and anticipatory anhedonia. Total or complete anhedonia is having all of them together where there is no positive emotion or interest in any area of life, which is what I refer to as emotional flatlining.
Musical, social, and sexual anhedonia are characterized by having no sense of pleasure in these particular areas. Appetitive or motivational anhedonia is having no motivation or desire to do something, while consummatory anhedonia is not enjoying the activity itself. Anticpatory anhedonia is the inability to experience any excitement about the future.
Causes of Anhedonia
Anhedonia often goes along with other mental conditions such as depression, bipolar disorder, and schizophrenia. It also sometimes occurs in people who have alcohol and drug dependencies. Part of the reason is that it is a common side effect of some narcotic and amphetamine drugs, and of some medications used to treat mental conditions.
In his book Brain Energy, Harvard Psychologist Christoher Pamer suggests that mental health issues such as anhedonia are actually metabolic disorders of the brain. I highly recommend his book if you have any mental health conditions.
Anhedonia may also be trauma-induced, and has been experienced by people with Post Traumatic Stress disorder. It can also be caused by severe or extended anxiety.
The part of the brain affected with this condition is complex, because it involves a variety of functions. In Neurobiological Mechanisms of Anhedonia, Philip Gorwood, MD, PhD, suggests that “The severity of anhedonia is associated with a deficit of activity of the ventral striatum (including the nucleus accumbens) and an excess of activity of the ventral region of the prefrontal cortex (including the ventromedial prefrontal cortex and the orbitofrontal cortex), with a pivotal, but not exclusive, role of dopamine.” He goes on to say that, “The role of dopamine and the ventral striatum in anhedonia, as a symptom of depression, is never-the-less a largely replicated finding; this does not mean that they explain the trait, but more likely, that they are definitely involved…among others.” Source
While there is no clear agreed-upon cause at this time, researchers are narrowing in on the parts of the brain affected and the metabolic disorder theory is promising for treatment.
Causes of Emotional Flatlining
I’ve worked with a number of people to help them overcome anhedonia, and below is a list of self-reported causes. My operating hypothesis is that inflammation is the underlying culprit and each of these below can cause inflammation:*
- Certain medications including ADHD meds, antidepressants, and especially antipsychotics.
- Certain recreational drugs.
- Severe or prolonged anxiety or stress that may or may not include PTSD
- Inflammation or infection.
While not always the case, people often describe Emotional Flatlining as a “switch” that went off and suddently they could no longer feel.
How to Overcome Emotional Flatlining Naturally
When a person has a stroke and loses movement of a body part like an arm, they can get it back through physical therapy where they basically keep trying to move the arm until the brain rebuilds those arm movement pathways. This is essentially what needs to be done to fix emotional flatlining, as the feeling pathways in the brain need to be rebuilt.
I offer a free program for rebuilding those pathway this which you can get by signing up on this page at the top right or bottom. There is no medication and it’s all natural – just written exercises! I also include a checklist on flatlining versus anhedonia since the way you treat them is different. Please remember I’m not a doctor, this is not a diagnosis, and is for general information only.
How to Overcome Anhedonia Naturally
Anhedonia can be a very serious condition and you should work with a mental health professional. I discovered a natural way to overcome it without medication that you can consider alongside the help you get from your doctor.
When I first became emotionally flat I fell into depression alonside the flatlining. I was able to completely get rid of the depression through diet and lifestyle changes, but it did absolutely nothing for the emotional flatlining. I had struggled with depression most of my life and overcame it several times, so I realized at this point they were distinct conditions.
I highly recommend three books for dealing with anhedonia or depression. Note: These will not help with Emotional Flatlining other than the first book, which basically suggests our program.
1. Feeling Blah? Why Anhedonia has Left You Joyless and How to Recapture Life’s Highs by Tanith Carey. The name says it all.
2. The Upward Spiral: Using Neuroscience to Change the Course of Depression, one Small Change at a Time by Alex Korb. A great resource for overcoming both depression and anhedonia.
3. Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health… by Harvard Psychologist Christopher Palmer, where he explains how to overcome mental health conditions like anhedonia and depression through diet and lifestyle. While his book and recommendations work great for anhedonia, they unfortunately don’t help Emotional Flatlining. This requires a physical rebuilding of brain pathways as I explain next.
PSSD – Post SSRI ____ Dysfunction
PSSD is a topic that is gaining a lot of attention recently. I won’t spell out what it is to avoid being blocked by search engines, but those of you have it know what I’m talking about. People often ask if the Flatlining Program will fix this issue once you get your feeling back.
Everyone who has Emotional Flatlining will have a complete loss of interest, enjoyment and arousal which are the same symptoms of PSSD. The Emotional Flatlining program does allow them to regain all their function and enjoyent in this area, but that’s because it was caused by blocked pathways in the reward center that got cleared and rebuilt. It’s possible PSSD issues could be caused by something different in the brain, I honestly don’t know. And since some people’s flatlining was caused by SSRI’s, it would seem possible to work, but I can’t say for sure.
The “Pointlessness” of Emotional Flatlining
I initially had emotional flatlining and anhedonia/depression, but was able to get rid of the depression part while total anhedonia remained. I was able to clearly see the difference between the two, and hesitate to mention another troubling characteristic of emotional flatlining that may be different from depression.
I continuously had a disturbing underlying feeling there was no point to my life. It all seemed meaningless because I did not enjoy anything, care about anyone, or look forward to anything. I could not feel the slightest bit of love or connection so I had no desire to be with people or even my cat. I could not experience pleasure in any part of my life, so I had no interest in going on vacation, going out to eat, doing my hobbies, getting together with friends, or doing other normally pleasurable activities. There was nothing I wanted to experience, nowhere I wanted to go, nothing I wanted to learn, and no one I wanted to be with. There was no point to anything, so life seemed completely meaningless.
When I got over depression and was high-functioning with emotional flatlining, I was able to put myself on autopilot and just get things done. But that same sense of meaninglessness continued, and I would break down at times in complete despair that I could not go on like this.
More on The Difference Between Flatlining and Depression
The main characteristic that distinguishes emotional flatlining from depression is the complete absence of any positive emotion. With depression you may have occasional, tiny, fleeting moments where you feel some little stir of a good feeling for a brief moment. It might be as simple as seeing your cat and momentarily thinking he is cute. Or hearing a song you like and enjoying it for an instant. With complete anhedonia you feel no positive emotion at all, at any time, with no one, or no thing.
Another characteristic of emotional flatlining is a total loss of interest. You have no motivation or desire to do things you might typically enjoy such as watching certain television shows, playing video games, having dinner with friends, surfing the internet, or listening to music. While loss of interest is also common in depression, the difference with flatlining is the totality of the loss. It is a complete and total loss of interest and no corresponding pleasure at all.
Finally is the experience with grief. A depressed person may not care as much, or feel as deeply when someone close dies, but they will have some sense of sadness or loss. With emotional flatlining their is not only a complete inability to grieve, there is an underlying disturbing or upsetting feeling that you can’t grieve.
Given the differences, I believe the way to treat anhedonia or depression should be different from emotional flatlining. I am not a doctor, so this is simply my opinion. Treating anhedonia/depression is more about increasing neurotransmitter flow through diet and somatic therapy, while treating emotional flatlining is about rebuilding the neural pathways in the reward center.
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