Anhedonia in patients with major depressive disorder (MDD): State-of-the-art consensus review

Anhedonia is a highly prevalent core pathognomonic symptom of a major depressive episode seen in major depressive disorder (MDD) and bipolar disorder. The symptom is associated with functional impairment, increased suicidality, psychiatric and somatic comorbidity, and poor therapeutic outcomes. It is an understudied and undertreated symptom, without clinically practical scales to measure its different aspects, and there are no therapies specifically designed to target anhedonia. This expert consensus aims to increase the awareness and understanding of anhedonia among healthcare professionals (HCPs) and provide consensus recommendations on the assessment, management, and treatment of anhedonia in patients with MDD. A group (N=6) of psychiatrists formed an expert consensus group that convened in a teleconference meeting in January 2024 to develop 14 consensus statements that provide an overview of the assessment, management, and treatment of anhedonia in patients with MDD. Anhedonia is a highly prevalent symptom of MDD, and it includes anticipatory, consummatory, and cognitive aspects. Several tools exist to assess the specific components of anhedonia, and the neural circuitry mediating anhedonia continues to be elucidated. The expert opinions provided by the authors aim to increase HCP awareness and understanding of anhedonia, and improve the evaluation, management, and treatment of anhedonia in patients with MDD. HCPs should routinely evaluate all aspects of anhedonia using clinical scales and welcome novel treatments that meaningfully target anhedonia. Future studies should assess the effectiveness of treatments for anhedonia and improve measurement-based initial assessment and monitoring of outcomes with comprehensive tools.