Anhedonia: Current and future treatments

Anhedonia, a reduced ability to experience pleasure, is a symptom that cuts across many mental disorders and is linked to poor treatment outcomes. This narrative review surveys interventions that target anhedonia, including medications such as vortioxetine, agomelatine, bupropion, ketamine, and brexpiprazole, which show promising anti-anhedonic effects, while traditional antidepressants like SNRIs and SSRIs are less effective. Neuromodulation techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and transcutaneous auricular vagus nerve stimulation, improve anhedonia when applied to targeted brain areas. Psychotherapeutic approaches such as behavioral activation, mindfulness, and savoring techniques help patients re-engage with pleasurable activities. Emerging treatments like aticaprant and psilocybin also show promise. Improving anhedonia is linked to better psychosocial functioning, quality of life, and sustained remission, supporting routine assessment and tailored intervention strategies.

Study at a glance

Abstract

Abstract Anhedonia is a transdiagnostic domain that leads to poor disorder outcome and low remission rates. This narrative review describes a broad range of interventions targeting anhedonia, including pharmacological, neuromodulatory, behavioral, and lifestyle‐based approaches. Drugs such as vortioxetine, agomelatine, bupropion, ketamine, and brexpiprazole show promising anti‐anhedonic effects, while traditional antidepressants, such as serotonin‐norepinephrine reuptake inhibitors (SNRIs) and, even more so, selective serotonin reuptake inhibitors (SSRIs), are less effective. Neuromodulation techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and transcutaneous auricular vagus nerve stimulation, proved effective at improving anhedonia, particularly when used in targeted areas. Psychotherapeutic interventions, including behavioral activation, mindfulness‐based strategies, and savoring techniques, also help re‐engage patients with pleasurable activities and enhance positive affect. Innovative treatments, such as aticaprant and psilocybin, showed promising results. Substantial evidence suggests that improving anhedonia leads to better psychosocial functioning, quality of life, and sustained remission. Although most data come from short‐term studies, several long‐term analyses suggest that maintaining hedonic improvements is feasible and beneficial. The reviewed evidence underscores the importance of routine assessment of anhedonia and the integration of symptom‐specific strategies. Tailoring interventions to address individual patterns of reward disruption may optimize outcomes for patients with anhedonia.