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Case 30
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
Core symptomsLoss of interest/pleasure in activities previously enjoyed (anhedonia)Persistent low mood
Clinical presentation of depression in the elderly
Published in Simon Lovestone, Robert Howard, Depression in Elderly People, 2020
Simon Lovestone, Robert Howard
The elderly person with depression may complain of low mood but often presents with loss of energy, loss of enjoyment, sleeplessness or aches and pains. Assessing reduced energy requires a different approach in the elderly as a reduction in energy accompanying old age is almost invariable. A recent change or a constant feeling of exhaustion or inertia, even at rest, are useful pointers. Loss of enjoyment, or anhedonia, in the elderly is not normal, despite the prejudices of the young. In assessing anhedonia in the elderly it is helpful to identify first those aspects of life that normally give enjoyment to the patient. Ask about enjoyment of television or visits from the family, for instance. Enjoyment of the company of younger members of the family, grandchildren or great grandchildren, is very rarely lost in the elderly except in the context of depression.
Anxiety and depression in patients with chronic respiratory disease
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
The aetiology of the relationship between depression and COPD is incompletely understood. The risk factors to elicit depression are multifactorial including genetic susceptibility, social factors (e.g. poor socioeconomic status), behavioural factors (e.g. smoking and excessive drinking), biochemical dysfunction (e.g. imbalance in neurotransmitters), systemic inflammation (e.g. interleukin-6), stressful life events and loss of loved ones (e.g. family, friends) (2,3,5–8). Thus, a diagnosis of depression requires a thorough clinical assessment of the patient by the physician or other healthcare professional with mental health expertise. The clinical diagnosis of depression requires the presence of five or more of several specific symptoms in the previous 2 weeks. At least one of two core symptoms must be present: anhedonia (lack of interest in previously pleasurable activities) or depressed mood. The core symptom(s) must be accompanied by three or more of these additional symptoms: insomnia, excessive guilt, feelings of worthlessness, lack of energy, poor concentration or diminished ability to think, suicidal ideations or weight changes (gain or loss) (11).
Association of anhedonia and suicidal ideation in patients with treatment-refractory depression after intravenous ketamine infusions
Published in International Journal of Psychiatry in Clinical Practice, 2023
Wei Zheng, Li-Mei Gu, Xin-Hu Yang, Yan-Ling Zhou, Cheng-Yu Wang, Xiao-Feng Lan, Bin Zhang, Yu-Ping Ning
Anhedonia, one of the core symptoms of MDD and BD, has been defined as a lack of ability to experience pleasure or interest (Treadway & Zald, 2011). Interestingly, anhedonia occurs independently of other depressive symptoms, suggesting that it might be associated with specific brain regions (Lally et al., 2015; Watson et al., 1995). Accumulating evidence suggests that anhedonia appears to be a promising modifiable clinical factor and therapeutic target for individuals experiencing suicidal ideation (Ballard et al., 2017; Ducasse et al., 2018; Lally et al., 2014), as it has been considered a predictive factor of suicide death within 1 year among subjects suffering from MDD (Fawcett et al., 1990). For example, Winer et al. reported that anhedonia independently predicted suicidal ideation among adult psychiatric inpatients (Winer et al., 2014) and undergraduates (Winer et al., 2016) even after controlling for depression, which was supported by a recent meta-analysis (Ducasse et al., 2018).
Long-term safety and efficacy, including anhedonia, of vortioxetine for major depressive disorder: findings from two open-label studies
Published in Current Medical Research and Opinion, 2023
Gregory W. Mattingly, Oscar Necking, Simon Nitschky Schmidt, Elin Reines, Hongye Ren
Overall, the exploratory efficacy analyses from these two studies demonstrates that long-term treatment of MDD with vortioxetine can be beneficial for patients having been treated acutely with this drug. There is now general acceptance of the goal to treat depressed patients to wellness or functional remission34. In a recent pooled-analysis of six to eight week randomized control trials, McIntyre et al. showed significant dose-dependent effects anhedonia and functioning compared with placebo over the range of 5–20 mg/day, with higher doses (10, 15, and 20 mg) shown to be associated with greater clinical response28. Moreover, using path analysis, they showed that the beneficial effects of vortioxetine on functioning in the placebo-controlled studies were mostly driven by the improvement in MADRS anhedonia factors, suggesting a potential mediation effect for anhedonia on other outcomes. Our findings confirm and extend these observations by showing a continued effect of vortioxetine treatment on anhedonia over 52 weeks, with EQ5D results supporting improvement of overall quality of life and SDS results from the 15–20 mg study also showing functional improvement that correlates with improvement with anhedonia.
Treatment for cognitive and neuropsychiatric non-motor symptoms in Parkinson’s disease: current evidence and future perspectives
Published in Expert Review of Neurotherapeutics, 2023
Elisa Mantovani, Chiara Zucchella, Andreas A. Argyriou, Stefano Tamburin
Anhedonia consists of a reduced ability to experience pleasure from physical or social experiences [97]. Being a symptom rather than a syndrome and due to lack of a clear definition, anhedonia in PD has been less studied than other neuropsychiatric NMS. The estimated prevalence of anhedonia in PD ranges from 10% to 40% because of the different scales used, the variable PD stages, and the difficulty to separate anhedonia from depression and apathy [98]. The association between anhedonia and PD clinical features has not been established due to the limited number of related studies. The pathophysiology of anhedonia in PD is shared with depression and apathy and is related to frontal dysfunction, more advanced PD stages, and dopaminergic and serotoninergic damage (Table 1) [98,99].