Anhedonia refers to the reduced ability to experience pleasure, and has been studied in different neuropsychi- atric disorders. Anhedonia is nevertheless considered as a core feature of major depressive disorder, according to DSM-IV criteria for major depression and the definition of melancholic subtype, and regarding its capacity to predict antidepressant response. Behavioral, electrophysiological, hemodynamic, and interview-based measures and self- reports have been used to assess anhedonia, but the most interesting findings concern neuropharmacological and neuroanatomical studies. The analyses of anhedonic non- clinical subjects, nonanhedonic depressed patients, and depressed patients with various levels of anhedonia seem to favor the hypothesis that the severity of anhedonia is associated with a deficit of activity of the ventral striatum (including the nucleus accumbens) and an excess of activ- ity of ventral region of the prefrontal cortex (including the ventromedial prefrontal cortex and the orbitofrontal cor- tex), with a pivotal, but not exclusive, role of dopamine. © 2008, LLS SAS Dialogues Clin Neurosci. 2008;10:291-299.

via The Core of Depression-27.

I want my Dopamine-and I want it NOW!
If you can read and understand this:
“The nucleus accumbens receives projections from midbrain regions (such as the ventral tegmental area), from regions involved in emo- tion (such as the amygdala, orbitofrontal cortex, and medial prefrontal cortex), from motor regions (such as the dorsal caudate and globus pallidus), and from regions involved in memory (such as the hippocampus).” Just click the link and enjoy the rest of this lengthy, educational and facinatimng article. Diane

Help!! My Brain is Shrinking!

Difficulties Experiencing Simple Pleasures May Be Caused By Smaller Brains

An area of the brain is smaller in those with anhedonia, or an inability to enjoy simple pleasures as much as the average person.

Yet another biological link between mental illnesses like depression and schizophrenia and brain physiology has been discovered by scientists at the Douglas Mental Health University Institute in Montreal.

Anhedonia, or the inability to experience simple pleasures as strongly as the average person, is a symptom of illnesses such as depression. It also may be because of a smaller area of the brain in which pleasures are processed. Douglas researchers have discovered that patients who suffer from anhedonia also have smaller area of the brain called the anterior caudate. This area of the brain, located in the center regions, is responsible for pleasure and reward.

According to MRI scans of patients with varying degrees of anhedonia, those who suffered the most from this ailment processed pleasurable images, such as a beautiful waterfall, in the part of the brain responsible for cognition rather than in the anterior caudate. The twenty-nine patients chosen for the study had no previously diagnosed mental illness. Their degrees of anhedonia were measured by a questionnaire that contained questions such as “I genegenerally agree that making love is an intense pleasure” that were rated on a scale from “strongly disagree” to “strongly agree”, with those choosing “strongly disagree” on such questions to be considered highly anhedonic.

“The hypothesis is that because they don’t feel pleasure as high as other people, when they analyze positive information, they have to process it at a more cognitive level,” explained lead author Philippe-Olivier Harvey to the Montreal Gazette. “So there is a genuine lack of pleasure and they have to compensate for this by an overactivation of this (cognitive) region of the brain.”

In those who enjoyed pleasure normally, this cognitive area of the brain, located just behind the forehead, was not active.

These findings are significant for advocates of the biological connections of various mental illnesses. It also will make treatment of some forms of depression and schizophrenia easier as a simple MRI scan can tell physicians why the patient is having a difficult time feeling pleasure and adjust treatment accordingly.

“It has been well established that anhedonia is a key symptom of major depression and schizophrenia,” said Douglas researcher Martin Lepage. “We chose to study this core symptom in hopes of finding a vulnerability marker to better diagnose these mental illnesses.”

via Anhedonia – Difficulties Experiencing Simple Pleasures May Be Caused By Smaller Brains.;

What exactly do I do about my subjective distress, the extreme distress I have not been able to convey to the Dr.? I do exactly what I’ve always done, I do IT myself, and I do IT my way without regard for “the rules.” I got online to find out where I could buy medication I would like to try without a prescription. That would usually mean Canada or Mexico. I set my $59 to Mexico, I hope I get something in return, something other than a talcum powder capsule. Does that sound desperate? Then you’re beginning to get the idea. But it’s always complicated, always- always complicate. The medication I am currently taking needs to be washed out, that is discontinued for two weeks prior to starting the MAOI (monoamine oxidase inhibitor), to avoid possible serious hypertensive reactions. That would not be such a big deal except, right now, I feel okay and whenever I feel okay, the last thing I want to do is rock the boat. When and if that med arrives, I won’t dare take it until I start to dive again. It’s never been very long to that point in recent history, no matter what I’m taking. Of course, when I get to that point, two weeks with no medications and another two or three weeks climb to a therapeutic blood level will really be screwed-and what if it doesn’t work? Sometimes I feel like an angry victim of my biochemistry.
This is not the first time I’ve gone the do it myself route. Last time, by the time I ordered the medication the doctor had prescribed it. That was the Metformin. It is supposed to be protecting my brain. I’m really very fortunate to have the Dr. I have. He is not a psychiatrist, he is an internist, with many years of experience, who specializes in brain disorders – dementia, Alzheimer’s and who has written a book on bipolar disorder. When I’m depressed, I think I’m an especially big pain in the ass in my doctor’s mind, and he doesn’t like me. I think he’s going to tell me he will not work with me anymore, but of course he doesn’t. If in fact, if I’m hurting anyone, I’m hurting myself, not him. When I am not depressed, I know he likes me. He would probably consider me more interesting than anything else. Everything is colored like that when I’m depressed.
Today my anxiety is low. I look out at the plan for the day, and I’m just a little bit afraid I can’t do it. Other days I’m terrified and the more urgent it is that I get out the door, the more difficult it is.
I am better this week, much better. One of the barometers by which I gauge my mental state is the condition of my bedroom. It is the one area I will let entirely fall apart while I’m trying to juggle everything else. It is one place where I can just shut the door and it is like shutting the door on the condition of my mind. The bedroom has been a deteriorating mess for the past couple months, until the day before yesterday, when I spontaneously spent hours cleaning and arranging it. Now I can leave the door open, now it is okay to look inside my mind, like you are doing right now.

Anhedonia

John Martz | March 12th, 2007

Anhedonia is a blog full of cartoons by Bart Vliegen. This piece that invites the reader to construct a rock song out of its list of cliche words, and which looks like it comes straight of a Moleskine sketchbok, stood out as a personal favourite.

via Anhedonia « Drawn! The Illustration and Cartooning Blog.

I’m having such a bad time lately, such a very bad time lately. I’m cycling so fast I don’t know if I’m coming or going. This morning I was driving around trying to get various works and errands done. I was perseverating on my latest trip to the Dr. It always feels like I’m spinning my wheels, wasting my time but more importantly like I’m just sinking further and further in. Into some bad bad place I’m never going to be able to get out of. I drive and think and cry because I feel hopeless, then I think some more and I am angry and say things inside my head I never say out loud. In my imagination I rail at the Dr. who doesn’t seem to understand, my rare hypomania is very unlikely to kill me but my depression is entirely threatening. I think about the people who threaten to kill themselves all the time, how I thought they were so full of crap, such a cheap annoying way to seek attention. I wonder if they didn’t spend a lot of time feeling the way I feel now-just more willing to make themselves heard.
I see pleasant old people and imagine they have wonderful memories keeping them warm and families and ties for comfort and a faith that gives them something to look forward to. I have none of these things and usually I can’t even be comfortable right now. A few minutes later I’m saying to myself, what is wrong with you? A terribly redundant question. There is nothing wrong right now. And there is nothing wrong for another 10, 15, 20 minutes, until some other cycle starts.

I told the doctor again, I believe I have a dopamine problem. I need a medication that kicks some dopamine into operation. I was saying the same thing to another “primary care provider” two years ago. He doesn’t want to give me a med that will do that. He is afraid it will make me hypomanic. He is however happy to give me some more seroquel, on which I gained 35 lbs in two mos. I wonder how happy he thinks I could be at 300 lbs, with diabetes and no hope of ever having a satisfying social life? I’ve never been arrested because I was hypomanic. I don’t believe I’ve ever been seriously hurt, because I was hypomanic. I’ve never hurt anyone else because I was hypomanic. What the hell does he think he’s protecting me from? It seems like he’d rather see me miserable, with my whole life crashed than take a chance I become hypomanic – which I become occasionally anyway. I have made no progress in my 4+ years of treatment.
I can’t do anything about that. But I’m still going to do whatever I can to help myself have some comfort in the rest of my life. It’s time to start concentrating on ways to enhance my dopamine level that don’t require a prescription or…
Angry, angry still angry…

“THE HEDONISTIC IMPERATIVE

A B S T R A C T

This manifesto outlines a strategy to eradicate suffering in all sentient life. The abolitionist project is ambitious, implausible, but technically feasible. It is defended here on ethical utilitarian grounds. Genetic engineering and nanotechnology allow Homo sapiens to discard the legacy-wetware of our evolutionary past. Our post-human successors will rewrite the vertebrate genome, redesign the global ecosystem, and abolish suffering throughout the living world.

Why does suffering exist? The metabolic pathways of pain and malaise evolved only because they served the inclusive fitness of our genes in the ancestral environment. Their ugliness can be replaced by a new motivational system based entirely on gradients of well-being. Life-long happiness of an intensity now physiologically unimaginable can become the heritable norm of mental health. A sketch is offered of when, and why, this major evolutionary transition in the history of life is likely to occur. Possible objections, both practical and moral, are raised and then rebutted.

Contemporary images of opiate-addled junkies, and the lever-pressing frenzies of intra-cranially self-stimulating rats, are deceptive. Such stereotypes stigmatise, and falsely discredit, the only remedy for the world’s horrors and everyday discontents that is biologically realistic. For it is misleading to contrast social and intellectual development with perpetual happiness. There need be no such trade-off. Thus states of “dopamine-overdrive” can actually enhanceexploratory and goal-directed activity. Hyper-dopaminergic states can also increase the range and diversity of actions an organism finds rewarding. Our descendants may live in a civilisation of serenely well-motivated “high-achievers”, animated by gradients of bliss. Their productivity may far eclipse our own.

        Two hundred years ago, before the development of potent synthetic pain-killers or surgical anaesthetics, the notion that “physical” pain could be banished from most people’s lives would have seemed no less bizarre. Most of us in the developed world now take its daily absence for granted. The prospect that what we describe as “mental” pain, too, could one day be superseded is equally counter-intuitive. The technical option of its abolition turns its deliberate retention into an issue of political policy and ethical choice. ”

OKaaaaaay every one has an opinion…        I’m entertained, are you entertained?  There appeared to be more where this came from.   I will read it some day when I am in an alternate mood state.  I offer it now in the name of diversity, perhaps to illustrate the down side of diversity.   Diane

via   The Hedonistic Imperative – Abstract.;

An endogenous opiate mechanism seems to be involved in stress-induced anhedonia

by Zurita A, Murua S, Molina V

Departamento de Farmacologia, Universidad Nacional de Cordoba, Argentina.

Eur J Pharmacol 1996 Mar 28; 299(1-3):1-7

ABSTRACT

This study assessed the effect of an uncontrollable stressor on the preference for a palatable solution (sucrose 1%), and on the preference for a context associated with a single administration of D-amphetamine (3 mg/kg i.p.) by means of the conditioning place preference test. We also evaluated the effect of prior naloxone (2 mg/kg, i.p.) administration on the influence of this stressful stimulus in both tests. Animals previously submitted to a 120-min–but not 60-min–restraint period showed a selective reduction in the preference for sucrose intake as compared to unstressed animals. Similarly, an identical restraint exposure elicited a diminished preference for the place previously paired with amphetamine. Both stress-induced effects were blocked by prior naloxone administration. These data demonstrate that a highly aversive experience decreased the reinforcing efficacy of sucrose and amphetamine, suggesting that uncontrollable stress may lead to an impaired capacity to experience pleasure, which could resemble the anhedonia observed in clinical depression. Furthermore, an endogenous opiate mechanism activated by stress seems to be involved in stress-induced anhedonia since naloxone normalized the reduction of the rewarding induced by both reinforcers.  Depression, stress, and anhedonia : the opioid connection.

To read more go here:  http://opioids.com/depression/index.html

Don’t read more if you are already depressed.    Diane

Today is Dr. day. I have to wait three months to see my Dr. and now I will have a short period of time in which to try to explain how not being severely depressed is not enough. Clinicians seem to think if I can take a shower, comb my hair, get dressed, smear on a little makeup and show up on time I must be okay.  I am much better than I was in April, when I felt suicidal.  Part of my brain was thinking up painless non-intrusive ways to kill me and the other part was saying “Bad idea!  We need more meds.”  I am much better than I was a few weeks ago, when I was getting things done, but walking around in psychic pain all the time, but it is not enough.  There is a huge space between feeling suicidal, entirely cut off, entirely unnecessary and wanting, really wanting to live. I fully appreciate not being in pain but I am so very tired of that huge gray space where I exist but never really get to live.  I exist and provide service to others and I exist and provide service to others-because I do not know how to give up and I do not know how to stay down long enough to die.  The best I can do is find some way to create an adrenaline rush and I have pretty much run out of energy for that, unless I become hypomanic….

Perhaps I can tell the Dr. I am not dead, but I’m not alive.  I can get things done, but I can’t see what I’ve done and I never believe I’ve done enough.  I am a work machine, and I have always been a work machine.  Decades ago I wrote a poem called Imitation “She’s a perfect imitation of a real person, she does her job. Then she turns herself off and goes home alone.” The only difference is now I work at home much of the time.  I could go to a party next Saturday night; part of me wants to go the other part is starting to feel ambivalent and a little sick already, so I avoid thinking about it.  That’s good, that will assure that I am completely unprepared, that I have not made the necessary plans.
The wonderful little aluminum trailer I was going to fix up has been sitting in the yard for over a year now. It’s now a wonderful little aluminum storeroom. I don’t have enough life in me to get started on it. 

I think of Halloween and what a pain it is to put up decorations.  It might however be nice to get in a good disguise and behave really badly…. I think of Christmas and what a pain in the butt it is to put up decorations, go shopping where there are lots of people, go any place where there are lots of people and watch all the cheer and not have access to a bit of it. I do it for the kids, for the neighbors, for my clients, for friends but I can’t do it for myself.  I want to feel what other people feel, I want to stop watching myself all the time.
           I read and I study – to escape ANHEDONIA.  I felt alive and connected once, for a week or so, over 20 years ago.  That’s the only way I know it can happen.  That time the meds were just right and I don’t remember exactly what happened.  Ultimately because of severe hypertensive reactions I had to quit taking that class of medication. I don’t even care if I have hypertensive reactions anymore.  I will try anything or anything again.
I always go to the doctor with my ‘papers’, new meds, new studies, or mood charts.  I’m taking a little lithium to protect and rehabilitate my brain.  I’m taking a little Metformin to protect my brain (I have the study someplace).  The Wellbutrin keeps me moving and producing.  The Buspar keeps me from having so much anxiety I can’t focus or breathe. The levothyroxine should help it all work.  5000u Vitamin D, lots of fish oil, melatonin, therapy, you should’ve seen me before I had all this stuff!!  Can you imagine a severely depressed person who can’t stop moving around but can’t focus or concentrate, who is always afraid “something bad” is about to happen, who is on the edge of a panic attack and trying hard to breathe, who is also trying desperately to look like they are okay-for 40+ years?  That was me.  So of course it’s better, incredibly better – but not good.  From a song, “It’s all very nice, but not very good”.  Later. Diane

When I begin to feel depressed I also begin to feel desperate and scattered. The last few weeks, I’ve been getting that way so I went to see an EFH (emotional freedom and healing) practitioner, in fact the founder of EFH. That was last Wednesday. I started getting better right away, I bought a bunch of cashmere sweaters and Argyle socks on eBay this week. Spending is a sign I’m getting better-perhaps too much better, but I am getting a lot done. That is the nature of bipolar illness, I’m down, I’m up, I’m rolling, or I’m not. As long as I don’t wander into the kind of “up” that gets me into trouble all will be fine.
I haven’t seen the emotional freedom healer for about six years and I can’t explain why. Last time the results were dramatic. After three healing sessions, I had the only nine-month period-far longer than I have ever had, of feeling good, social and productive.
I had been desperately depressed. I was afraid to lie down because I was afraid I couldn’t get back up. I was terrified I couldn’t take care of my dogs and they would be taken away. I was leaving a parking lot thinking about all this when on the bumper of the car in front of me I saw www.emotionalfreedom.com. Immediately I said to myself and probably out loud “that’s what I need!” A soon as I got home I got on the computer, found the phone number, made the call.

Two weeks ago I got on the computer found the phone number again and made the call. It can take two or three months to get to see my doctor, only a week to see Richard Ross. I guess I’m just a lucky puppymother.

>

I made up stories, so I could feel safe. To my head, I said, “I am just like my father and he knows it. I am tough and mean and I could hurt someone. I am just like my father and he knows it. He knows if he hurts me I will do something just as bad to him. Therefore he respects me and is careful around me. My father likes me because I am just like him. I am safe. My father treats me better than the other people in the house because I am just like him. He is a little bit afraid of me and I like that.” Perhaps not in those exact words, but certainly in those exact thoughts, I tried to make myself feel safe. Of course that didn’t make everything all better. When I got a haircut he said I looked so bad, I couldn’t go any place with him anymore. That is one of the two or three most painful things anyone has ever said to me. I was nervous and I stuttered on a regular basis. Dad teased me about it on a regular basis.

Dad was in a tough spot, seven kids to take care of, money problems, time lost drinking, painful hangovers, and fights with mom over drinking, money, lost time and painful hangovers. No doubt, he also acquired some traumatic brain injury from the dramatic single vehicle ‘accidents ‘he had, totaling two pickup trucks. He had a big scar that went all the way up his forehead and into his hairline and another one from his lip down his chin.

When I was a kid I could see the black cloud over my father’s head. At the time I didn’t know that was depression, but I did know that was when he was most abusive. I understand dad felt bad, most of the time. He couldn’t get away from us, so he tried to make us get away from him. I think I was particularly sensitive. I decided early, by eight years old, I would not let what he said hurt me anymore. The best way to do that seemed to remain neutral to all commentary from him. If he said I looked bad it had no meaning . If he said I looked good it had no meaning. If he liked my report card it had no meaning. If didn’t like my report card it wouldn’t have had any meaning. And that is how I consciously started shutting down my emotions. I started being able to make everything into nothing. It is much easier to turn them off than it is to turn them back on.
Has anyone had a similar experience? How did you deal with it?