Anhedonia in children and adolescents

This chapter is intended to be a review of the multiple aspects of anhedona in children and adolescents. While anhedonia occurs not only in depression but also in schizophrenia and substance use disorders in this review we will focus on anhedonia in depressed youth. Anhedonia, a decreased ability to experience pleasure, is of major public health and clinical importance. It causes a sense of disengagement from the surrounding world and increases the risk of suicide. The prevalence of anhedonia is higher than the prevalence of depression and anhedonia is often underrecognized in youth. This review will address contributing factors in the development of anhedonia in children and adolescents. It will review the relationship between anhedonia and the severity and subtypes of depression in children and adolescents. The stability of anhedonia in relation to the severity of depressive episodes and outcomes of the episodes will be explored. As part of the chapter, the author will provide his own data from original research demonstrating that, at least in some depressed adolescents, anhedonia is a trait rather than a state. The literature on the neural substrate of anhedonia in children and adolescents at different developmental stages will be reviewed. The literature on anhedonia in treatment resistant depression will be explored separately. Finally, the author will review the literature on the somatic treatment approaches to treating anhedonia.