Emotional Flatlining: How to Deal with Anhedonia

Anhedonia or emotional flatlining is the inability to feel joy. Most of the time its a symptom of Major Depressive Disorder. But, it can also occur in the first 2-12 months of sobriety when recovering from drug and alcohol abuse. People suffering from anhedonia feel numb, hopeless, empty, or blank which leaves them vulnerable either to relapse or other self-harming actions as way to feel better. But once you understand what causes anhedonia, addressing the symptoms is a matter of modifying your daily activities in 6 possible ways.

Symptoms of Anhedonia:

Avoiding social situations with friends.
Avoiding romantic relationships or pulling away from current relationships.
Feeling or thinking more negative about yourself or other people. Including saying negative things to yourself.
Feeling fewer emotions like joy, sympathy, empathy, and having more blank/unemotional facial expressions.
Uncomfortable around other people. Including friends, coworkers, or acquaintances.
Putting on fake emotions. For example, pretending you’re happy around others.
Decreased or missing sex drive.
No interest in physical or emotional intimacy.
Reoccuring physical problems, such as being sick often, aches, pains, or headaches.

What Causes Emotional Flatlining?

Anhedonia happens because there’s a shortage of the pleasure transmitter dopamine in your brain. For those who are recovering from addiction, this occurs because drugs and alcohol create excessive amounts of dopamine. As a result, the brain (in an attempt to rebalance) stops making dopamine on its own. And since drugs and alcohol are capable of creating such massive amounts of dopamine, it creates a tolerance to dopamine. In fact, this is one reason why it eventually takes more drugs and alcohol to experience the same euphoria. When substances are withdrawn the brain is left with a high tolerance to dopamine, no supply of it, and a very limited ability to produce it. The result is anhedonia.

For those with major depressive disorder, anhedonia is caused by a lack of dopamine, but what precisely causes this shortage is not completely understood. Interestingly, brain scans and autopsies of people with depression show that some brain regions are smaller including:

Amygdala: The part of the brain which creates all our emotional responses, positive or negative.
Prefrontal Cortex: Allows us to cognitively regulate our moods, make long term goals, and delay gratification.
Hippocampus: Has many functions including being a highway for dopamine between the pleasure processing part of the brain, and the above two brain regions.

When brain regions shrink, they can no longer work as well or as much (like a muscle). So when these shrink, a person may be less able to consciously control their mood, less likely to feel emotions in response to their environment.

Want to Feel Better Now?

Whether or not you are recovering from addiction, if you are suffering from anhedonia there is a way to temporarily feel better right now. You just need to get your heart pumping fast and create some adrenaline. Anything that triggers your fight or flight response will work, including:

Going rock climbing
Watching a really scary movie
Giving a speech (if that scares you)
Speaking up in a crowd (if that scares you)
Facing the wrong way in an elevator.
Asking for a free meal at a restaurant
Going for a jog or run.

Why It Works: All these things activate your body’s stress response (AKA the sympathetic nervous system). And with enough stress, your body will begin making adrenaline. This is an unconscious survival mechanism that elevates your body to its most heightened physical state and thus makes short work of that anhedonic emptiness you’re feeling.

The Science: Adrenaline for fight-or-flight is not created in the brain (your adrenal glands are above your kidneys). And, unlike other emotions, is not processed by the hippocampus or prefrontal cortex. So, put simply, even if these regions have shrunk due to addiction or depression, adrenaline can still temporarily relieve your symptoms.

Six Holistic Ways to Treat Anhedonia

Whether or not anhedonia is caused by addiction, the secret to treating it is doing anything that helps create more dopamine or regrow your brain (a process called neurogenesis). There is no quick way to do this and these methods (like anti-depressants) can take 2 to 4 weeks to begin working. But, below are five ways to get started:

1: Aerobic Activity & Strength Training

Strength Training and aerobic activities (like running or jogging) create adrenaline which, in addition to temporary relief from anhedonia, can also be part of a long term treatment. Exercise elevates your heart rate and puts tension on your muscles. After about 30 minutes of tension or elevated heart rate, your brain begins to create a protein called BDNF (Brain Derived Neurotropic Factor) that works like brain fertilizer: [1] [2]

It turns on the growth of new brain cells in order to repair damage much like how other proteins repair damage to muscles after exercise (aka how muscles grow).
It grows more connections so that the brain can send and receive signals more effectively. Studies have shown this is most noticeable in the prefrontal cortex and hippocampus.
It creates more BDNF receptors so that more BDNF is created in the future.
It creates dopamine.

For people recovering from addiction, anhedonia is usually the result of PAWS (or post-acute withdrawal syndrome). PAWS occurs because the brain learned to depend on substances for dopamine instead of producing its own. So when substances are withdrawn, it leaves a large dopamine deficit. Working out helps repair this deficit and creates dopamine. At Tree House Recovery we have a custom exercise program called ESM Fitness Therapy to treat anhedonia.

Why It Works: Putting tension on your muscles or heart for long periods releases proteins to heal that damage. As a result, your those body parts become bigger and stronger. But exercise is also taxing on the brain. That’s why these same proteins also trigger the production of the brain fertilizing BDNF designed to heal your brain. And, for somebody suffering from anhedonia, BDNF will repair the damage responsible for your symptoms. By building new brain cells, new pleasure receptors, and new pathways you’ll become better able to feel and process pleasure. Most importantly, as BDNF is re-absorbed it turns on dopamine production.

3: Nutrition

There are certain nutrients that either increase your dopamine production or can be converted into dopamine as they’re digested. So changing your nutrition in strategic ways is an easy way tactic to decrease anhedonia symptoms.

You should eat protein-rich foods such as turkey, beef, dairy, soy, and legumes: They have an amino called Tyrosine that can be converted into dopamine, as well as an amino acid called phenylalanine which can be converted into Tyrosine [3].
Limit things high in saturated fat such as animal fat, butter, full-fat dairy, palm oil, and coconut oil. They contain Saturated Fats which lowers dopamine production [3].
Eat Velvet Beans. They contain L-dopa which raises dopamine production [3]. BUT in high amounts, these can be toxic. Follow the product guidelines on the packaging.
Take Vitamins like iron, niacin, folate, and vitamin B6. Your body needs these to create dopamine [3].

4: Meditation

Meditation is the act of focusing on breathing or immediate surroundings as a way to calm the mind and relieve stress. But it can be used help treat anhedonia.

Meditation decreases depression symptoms by lowering the amount of the stress hormone cortisol. In consistently high amounts, cortisol can shrink parts of the brain that use dopamine and serotonin (the chemical in most anti-depressants) to help regulate mood and emotion [4]. As a result, dopamine levels and these functions suffer. But studies have shown that meditation decreases cortisol levels, which can decrease anhedonia symptoms.

5. Meaningful Social Interactions with People.

It’s not enough to be around people, you have to feel close to them or connected. Often this means sharing trust and vulnerability with one another.

Deeply bonding with others creates dopamine According to Dr. Lisa Feldman Barrett, Professor of Psychology at Northeastern University “strong social relationships have the potential to improve your outcome … when dopamine is compromised.” And because someone with anhedonia has a large shortage of dopamine, socialization is one more way to find relief. This does not mean you need a best friend or mate, only that you need to talk to people and not feel alone. This may take some practice if you’ve become isolated.

Physical Touch can decrease anhedonia symptoms by creating oxytocin. Physical connection with other humans like hugs, holding, or even intercourse produces the “love hormone” (aka oxytocin) which lowers cortisol levels [8] [9] [10] [11]. And since high cortisol levels can produce anhedonia, lowering cortisol can be an effective treatment.

6. Talk-Therapy

No matter what you do whether it’s holistic or medicinal, recovering from anhedonia will take some time. In the meantime, it’s important to learn some coping mechanisms for further dealing with stress and processing any stress-causing trauma. This is especially important when recovering from addiction as both stress and anhedonia are frequent causes of relapse.

To deal with anhedonia, your counselor might have you try activation therapy. In activation therapy, each week you try one new thing as a short term commitment, just to try it. In the therapy session, you’ll do a “savoring” reflection where you recount the experience and maybe what you liked about the activity using only the five senses [12].

By recalling things that were pleasing to the senses, activation therapy is basically sending sparks to the brain’s reward center, which is the dopamine powerhouse. When activation therapy is successful it increases the amount and production of dopamine.

How Long Does Anhedonia Last in Sobriety?

For those not in recovery, after you begin treating anhedonia symptoms you can expect to feel noticeable relief after the first month. Because parts of your brain are regrowing the process takes time. But some people report that the symptoms come in waves, which provides relief.

For people recovering from addiction, milestones such as 3, 6, and 12 months of sobriety are when symptoms like anhedonia noticeably improve. Like most symptoms of PAWs, anhedonia comes in waves. For some people episodes of anhedonia fade after a few hours or days. For others, they can last weeks. But with time, anhedonia symptoms don’t last as long and don’t happen as often.

Take Your Life Back From Addiction.

Tree House Recovery is a drug and alcohol rehab facility based on the latest addiction science. Our program uses a unique form of talk therapy, exercise, and social bonding to combat PAWS symptoms like anhedonia and reverse the effects of addiction. For more info, see our reviews and success rates.