Anhedonia as Marker and Predictor: Screening Strategies for Clinical Practice

Anhedonia, or the loss of interest or pleasure in activities a person used to enjoy, reflects what a patient has already been through and what may lie ahead, according to Anita Clayton, MD, the Wilfred W. Spradlin Professor in Psychiatry and Neurobehavioral Sciences and professor of clinical obstetrics and gynecology at the University of Virginia in Charlottesville.

In an interview at the 2026 Jersey City Psychiatry Conference, Clayton said anhedonia often has its roots in earlier adversity. She named childhood trauma as likely a major contributor to its onset.

Loss of interest is a core feature of depression. However, Clayton noted anhedonia can occur in patients who do not report depressed mood or sadness. Its significance also extends beyond the depressive episode, because anhedonia predicts suicide risk. A meta-analysis found anhedonia was associated with suicidal ideation independently of depression.¹

Residual Symptom

Clayton described anhedonia as a common residual symptom. Monoaminergic antidepressants do not treat it well, so it often persists after other symptoms improve. Patients who do not reach full remission face a higher risk of relapse.

"It becomes this sort of anchor dragging people down, and we have to cut the chain and get them out of it," said Clayton.

Screening in Practice

Clayton called it reasonable to use the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale in routine practice. Patients complete both questionnaires themselves, so clinicians only need to score them and follow up on the results.

There are also tools built specifically for anhedonia, and Clayton cited the Snaith-Hamilton Pleasure Scale (SHAPS) as an example. The SHAPS is a 14-item self-report measure of hedonic capacity across areas such as social interaction, food, and sensory experience.² In clinical practice, she said, a simple yes/no response for each item is quick and easy to use. In clinical trials, the scale is typically scored on a 4-point rating scale.

Assessing anhedonia directly, rather than relying only on global depression scores, may help clinicians find patients at risk of incomplete remission, relapse, and suicidality.

Dr Clayton is chair of psychiatry and neurobehavioral sciences and professor of clinical obstetrics and gynecology at the University of Virginia. She is also current president of the American Society for Clinical Psychopharmacology.

References

1. Ducasse D, Loas G, Dassa D, et al. Anhedonia is associated with suicidal ideation independently of depression: a meta-analysis. Depress Anxiety. 2018;35(5):382-392.

2. Snaith RP, Hamilton M, Morley S, et al. A scale for the assessment of hedonic tone: the Snaith-Hamilton Pleasure Scale. Br J Psychiatry. 1995;167(1):99-103.