Transdiagnostic Anhedonia: A Conversation With Roger S. McIntyre, MD, FRCPC

TALKING WITH TITANS

At the 2026 American Society of Clinical Psychopharmacology (ASCP) Annual Meeting, Psychiatric Times' Editor in Chief, John J. Miller, MD, sat down with leaders in the field to discuss the topics they find most important.

Miller asked Roger S. McIntyre, MD, FRCPC, about anhedonia across diagnostic boundaries.

Anhedonia was first described in 1896 by French psychologist Théodule-Armand Ribot,¹ and is now recognized as transdiagnostic,² affecting various mental and physical conditions, including obesity and type 2 diabetes.³ It is multidimensional, explained McIntyre, involving reward salience, response, and learning.

Individuals with depression may still experience consummatory pleasure (such as alcohol, drugs, food) but lose anticipatory pleasure.

Miller and McIntyre also noted the challenges of diagnosing and treating anhedonia in clinical practice. It is important to understand the different dimensions of anhedonia to tailor treatment. Additionally, social media and digital rewards can play an important role in altering hedonic tone.

McIntyre also noted the impact of loneliness on metabolism and inflammation, and its link to anhedonia: “Loneliness has such a profound effect on metabolism and inflammation. It is a very common problem, and loneliness triggers inflammation and metabolic disturbances,” he said. “So, in fact, social prescribing or behavioral activation, these types of nonpharmacologic approaches, could be very useful for people with psychiatric and/or medical problems.”

While anhedonia is commonly associated with major depressive disorder, other disorders, such as bipolar disorder and personality disorders, can see symptoms of anhedonia too: “There is no disorder that is immune from this, that also is a risk, or at least a correlate of comorbidity,” shared McIntyre.

Treating anhedonia can be a challenge, the pair discussed, as people with anhedonia often have a problem with reward learning. We tend to repeat behaviors that are positive and reinforcing, and we tend to extinguish behaviors that are punishing or that take away from us. In individuals with anhedonia, their ability to learn and make corrective changes in their life is lesioned at the neurologic level; they are not learning reinforcement, explained McIntyre: “I'm not stating that I think people are nonadherent for just 1 reason. One of many possibilities is that there is a reward learning problem in what is abundantly axiomatic and self-evident to all of us, is something that is completely not even available to them.”

Dr Miller is Medical Director, Brain Health, Exeter, New Hampshire; Editor in Chief, Psychiatric Times; Volunteer Consulting Psychiatrist, Seacoast Mental Health Center, Exeter; Consulting Psychiatrist, Insight Meditation Society, Barre, Massachusetts.

Dr McIntyre is a professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit at the University Health Network in Toronto, Canada. He is also the executive director of the Brain and Cognition Discovery Foundation and director and cochair of the scientific advisory board of the Depression and Bipolar Support Alliance. He is a professor and Nanshan Scholar at Guangzhou Medical University in China, an adjunct professor at Korea University College of Medicine in Seoul, a clinical professor at the State University of New York Upstate Medical University in Syracuse, and a clinical professor in the Department of Psychiatry and Neurosciences at the University of California Riverside School of Medicine. He is the founder of the Canadian Rapid Treatment Centre of Excellence and CEO of Braxia Scientific Corp.

References

1. Ribot T. La Psychologie des Sentiment [The Psychology of Feelings]. Felix Alcan; 1896.

2. Barkus E, Badcock JC. A transdiagnostic perspective on social anhedonia. Front Psychiatry. 2019;10:216.

3. Williame H, Wacquier B, Point C, et la. The association between type 2 diabetes and anhedonic subtype of major depression in hypertensive individuals. J Clin Hypertens (Greenwich). 2022;24(2):156-166.