A new paper suggests that the brain chemical dopamine could play a role in anhedonia - a symptom of depression which involves people being unable to experience joy or pleasure.
Researchers led by a team at the University of Oxford reviewed and analysed existing evidence on the effectiveness of pro-dopaminergic interventions, such as some antidepressants, in reducing anhedonia in people with Major Depressive Disorder (MDD).
Published in the journal EBioMedicine, they found that dopamine was implicated in anhedonia, but the underlying cause and effect was complex and may involve other neurotransmitters as well. They said more research was needed.
The study, led by Dr Edoardo Ostinelli and Professor Andrea Cipriani, was part of the Global Alliance for Living Evidence on aNxiety, depressiOn and pSychosis (GALENOS), funded by Wellcome.
A member of the GALENOS lived experience board, Sandra Kimuge, is a psychotherapist and mental health advocate who has lived experience of MDD. She outlines more about her role and that of the wider board in this paper.
Tell us a bit about yourself and how you came to be involved with GALENOS and this review?
"I am Sandra, a Kenyan in Africa. I have lived experience of MDD with suicidal ideation, and was put on medication and psychotherapy.
I came across GALENOS on LinkedIn, that's where I saw the link to register for participation in the prioritisation process for the GALENOS research on pro-dopamine agents to reduce symptoms of anhedonia in individuals with depression. I then applied and was considered to participate."
What is anhedonia?
"Before the depression episode I used to enjoy watching movies, laughing, interacting with colleagues and playing volleyball, but when I got into depression sadness overtook me, I was unable to play volleyball, watch movies or laugh. Instead could spend time secluded and crying for no apparent reason. The prescription did not help much with going back to my previous health, and those around me noticed a lot of change in me though they did not understand what was happening. With psychotherapy and also better understanding of my condition I was able to enjoy the activities I had lost interest in. Although at times I go into depression I don't use medication currently and I am able to come out of the brief episodes which are not severe as the first episode."
Why did GALENOS decide to look into this and what role did the lived experience advisory board play in this?
Anhedonia is important because it has been neglected...
"Anhedonia is important because it has been neglected, I think it's the most important part to be dealt with. Getting to hear how anhedonia has affected individuals from lived experience is important because it brings in the real picture on what is missed during prescription. The advisory board ensured the collaboration between the researchers and those with lived experience."
What did you find?
"I found out that there is medication which can alleviate anhedonia although these drugs are not easily available here in Kenya, so alternative activities which increases production of dopamine should be encouraged. These alternative activities are usually overlooked because the majority of the population don't embrace psychotherapy. Organisations like GALENOS can use opportunities such as the psychiatric national conference to create awareness about the dopaminergic drugs."
What are the implications for research and what needs to be studied next?
"I think coming up with an assessment tool specific to anhedonia to be adopted across different communities, studying anhedonia in MDD with comorbid disorders and considering different communities, i.e patients in Africa, Asia and Europe."
What were your recommendations in this research and how did you come up with them?
"Some of my recommendations were about using layman's terms in the questionnaire is important, some terms were a bit technical. After going through the questionnaire I made the recommendation in the comment section. Also the study to be done in diverse continents, i.e. collaboration with African, Asian researchers. Lastly, a study which collaborates drugs and psychotherapy to be considered."
Why is a structure like GALENOS important when looking at evidence?
Understanding anhedonia is very complex and in order to understand it better collaboration has to be done...
"Understanding anhedonia is very complex and in order to understand it better collaboration has to be done. This entails those with lived experience working together with the mental health professionals. GALENOS works to ensure meaningful collaboration between researchers and individuals with lived experience expertise."
What role did lived experience play in this study - why is it important and what extra value do you think it adds in studies like these?
"Anhedonia being intrinsic can only best be explained by a person with lived experience who are the experts in the subject matter, rather than by an observer who can make a false interpretation. People with lived experience were involved in answering the questionnaire by scoring and writing recommendations."