Qualitative Study to Assess the Patient Perspective on Anhedonia Symptoms and Impacts in Major Depressive Disorder

This work was sponsored by Janssen Global Services, LLC Background: Anhedonia, loss of interest or enjoyment in pleasurable activities/experiences, is a core symptom of major depressive disorder (MDD) and a strong risk factor for more severe depression and poorer outcomes. Anhedonia has been conceptualized as a reward processing model with deficits in facets of interest/desire, anticipation, motivation, effort, consummatory pleasure, and feedback integration. Since anhedonia is a personal, subjective experience, it should be assessed using fit-for-purpose patient-reported outcome (PRO) measures. The aim of this study was to understand the patient experience of anhedonia to determine suitability for PRO measurement. Methods: Patients from the US with a clinician-confirmed diagnosis of MDD and anhedonia participated in qualitative semi-structured, telephone interviews. Patients’ experiences of depression and anhedonia, including anhedonia facets and impacts, were explored. Transcripts were analyzed using thematic techniques. Results: 15 interviewees (mean age 52.7 years, 67% female, 53% white) spontaneously reported experiences of anhedonia; the most commonly experienced anhedonia facet was lack of motivation. Patients reported deficits in all facets – interest, motivation, effort, consummatory pleasure, reward processing – to varying degrees. Social activities (n=13), daily activities (n=11), sensory experiences (n=10), hobbies (n=9), work (n=9), family (n=8), food/drink (n=3), and romantic relationships (n=3) were impacted by anhedonia. Conceptual saturation was achieved, suggesting key anhedonia facets and impacts were identified. Conclusion: The patient experience of anhedonia is complex and comprises deficits across all facets, with direct impacts on patients’ daily lives. Future MDD studies should comprehensively assess anhedonia with fit-for-purpose PRO measures whose content validity can be informed by this study.