Frequently Asked Questions

In this study, chronic anhedonia was associated with higher rates of both suicidal ideation and suicide attempt among patients with treatment-resistant depression. Among participants with treatment-resistant depression, those with chronic anhedonia were 2.4-fold more likely to report suicidal ideation and 3.9-fold more likely to report a suicide attempt in the month prior to assessment than those with past-only or acute-only anhedonia.

The associations were statistically significant for both suicidal ideation (c7b2[1, N=97]=3.86, P=.049, a6=.205) and suicide attempt (c7b2[1, N=97]=4.43, P=.035, a6=.220).

Suicidality was common in the treatment-resistant depression cohort. After correcting for missing suicide data, 60 of 92 participants (65%) reported suicidal ideation in the month prior to assessment, and 16 of 92 (17%) reported a suicide attempt in the same timeframe.

The mean score on the MINI Suicide Module in the treatment-resistant depression group was 4.32 (SD, 7.67).

The study defined chronic anhedonia as endorsement of both historical and current anhedonia on the MINI depression module, along with a history of at least 1 lifetime depressive episode. Specifically, participants had to answer yes to MINI item A2a, which asked whether they had ever been much less interested in most things or less able to enjoy things for 2 weeks, and yes to item A2b, which asked whether this had occurred in the past 2 weeks.

The authors noted that this classification reflects temporal persistence of anhedonic symptoms rather than confirmed unbroken continuity across all episodes.

• Past anhedonia meant the participant endorsed historical anhedonia on MINI item A2a but not current anhedonia on A2b, suggesting anhedonia occurred outside the 2 weeks before assessment.
• Acute anhedonia meant the participant endorsed anhedonia in the past 2 weeks on A2b and reported the current depressive episode as their only depressive episode.
• Chronic anhedonia meant the participant endorsed both A2a and A2b and reported at least 1 lifetime depressive episode, indicating anhedonic symptoms were present both historically and currently.

Chronic anhedonia was common in the treatment-resistant depression cohort. After correction for missing suicide data, 53 of 92 participants (58%) with treatment-resistant depression met the study definition of chronic anhedonia.

In the same cohort, 84 of 92 (91%) reported past anhedonia and 54 of 92 (59%) reported acute anhedonia, which is why the clinically relevant comparison in this study was chronic anhedonia versus past-only or acute-only anhedonia rather than any anhedonia versus none.

Yes. In the treatment-resistant depression group, 65% of participants with chronic anhedonia reported suicidal ideation, compared with 44% of those with past or acute anhedonia.

This difference was statistically significant (c7b2[1, N=97]=3.86, P=.049, a6=.205), and participants with chronic anhedonia were 2.4-fold more likely to report suicidal ideation.

According to the study, chronic anhedonia can be screened using 2 simple questions from the MINI depression module. The key distinction is whether the patient reports anhedonia both historically and in the past 2 weeks, rather than only at one time point.

The authors suggest that clinicians treating treatment-resistant depression should assess the persistence of anhedonic symptoms, not just their current presence, because patients reporting both historical and current anhedonia may be at elevated risk for suicidal ideation and suicide attempt.

No. The study was cross-sectional and relied on self-report measures for diagnostic assessment, so its findings are correlational rather than causal.

The authors state that the design limits conclusions about directionality and leaves open the possibility of third-variable confounding.

Treatment-resistant major depressive disorder was defined using criteria from McIntyre et al (2014) as nonresponse to 2 or more distinct antidepressants taken at adequate doses for a sufficient duration. Participants also had a history of at least 1 major depressive episode.

Of the 160 participants in the overall sample, 97 (61%) met criteria for treatment-resistant depression.

• The study was cross-sectional, so it cannot establish causality between chronic anhedonia and suicidality.
• Diagnostic assessment relied on self-report measures.
• The sample size limited analysis of more nuanced relationships and prevented adjustment for covariates such as age, sex, and comorbid diagnoses.
• The study did not use a validated stand-alone anhedonia scale or reward-based paradigm, so it could not distinguish anhedonia subtypes such as anticipatory versus consummatory anhedonia.
• The chronic anhedonia classification reflected symptom persistence across history and current assessment, but did not verify uninterrupted chronicity episode by episode.