Mapping the relationship between anxiety, anhedonia, and depression

J Affect Disord. 2017 Oct 15:221:289-296. doi: 10.1016/j.jad.2017.06.006. Epub 2017 Jun 13.


Introduction: Anxiety and depression are often comorbid conditions, but there is uncertainty as to how this comorbidity develops. Thus, in three studies, we attempted to discern whether anhedonia may be a key linking factor between anxiety and depression.

Methods: Three studies asked participants about their symptoms of anxiety and depression: in Study 1, 109 participants completed measures of anxiety, depression, activity avoidance, and perceived enjoyability and importance of avoided activities; in Study 2, 747 participants completed measures of anhedonia, anxiety, depression, and defensiveness; in Study 3, 216 participants completed measures assessing the same constructs as in Study 2 at four time-points (ranging 11 months in span).

Results: In Study 1, symptoms of anxiety and depression were positively related only in individuals who relinquished potential enjoyment due to their anxiety-related avoidance; in Study 2, the indirect effect of anhedonia helped explained how anxiety symptoms imparted risk onto depressive symptoms; and in Study 3, anxiety led to anhedonia and then depression over time and anhedonia led to anxiety and then depression at both 5 and 11 months.

Limitations: The manuscript is limited by the use of a student sample in study 2, cross-sectional methods in studies 1 and 2, and reliance on self-ratings.

Conclusions: Anxiety may devolve into depression through anhedonia, such that anxious individuals begin to lose pleasure in anxiety-provoking activities, which results in the development of other depressive symptoms.

Keywords: Anxious; Comorbidity; Depressive; Longitudinal; Loss of interest; Loss of pleasure.

MeSH terms

  • Adult
  • Anhedonia / physiology*
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / physiopathology*
  • Comorbidity
  • Cross-Sectional Studies
  • Depressive Disorder / diagnosis
  • Depressive Disorder / physiopathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Students
  • Surveys and Questionnaires
  • Uncertainty
  • Young Adult