“It becomes this sort of anchor dragging people down, and we have to cut the chain and get them out of it,” said Clayton.
Screening in Practice
Clayton called it reasonable to use the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale in routine practice. Patients complete both questionnaires themselves, so clinicians only need to score them and follow up on the results.
There are also tools built specifically for anhedonia, and Clayton cited the Snaith-Hamilton Pleasure Scale (SHAPS) as an example. The SHAPS is a 14-item self-report measure of hedonic capacity across areas such as social interaction, food, and sensory experience.2 In clinical practice, she said, a simple yes/no response for each item is quick and easy to use. In clinical trials, the scale is typically scored on a 4-point rating scale.
Assessing anhedonia directly, rather than relying only on global depression scores, may help clinicians find patients at risk of incomplete remission, relapse, and suicidality.
Dr Clayton is chair of psychiatry and neurobehavioral sciences and professor of clinical obstetrics and gynecology at the University of Virginia. She is also current president of the American Society for Clinical Psychopharmacology.
References
1. Ducasse D, Loas G, Dassa D, et al. Anhedonia is associated with suicidal ideation independently of depression: a meta-analysis. Depress Anxiety. 2018;35(5):382-392.
2. Snaith RP, Hamilton M, Morley S, et al. A scale for the assessment of hedonic tone: the Snaith-Hamilton Pleasure Scale. Br J Psychiatry. 1995;167(1):99-103.