Anhedonia predicts poor psychosocial functioning: results from a large cohort of patients treated for major depressive disorder by general practitioners
Abstract
BACKGROUND: Anhedonia is a core symptom of major depression and a key prognostic factor that is often poorly explored in clinical trials of major depressive disorder (MDD). Beyond symptomatic remission, psychosocial functioning also reveals difficulty in achieving remission in patients with MDD. The main objective of this study was to explore the interrelationships between social functioning and anhedonia on a longitudinal basis. METHODS: In total, 1570 outpatients treated for MDD with agomelatine were included. Severity of depression and levels of anhedonia and of psychosocial functioning were assessed at inclusion and at 10-14 weeks, with specific standardized scales (MADRS, QFS, SHAPS, CGI). Multivariate regression and mediation analyses were performed. RESULTS: Using multivariate regression, we showed that improvement of anhedonia was the strongest predictor of improvement in psychosocial functioning (odds ratio=7.3 [4.3-12.1] P<0.0001). In addition, mediation tests confirmed that the association between improvement of depressive symptoms and improvement of social functioning was significantly underpinned by the improvement of anhedonia over time. Finally, we explored the determinants of the dissociation of the response, i.e., the persistence of psychosocial dysfunctioning despite a symptomatic response to antidepressant treatment, which remains a widespread situation in clinical practice. We showed that this dissociation was strongly predicted by persistence of anhedonia. CONCLUSION: Our results suggest that anhedonia is one of the strongest predictors of psychosocial functioning, along with symptomatic remission, and should be carefully assessed by health professionals, in order to optimize pharmacological as well as non-pharmacological management of depression.
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Improvement of anhedonia is a strong predictor for improvement in psychosocial functioning.
“and improvement of anhedonia is a strong predictor for improvement in psychosocial functioning (Vinckier et al., 2017).”
From Circuit Mechanisms of Reward, Anhedonia, and Depression (2019) · cites this paper as Vinckier et al., 2017
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PPARα Signaling: A Candidate Target in Psychiatric Disorder Management
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Pharmacological Treatments for Anhedonia
Klein, M. E., Grice, A. B., Sheth, S., Go, M., & Murrough, J. W. (2022) · Current topics in behavioral neurosciences · doi:10.1007/7854_2022_357 · Cited by 24 · see citing works
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“Anhedonia is a persistent feature in mood disorders, shows a poor response to most available antidepressants, and is a main mediator of poor functional outcome.(24,74,75) In AUD subjects, higher levels of anhedonia are associated with greater alcohol use severity, and anhedonia is relevant during alcohol withdrawal an…”
BackgroundRepeated testing modulates chronic unpredictable mild stress effects in male rats
Bosch, K., Sbrini, G., Burattini, I., Nieuwenhuis, D., Calabrese, F., Schubert, D., Henckens, M. J. A. G., & Homberg, J. R. (2022) · Behavioural Brain Research · doi:10.1016/j.bbr.2022.113960 · Cited by 20 · see citing works
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“The remission of apathy and loss of interest or pleasure predicts improved social behavior (Vinckier et al. 2017).”
BackgroundVieta, E., Ahmed, N., Arango, C., Cleare, A. J., Demyttenaere, K., Dold, M., Ito, T., Kambarov, Y., Krüger, S., Llorca, P., et al. (2025) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2024.12.013 · Cited by 19 · see citing works
“(Vinckier et al., 2017; Wong et al., 2024) Thus, future work may investigate whether treatment with esketamine NS demonstrates a similar trend.”
Depression and approach-avoidance decisions to emotional displays: The role of anhedonia
Grèzes, J., Risch, N., Courtet, P., Olié, É., & Mennella, R. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104306 · Cited by 16 · see citing works
Anhedonia in bipolar depression treated with ketamine
Wilkowska, A., Wiglusz, M. S., Arciszewska, A., Gałuszko‐Węgielnik, M., & Cubała, W. J. (2024) · Bipolar Disorders · doi:10.1111/bdi.13409 · Cited by 19 · see citing works
“8 Data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial indicate that anhedonia is an acute (4 months before) risk factor for suicide attempts or completed suicide in outpatients with bipolar disorder.”
BackgroundOutcome in depression (I): why symptomatic remission is not good enough
Demyttenaere, K., Kiekens, G., Bruffaerts, R., Mortier, P., Gorwood, P., Martin, L., & Di Giannantonio, M. (2021) · CNS Spectrums · doi:10.1017/s1092852920001418 · Cited by 17 · see citing works
“It has been shown earlier that anhedonia is a strong predictor of psychosocial dysfunctioning in depressed patients and that persistence of psychosocial dysfunctioning despite symptomatic response (measured with the MADRS) is strongly predicted by persistence of anhedonia.(21) A recent study in depressed patients trea…”
BackgroundAnhedonia: Current and future treatments
Serretti, A. (2025) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.70088 · Cited by 17 · see citing works
“34 Using MADRS for depression severity, questionnaire for social functioning for psychosocial functioning, SHAPS for anhedonia, and CGI for global assessment, they reported that improvement in anhedonia was the strongest predictor of psychosocial improvement with an impressive odds ratio of 7.3.”
InfluentialCan Understanding Reward Help Illuminate Anhedonia?
Kaya, S., & McCabe, C. (2019) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-019-00186-1 · Cited by 16 · see citing works
Watanabe, K., Fujimoto, S., Marumoto, T., Kitagawa, T., Ishida, K., Nakajima, T., Moriguchi, Y., Fujikawa, K., & Inoue, T. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s340281 · Cited by 19 · see citing works
“Anhedonia can therefore persist in individuals with MDD who have experienced improvement in other symptoms and may continue to affect quality of life.(31,32) Multiple pharmacological treatment approaches for anhedonia have been investigated over the years; certain monoaminergic antidepressants, glutamatergic agents, p…”
BackgroundKong, S., Chen, Y., Huang, H., Yang, W., Lyu, D., Wang, F., Huang, Q., Zhang, M., Chen, S., Wei, Z., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.01.041 · Cited by 18 · see citing works
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Self-evaluation of negative symptoms in adolescent and young adult first psychiatric episodes.
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Social Interpretation Inflexibility and Functioning: Associations with Symptoms and Stress
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Effect of venlafaxine on anhedonia and amotivation in patients with major depressive disorder
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Effect of DLPFC rTMS on anhedonia and alpha asymmetry in depressed patients
Kazemi, R., Rostami, R., Hadipour, A., Zandbagleh, A., Khomami, S., Kiaee, N., Coetzee, J. P., Philips, A., & Adamson, M. M. (2025) · Scientific Reports · doi:10.1038/s41598-024-85057-w · Cited by 11 · see citing works
“not considered a symptom exclusive to MDD. Anhedonia has been found to be a predictor of poor psychosocial functioning 20 and treatment outcomes after pharmacotherapy 21,22 , psychotherapy 23 , and rTMS treatment 24 .”
Agomelatine Effectiveness, Tolerability, and Impact on Anhedonia in Major Depression
Giannantonio, M. D., Montemitro, C., Sepede, G., Brunetti, M., Baroni, G., Corbo, M., Anders, M., Tavčar, R., Martinotti, G., & Manzoli, L. (2019) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000001038 · Cited by 13 · see citing works
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Association between Neuroticism and Premenstrual Affective/Psychological Symptomatology
Hamidovic, A., Dang, N., Khalil, D., & Sun, J. (2022) · Psychiatry International · doi:10.3390/psychiatryint3010005 · Cited by 10 · see citing works
“It is a significant predictor of psychosocial functioning [52].”
BackgroundCheng, C. P. W., Herr, K. J., Jeon, H. J., Kato, T., Ng, C. H., Yang, Y. K., & Zhang, L. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1338063 · Cited by 12 · see citing works
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The Impact of Negative Symptoms and Neurocognition on Functioning in MDD and Schizophrenia
Quek, Y. F., Yang, Z., Dauwels, J., & Lee, J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.648108 · Cited by 12 · see citing works
“A past study (57) has found that anhedonia is a strong predictor of psychosocial functioning in depressed patients.”
BackgroundWang, Y., Yang, Q., Chen, C., Yao, Y., Yuan, X., & Zhang, K. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01913-w · Cited by 11 · see citing works
“MDD patients with anhedonia are also strongly associated with greater levels of social withdrawal and social impairment [4], and the appearance of anhedonia makes it more challenging for TRD patients to achieve functional recovery [5].”
Metabolic factors modulate effort-based decision-making in major depressive disorder
Gill, H., Badulescu, S., Vincenzo, J. D. D., Tabassum, A., Mckenzie, A., Shah, H., Amin, M., Llach, C.-D., Rosenblat, J. D., McIntyre, R. S., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.12.090 · Cited by 11 · see citing works
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“This pattern has been related to anhedonia, which is a strong mediator for functional remission of depression [5] and could be predictive of suicide attempt lethality among depressed individuals [6,7].”
Positive Affect Treatment for Depression and Anxiety
Craske, M. G., Dour, H. J., Treanor, M., & Meuret, A. E. (2022) · doi:10.1093/med-psych/9780197548523.001.0001 · Cited by 10 · see citing works
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Anhedonia in depression: neurobiological and genetic aspects
Kibitov, A. O., & Mazo, G. E. (2021) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro2021121031146 · Cited by 10 · see citing works
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Validation of the Chinese Dimensional Anhedonia Rating Scale in Depressed Patients in Hong Kong
Ching, E. W.-K., Chiang, T. P., Wong, J. O. Y., Siu, B. W. M., Cheng, K. M., Lui, S. S. Y., & Cheung, E. F. C. (2021) · Psychological Test Adaptation and Development · doi:10.1027/2698-1866/a000012 · Cited by 9 · see citing works
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Anhedonia and sensitivity to punishment in schizophrenia, depression and opiate use disorder
Ossola, P., Garrett, N., Biso, L., Bishara, A. J., & Marchesi, C. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.02.120 · Cited by 8 · see citing works
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“It is notable that anhedonia typically persists following the improvement of other symptoms, seriously affecting the recovery of social functioning [5 – 7].”
InfluentialMcIntyre, R. S., Maletic, V., Masand, P. S., Wilson, A. C., Yu, J., Adams, J. L., & Kerolous, M. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.05.026 · Cited by 9 · see citing works
Positive Affect Treatment for Depression, Anxiety, and Low Positive Affect
Meuret, A. E., Rosenfield, D., Wang, E., Hough, C. M., Ritz, T., & Craske, M. G. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.7403 · Cited by 9 · see citing works
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“…the criterial symptoms of depression and is associated with a host of negative correlates and outcomes, including impaired psychosocial functioning (Vinckier et al., 2017), reduced treatment response (Burkhouse et al., 2018; Khazanov et al., 2020; McMakin et al., 2012), more chronic and severe…”
Lindahl, J., Asp, M., Ståhl, D., Tjernberg, J., Eklund, M., Björkstrand, J., van Westen, D., Jensen, J., Månsson, K. N. T., Tornberg, Å. B., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-076900 · Cited by 8 · see citing works
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“…example, a lack of interest, enjoyment, or motivation for previously pleasur-able activities, is a core symptom of depression, and is associated with an additional risk of poorer outcomes and morbidity (Ducasse et al., 2018; Leroy, Loas, & Perez-Diaz, 2010; Vinckier, Gourion, & Mouchabac, 2017).”
Walsh, E. C., Prim, J., Gibson, K., Hynd, M., Phillips, R. D., Dichter, G. S., Nathan, M., Lundegard, L. C., Schiff, L. D., Bizzell, J., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.01.033 · Cited by 7 · see citing works
A Narrative Review on Toxidromes in the Psychiatric Population: Implications for Overdose Prevention
Dutta, S., Buciuc, A. G., Barry, P., & Padilla, V. L. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14176160 · Cited by 7 · see citing works
“Meta-analytic and cohort findings show anhedonia predicts worse psychosocial and functional outcomes, consistent with reduced engagement with protective factors [38,39].”
Exploring mechanisms of anhedonia in depression through neuroimaging and data-driven approaches
Wang, W., Zhou, E., Nie, Z., Deng, Z., Gong, Q., Ma, S., Kang, L., Yao, L., Cheng, J., & Liu, Z. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.07.133 · Cited by 7 · see citing works
Burrows, K., Figueroa‐Hall, L. K., Alarbi, A. M., Stewart, J. L., Kuplicki, R., Tan, C., Hannafon, B. N., Ramesh, R., Savitz, J. B., Khalsa, S. S., et al. (2022) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2022.100582 · Cited by 7 · see citing works
“…treatment outcomes in clinical populations, such that individuals with MDD display deficits in brain reward processing in the form of decreased activity of ventral striatum (VS) (Epstein et al., 2006; Husain and Roiser, 2018; Pizzagalli et al., 2009; Takamura et al., 2017; Vinckier et al., 2017).”
Herr, K. J., Berk, M., Huang, W.-L., Kato, T., Lee, J. G., Ng, C. G., Wang, Z., Webb, T., Kasahara‐Kiritani, M., & Vandervoort, L. (2024) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s487747 · Cited by 6 · see citing works
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Bogaert, L., Lau, H., Dunn, B., & Raes, F. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104861 · Cited by 6 · see citing works
Hewitt, J. M. A., Zareian, B., & LeMoult, J. (2023) · The Journal of Early Adolescence · doi:10.1177/02724316231207290 · Cited by 6 · see citing works
“For example, consummatory anhedonia predicts poor psychosocial functioning (Vinckier et al., 2017), whereas anticipatory an-hedonia has been associated with depressive symptoms (Ho et al., 2015).”
BackgroundLopes, I. S., Souza, A. G., Filho, A. J. M. C., Sampaio, T. L., da Silva, D. M. A., Valentim, J. T., Chaves, R. D. C., Soares, M. V. R., Júnior, D. C. C., Barbosa‐Filho, J. M., et al. (2024) · Behavioural Pharmacology · doi:10.1097/fbp.0000000000000788 · Cited by 6 · see citing works
“…potential, since the social deficit in depressive patients can persist even after remission of affective symptoms, impairing the individual’s quality of life and favoring the occurrence of new depressive conditions (Gilhotra and Dhingra, 2010; Llerena et al. , 2012; Vinckier et al. , 2017).”
Lin, S., Du, Y., Xia, Y., Xie, Y., Xiao, L., & Wang, G. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.950910 · Cited by 7 · see citing works
“Besides improvement of anhedonia significantly correlates with better overall functioning in depressed patients and is a strong prediction for psychiatrical functioning improvement (38, 39), which emphasizes its critical role in depression.”
Background
- Authors
- Vinckier, F., Gourion, D., & Mouchabac, S.
- Affiliations
- Sorbonne Paris Cité (FR)
- Sorbonne Université (FR)
- Corresponding author
- Vinckier, F.
- Venue
- European Psychiatry
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-07
- Volume
- 44
- Pages
- 1-8
- ISSN
- 0924-9338 (ISSN-L)
- 1778-3585
- OpenAlex
- W2592834759
- Cited by
- 201
- References
- 43
- Citations by year
- 2026: 22 · 2025: 44 · 2024: 29 · 2023: 22 · 2022: 35 · 2021: 16 · 2020: 13 · 2019: 14 · 2018: 4 · 2017: 2
- FWCI
- 6.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- anhedonia, major depressive disorder, psychosocial functioning, social functioning, agomelatine, antidepressant response, prognostic factors, general practitioners, mediation analysis
- MeSH terms
- Adaptation, Psychological, Adult, Antidepressive Agents, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Outpatients, Severity of Illness Index, Social Adjustment, Cohort Studies, Treatment Outcome, General Practitioners, Anhedonia
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