Here we are, with my ADHD brain having been inspired to dive into the depths of Research once again. I touched up on my last phase – because damn, I forgot what I wrote about in less than 3 months. Also… it’s really friggin long!
The inspiration? Learning about the Limbic System in the Recovery Program, specifically a nifty part called the Ventral Tegmental Area – a region (?!) I hadn’t previously heard or read about. And I’ll just say that my initial toe-dipping was focused on what role the VTA would play in Anhedonia – which somehow lead me to the following video:
I don’t actually recall how I got to that video, as I was in bed after having went through a really rough session of EMDR (this past Tuesday morning). I only remember laying there, watching this, and passing out for a nap after.
However, I will go ahead and provide search criteria and whatnot, and possibly follow up on key words… because RABBIT HOLES! Weeee!
Google Search: Ventral tegmental area and anhedonia
The Ventral Tegmental Area (VTA) is crucial for reward processing, and its dysfunction, particularly reduced dopamine signaling to areas like the Nucleus Accumbens, is a key neural basis for anhedonia (inability to feel pleasure). Reduced VTA activity or connectivity, often seen in depression, links to decreased motivation and pleasure from natural rewards, with emerging evidence showing how pain can directly suppress VTA dopamine neurons to induce anhedonia. Targeting the VTA offers potential for new treatments for anhedonia in mood and pain disorders.
How the VTA relates to anhedonia:
- Core of the Reward System: The VTA produces dopamine, which it sends to brain regions like the Nucleus Accumbens (NAc) and prefrontal cortex (PFC), forming the mesolimbic pathway essential for motivation, reward, and pleasure.
- Reduced Activity: In anhedonia, there’s often reduced dopamine release from the VTA, leading to less activation in the NAc and PFC, which translates to less experienced pleasure and motivation.
- Pain Connection: Chronic pain can directly decrease VTA dopamine neuron activity, making them less excitable and causing anhedonia-like behaviors, highlighting the VTA as a bridge between pain and mood.
- Connectivity Deficits: Trait anhedonia is linked to weaker functional connections between the VTA, NAc, and other emotional processing areas, indicating impaired communication within the reward network.
- Therapeutic Target: Because of its role, the VTA is being explored as a potential target for therapies, like brain stimulation, to alleviate anhedonia in depression and chronic pain.
Types of Anhedonia and VTA Involvement:
- Anticipatory Anhedonia: Difficulty desiring or anticipating rewards, linked to prefrontal cortex areas connected to the VTA.
- Consummatory Anhedonia: Reduced pleasure during an enjoyable activity, linked to dopamine‘s role in the ventral striatum (including the NAc).
Love me some Keanu GIFs!
But seriously… this is one of the most accurate results I’ve gotten in… well, forever?!
Taking a moment to review how Anhedonia presents itself specifically for me from those results:
- inability to feel pleasure
- depression
- decreased motivation and pleasure from natural rewards
- chronic pain
- Difficulty desiring or anticipating rewards (Anticipatory)
- Reduced pleasure during an enjoyable activity (Consummatory)
Then a list of the symptoms of Anhedonia:
Anhedonia symptoms include a persistent inability to feel pleasure, loss of interest in hobbies, social withdrawal, emotional numbness, low motivation, fatigue, and changes in sleep/appetite, feeling like life is dull, colorless, or empty, and experiencing less joy from activities like eating or intimacy. It’s a core symptom of depression but also linked to other conditions like PTSD or substance abuse, manifesting as a muted response to rewarding experiences.
Core Symptoms
- Loss of Pleasure: Inability to enjoy things you once loved, like favorite foods, music, sex, or hobbies, even when you try.
- Emotional Numbness: Feeling detached, empty, or like you’re “in black and white” instead of color.
- Social Withdrawal: Pulling away from friends, family, and social situations because they no longer feel rewarding.
- Low Motivation: Lack of energy or enthusiasm (apathy) to start or complete daily tasks, even self-care.
Other Common Signs
- Fatigue: Persistent tiredness that isn’t relieved by rest.
- Sleep Disturbances: Insomnia or oversleeping.
- Appetite Changes: Eating more or less than usual, leading to weight changes.
- Reduced Libido: Less interest in physical intimacy.
- Irritability: Increased negative emotions like guilt, shame, or irritability.
- Difficulty Concentrating: Trouble focusing on tasks.
Types of Anhedonia
- Social Anhedonia: Reduced interest or pleasure in social interactions.
- Physical Anhedonia: Reduced enjoyment of physical sensations (food, touch, music).
What It Feels Like
- A dull, flat, or muted experience of life.
- The effort to do things feels too high, even if you want to.
- A general sense of meaninglessness or emptiness.
Also, in my recent EMDR session, I was also able to come up with a really great analogy… something I wasn’t able to do in the past. It’s difficult to describe something like this and I totally understand why… I mean, shit, most people know what it feels like to be sad or grieve, but that’s not the same thing. I still feel those things (sometimes too intensely, ffs), but I do not feel the dopamine-induced happy joy joy feels. The warm fuzzies – if you will.
But I digress: Imagine you have a plumbing system inside you, where cold water represents negative feelings and hot water the positive. They both run between your brain (the mind) and “heart” (the emotions). When you receive input from literally any source that your brain perceives as positive, the hot water pipe runs more and you get those “warm fuzzies” (colors become more vivid, smells more inviting, etc – sensory input be on extra). The same for a sad incident, the cold water runs harder, things seem more dull. The thing is – in “normal” people – both of these water sources are always running, to varying degrees, no matter the circumstances.
Side Quest: People suffering from depression have their cold water turned up constantly!
Now for me – because I have a pivotal incident (i.e. trauma) – my hot water pipe exploded and all the hot water leaked out, taking the literal color of life with it. When I think about past memories, they are all gray-washed and dull. The hot water/positive connection between my brain (mind) and heart (emotions) was destroyed.
Mind you, if you met me, you wouldn’t be able to tell. I mean, duh, there’s no physical indications that anyone can see. The problem is that I’ve had an entire lifetime of programming and my brain didn’t get the memo (or blatantly ignored it). I can and do laugh and smile at things that I logically enjoy, but that severed connection means that I don’t feel the positive stuff that comes with it. I don’t emotionally enjoy them. I definitely remember what it felt like (which makes it worse sometimes) and miss it terribly. The sense of loss is akin to nothing I’ve ever felt before.
Soooo… what to do about it?!
Well, I’ve tried all sorts of medications and therapies over the last 3-4 years, to no avail. I’ve mentioned previously that – for some fucked reason – my periods would render medications useless. I’m barely a month beyond having had an IUD put in to regulate these hormones, too. I’ve started a new regiment with EMDR specifically focused around the incident that caused this brain breakage, in the hopes that somehow we can resolve it and maybe – just maybe – help alleviate or fix the Anhedonia. My fingers are crossed.
But here’s a really cool thing I encountered because of that wonderful video I provided earlier: Ketamine. I’m not new to what it is or that it works… my last surgery on my back (cyborg parts adjustment) – in Arkansas – Ketamine was used for anesthesia. I tripped balls (first and only time in my life). And my depression got better for an entire month before it started to wear off.
Now then! Remember the Ventral Tegmental Area? Ketamine specifically targets that:
Google: does ketamine target the ventral tegmental area?
Yes, ketamine significantly targets the Ventral Tegmental Area (VTA), increasing the activity of dopamine neurons there, which strengthens brain circuits involved in mood and reward and contributes to its rapid antidepressant effects by influencing dopamine release in areas like the frontal cortex, nucleus accumbens, and hippocampus. Ketamine’s primary action involves blocking NMDA receptors, but its effects on the VTA involve complex changes in AMPA receptors that lead to this increased dopamine neuron firing and circuit plasticity.
How Ketamine Affects the VTA:
- Increases Dopamine Neuron Activity: Ketamine boosts the firing rate and overall activity of dopamine-producing neurons in the VTA.
- Alters AMPA Receptors: It changes AMPA receptor function, promoting the insertion of calcium-impermeable AMPA receptors, which contributes to stronger neuronal connections (synaptic plasticity).
- Strengthens Circuits: By affecting VTA dopamine neurons, ketamine strengthens pathways to other brain regions, like the frontal cortex and hippocampus, which are crucial for mood regulation and resilience.
Why it Matters:
- Antidepressant Action: This enhanced VTA-mediated dopamine activity helps reverse symptoms of depression and stress-induced learned helplessness.
- Reward System: The VTA is central to the brain’s reward system, and ketamine’s influence here helps restore motivation and goal-directed behaviors.
And guess what?! Yes, Colorado Medicaid (Health First Colorado) does cover certain ketamine treatments, especially Spravato (esketamine) for treatment-resistant depression, and some providers offer full coverage for general ketamine therapy/infusions, though IV infusions are often considered off-label and can be private pay unless covered by a specific clinic’s policy. Coverage for traditional ketamine infusions (IV) varies, but many clinics in Colorado accept Medicaid and offer full coverage for holistic ketamine-assisted therapy, while Spravato is more consistently covered.
So yeah… looks like I might need to get myself into this and see how it goes. EMDR plus Ketamine therapy might just be my ticket to feeling the warm fuzzies again.
Who IS EnchiPants?! 