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Master Thesis

L’anhédonie dans la dépression unipolaire : de son évaluation à sa prise en charge

Abstract : Unipolar depression, frequent psychiatric disorder, is a major public health issue as it was predicted as the leading cause of disability in the 2030s by the World Health Organization (WHO). Its diagnosis, according to the WHO, requires the presence of one of the following two cardinal symptoms: sadness of mood and / or anhedonia. Anhedonia, classically defined as the inability to feel pleasure and interest, is common in depressive disorders. It is a factor of severity of depression, and a predictor of poor response to antidepressant treatments. This symptom is often presented with an univocal and preserved appearance since its original definition. This work underlines the historical, categorical but also conceptual approaches to anhedonia from its original definition to the present day. Thus, the importance of links with the reward processes builds a conception of anhedonia in sub-dimensions including consummatory, motivational and decisional anhedonia. Parallelism with this process and the pleasure cycle then makes it possible to define anhedonia as the total or partial inability to experiment, to pursue and / or learn pleasure, with deficits in experienced hedonic impacts (liking), incentive motivation (wanting), or representations and learning related to the reward (learning). A detailed characterization of the concept aims to provide a more precise diagnostic approach to the symptom. Literature lists empirical psychometric tools to evaluate experienced pleasure, including SHAPS. Recent tools evaluate the other components of the reward processes. In parallel, the use of more objective behavioral tasks is mainly focused on wanting and learning assessments. Finally, clinical management, whether pharmacologically or not, can benefit from a clarification of the role of anhedonia as a lever in unipolar depression. Literature suggests a limit of serotoninergic antidepressants efficacy. There is an interest in cognitive-behavioral therapies and brain stimulation in the specific treatment of this symptom.
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https://dumas.ccsd.cnrs.fr/dumas-01877515
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Submitted on : Wednesday, September 19, 2018 - 6:57:35 PM
Last modification on : Saturday, September 22, 2018 - 1:13:23 AM

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Frédéric Sirvin. L’anhédonie dans la dépression unipolaire : de son évaluation à sa prise en charge. Médecine humaine et pathologie. 2018. ⟨dumas-01877515⟩

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