Patient perspectives on the challenges, obstacles, and opportunities in discussing and managing anhedonia in major depressive disorder (MDD): a focus group study

Major depressive disorder (MDD) is a common mental health disorder and a leading cause of disease burden. Anhedonia—defined for participants in this study as diminished interest, motivation, or ability to experience pleasure in daily activities—is a core symptom required for diagnosis of MDD and may persist despite treatment. Limited awareness and shared understanding of anhedonia between patients and healthcare professionals (HCPs) may complicate communication during clinical encounters, highlighting an ongoing need to better characterize how this symptom is recognized and discussed in clinical practice. This Johnson & Johnson (J&J) Patient Engagement Research Council (PERC) focus group study explored patient perspectives on conversations with HCPs about anhedonia and perceived barriers to these discussions. Four focus group sessions were conducted virtually in Nov-Dec 2023, with n = 12 adult patients with moderate-to-severe MDD in the US, using a semi-structured discussion guide to stimulate discussion and patient feedback. Across discussions, participants reported that conversations about anhedonia were more commonly initiated by patients (n = 8/12) than by HCPs (n = 7/12 reporting that HCPs rarely or never initiated such discussions). Participants also reported that treatment options specifically addressing anhedonia were infrequently discussed (n = 9/12). Perceived barriers to effective communication included time-constrained appointments, uncertainty or limited awareness of anhedonia, and discouragement related to prior ineffective treatment experiences. Participant-derived recommendations focused on the potential value of patient and HCP education, including educational materials for patients and HCPs, proactive screening protocols or structured prompts to facilitate discussion, and regular follow-up visits to revisit symptoms over time. These findings from a small, purposive sample suggest that challenges in discussing anhedonia during clinical visits may contribute to its limited consideration in ongoing care, underscoring the need for approaches that better support recognition and dialogue around this multifaceted symptom within routine clinical practice.