I Used to Think Depression Was About Sadness

I have been thinking about this study for two days now. What stays with me is not the data — though the data is striking — but the implication. For most of my life, I assumed depression was a presence. A heaviness that arrived and needed to be lifted. Sadness that needed to be talked through, medicated, or simply waited out. The treatment goal, in my mental model, was always subtraction: remove the dark, and the light returns on its own.

A 2026 paper in JAMA Network Open suggests this model may have the order wrong. The researchers — Alicia Meuret and Thomas Ritz at Southern Methodist University, and Michelle Craske at UCLA — argue that for the majority of people with major depression, the disabling feature is not the sadness itself. It is the absence of joy. The technical name is anhedonia, and the research suggests it affects nearly 90 percent of people with major depressive disorder (Meuret et al., 2026).

Reading that statistic stopped me. Ninety percent.

What anhedonia actually does

Anhedonia is the reduced ability or inability to feel positive emotions. It is not the same as feeling sad. A person can be free of sadness and still be unable to take pleasure in food, music, conversation, or accomplishment. Some researchers describe it as a kind of emotional flatness — not painful, exactly, but emptied out.

The clinical evidence is sobering. Anhedonia predicts a longer and more severe course of illness (Serretti, 2023). It undermines recovery and is a substantial predictor of suicidal behavior (Ducasse et al., 2018; Gillissie et al., 2023). It appears not only in depression but in anxiety disorders, post-traumatic stress disorder, substance use disorders, and schizophrenia (Taylor et al., 2022; Vinograd et al., 2022; Garfield et al., 2014). Conventional treatments, the authors note, demonstrate limited efficacy in achieving remission of anhedonia, contributing to elevated risk of relapse (Cao et al., 2019; Alsayednasser et al., 2022).

What I find most striking is what patients themselves say. When asked what matters most in being cured from depression, they consistently rate restoring positive emotions higher than reducing negative ones (Demyttenaere et al., 2015). The thing they want back is the capacity to feel good. Yet that is not, traditionally, what treatment has been organized around.

The frame shift

I think this is what I keep returning to. If anhedonia is the more disabling feature, and if patients themselves prioritize the return of joy over the removal of sadness, then a treatment model that primarily targets negative affect may be working on the wrong side of the equation. Not the wrong problem entirely, but a secondary one.

The new study tests whether targeting positive affect directly produces better outcomes than the traditional approach. The next chapter walks through what they found.

References

Alsayednasser, B., et al. (2022). Behaviour Research and Therapy, 159, 104185.

Cao, B., et al. (2019). Progress in Neuro-Psychopharmacology and Biological Psychiatry, 92, 109-117.

Demyttenaere, K., et al. (2015). Journal of Affective Disorders, 174, 390-396.

Ducasse, D., et al. (2018). Depression and Anxiety, 35(5), 382-392.

Garfield, J. B., et al. (2014). Australian and New Zealand Journal of Psychiatry, 48(1), 36-51.

Gillissie, E. S., et al. (2023). Journal of Psychiatric Research, 158, 209-215.

Meuret, A. E., Ritz, T., Craske, M. G., et al. (2026). JAMA Network Open.

Serretti, A. (2023). Clinical Psychopharmacology and Neuroscience, 21(3), 401-409.

Taylor, C. T., et al. (2022). Current Topics in Behavioral Neurosciences, 58, 201-218.

Vinograd, M., et al. (2022). Current Topics in Behavioral Neurosciences, 58, 185-199.