Depression and anxiety are often comorbid, in up to 70% of cases, and the level of one or the other may fluctuate, leading now to a diagnosis of depression, now to a diagnosis of anxiety. For these reasons, and for the presence of many other common factors, it has been suggested that both are part of the same continuum of problems and that they have a common substrate. This paper proposes the possibility that anhedonia may be an important component of this possible common substrate, and it tries to identify the mechanism with which anhedonia could contribute to causing both depression and anxiety. It also proposes an explanation why an intense pleasure could improve both depression and anxiety.

In the prodromal phase of schizophrenia, severe alterations of the visual appearance of the environment have been found, accompanied by a state of intense anxiety. The present study considers the possibility that these alterations really exist in the appearance of objects, but that healthy people do not see them. The image of the world that we see is continuously deformed and fragmented by foreshortenings, partial overlapping, and so on and must be constantly reassembled and interpreted; otherwise, it could change so much that we would hardly recognize it. Since pleasure has been found to be involved in visual and cognitive information processing, the possibility is considered that anhedonia (the reduction of the ability to feel pleasure) might interfere with the correct reconstruction and interpretation of the image of the environment and alter its appearance. The possibility is also considered that these alterations might make the environment hostile, might at times evoke the sensation of being trapped by a predator, and might be the cause of the anxiety that accompanies them. According to some authors, they might also induce delusional ideas, in an attempt to restore meaning in a world that has become chaotic and frightening.

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Various pleasant sensations that give a particularly intense pleasure are able to improve anxiety. In the present study I consider the possibility that their anti-anxiety action depends on the strong pleasure they provide, and I propose a possible mechanism of this action. According to some studies, also appetitive aggression (an aggression that provokes a strong pleasure and that is performed only for the pleasure it provides) can improve anxiety, and in this article I consider the possibility that the pleasure of appetitive aggression is able to reduce anxiety by the same mechanism I have proposed for other intense pleasurable sensations. The aggression performed by a child against the mother or against a substitute for the mother in the first period of life (a period in which this aggression is not dangerous) is a recurring theme throughout the work of of Donald Winnicott. Winnicott stresses that this aggression is necessary for the normal development of the child, and that the child must be free to practise it. According to Winnicott, this aggression is highly pleasurable and is not a response to unpleasant or hostile external situations. For these characteristics it seems to correspond to appetitive aggression in the adult that has been found to be able to reduce anxiety. Consequently, aggression performed by the child in the first period of life may also relieve anxiety, in the same way that appetitive aggression helps against anxiety in the adult. In his writings, Winnicott returns several times to an unthinkable or archaic anxiety that children experience when they feel abandoned by their mother for a period that is too long for them, and all children, according to Winnicott, live on the brink of this anxiety. In this study I propose the hypothesis that aggression in the early period of life may be necessary for children because the intense pleasure it provides may help them against this continuously impending anxiety.

Introduction Anhedonia (a reduction of the abil ity to feel pleasure) is considered a key symptom in major depression and may influence some of its most imp ortant symptoms, such as apathy, difficulty in concentrating and main taining attention, and gloomy mood. Various pleasurable sensations seem to be useful both in anhe donia and in depression. These pleasures are more intense than the usual daily ones, and their greater intensity could mean they can still be felt by a certain number of anhedonic individuals. Hypothesis Feeling a pleasant stimulus enhances the user's sensitivity to subsequent rewards, so subsequent pleasures can be felt more strongly for a certain time. In this way, a pleasure strong enough to be still felt by some anhe donic individuals might reinforce their sensitivity to other rewards, enabling them to regain previously faded or lost pleasures, hence impro ving the anhedonia. Evaluation of Hypothesis Anhedonia is a key symptom of major depression and may influence some of its symptoms; hence an improve ment in anhedonia, produced by a pleasure strong enough to be felt, might positively influence the life of depressed people. Consequences of Hypothesis Since many symptoms of depression could be influenced by anhedonia, ameliorating anhedonia may alleviate also these symptoms of depression. Conclusion A pleasure, strong enough to be felt, might allow anhedonic and depressed persons to regain, for a certain time, previously lostnormal pleasures, thus enabling them to temporarily lead a more enjoyable life.