Blunted anticipation, but not consummation, of food rewards in depression.

Anhedonia is a core symptom of major depressive disorder (MDD) and includes anticipatory and consummatory reward processes. Yet some measures still equate anhedonia with reduced consummatory pleasure and have rarely been validated against behavioral tasks. In a cross-sectional study, 52 patients with MDD and 51 healthy control participants (HCPs) completed metabolic assessments and repeated food reward ratings, measuring wanting and liking from anticipation to consumption. Patients with MDD showed blunted anticipatory wanting instead of consummatory liking. Once food rewards were available, wanting increased relative to HCPs. More severe anhedonia was linked to reduced anticipatory wanting and steeper increases with consummation, arguing against a consummatory pleasure deficit. Acyl ghrelin was associated with higher reward ratings, while poorer glycemic control related to more severe anhedonia. These findings suggest that anhedonia reflects impaired reward anticipation rather than diminished enjoyment of food rewards and highlight the gut-brain axis as a potential therapeutic target.