Table 2.

Key insights from the modified Delphi panel study on MDDwA.

		Insights
Clinical definitions and concepts	1	Anhedonia is multifaceted and thus, the current definition in the DSM-5 that focuses only on motivational and consummatory anhedonia, is insufficient.
	2	Anhedonia is insufficiently recognized.
	3	There is clinical value and importance in defining MDDwA as a distinct mood subtype if there are:  • Therapeutic options available that target anhedonia  • Different treatment implications compared to other  MDD subtypes  • Robust evidence that MDDwA has a distinct and  stable descriptive psychopathology
	4	MDDwA is not equivalent to MDDwM, but there may be some overlap between the two subtypes.
	5	Further research is needed to assess whether MDDwA has different psychopathology and treatment implications from other subtypes.
Prevalence and Risk factors	6	Factors contributing to variation in estimated prevalence across clinical populations include:  • Culture and linguistics  • Awareness of anhedonia  • Inconsistencies in the definition of anhedonia
	7	MDDwA can affect individuals from all backgrounds and age ranges.
	8	Further research is needed to identify specific risk factors and support their association with MDDwA.
Diagnosis	9	Anhedonia is important to diagnose but can be challenging to detect and/or may be overlooked.
	10	Challenges in diagnosis of anhedonia include:  • A lack of established diagnostic criteria & interview  frameworks that are specific to anhedonia.  • Assessment of anhedonia is subjective in nature.  • Poor physician awareness of assessment scales to  measure anhedonia.
	11	The severity of anhedonia is dependent on the clinician’s impressions & symptoms reported by patients.
	12	Assessment scales can be helpful for evaluating anhedonia but are mostly used in research.
	13	The SHAPS is potentially a suitable anhedonia assessment scale but its utilization among psychiatrists may vary.
	14	The DARS is an alternative to the SHAPS but less widely used.
	15	There is a need to develop simple and quick tools for the assessment of anhedonia.
Patient impact and clinical burden	16	Anhedonia in MDD patients is associated with poor overall clinical outcomes.
	17	The persistence of anhedonia is associated with poorer psychosocial functioning.
	18	The severity of anhedonia influences the disease course and extent of psychosocial impairment.
	19	Further research is required to understand clinical burden and patient impact of anhedonia, which negatively affects social relationships and leads to productivity losses.
Treatments	20	Treatment of anhedonia is important but limited by the availability of effective pharmacological agents and established guidelines.
	21	Differences in treatment choices across severities for MDDwA were observed across APAC countries/territories.
	22	It can be difficult to distinguish between emotional blunting and anhedonia
	23	Approaches to the management of emotional blunting vary across the medical community.
	24	Management of MDDwA can be optimized by enhancing patient engagement and perceived treatment value.
	25	Further research is required to assess the efficacy of various pharmacological treatments on anhedonia outcomes in MDD.
Physician perspectives of a novel therapy	26	An ideal therapeutic drug for MDDwA should be effective, safe and tolerable.
	27	Consensus surrounding potential comparators for a novel pharmacotherapy was not achieved.