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Summary
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A reader reports diminished pleasure and emotional numbness after depression, anxiety, and a medication trial. Concerns about caffeine and sexual habits have led to fears of permanent physical damage.
The response finds no clear evidence of physical damage in the letter but recommends a medical consultation for health concerns.
It emphasizes psychotherapy, possible medication review with professionals, exercise where appropriate, and meaningful connection, presenting its interpretations of isolation and symptoms as the author’s views.
Question
Reader · Identity withheldI'm having trouble experiencing pleasure. The small things I used to enjoy, like evening walks, taking in a beautiful view, or eating dessert, just don’t feel the same anymore. My sex drive has also significantly decreased. I’d really like to understand what’s going on and what I can do to feel better.
\nSome background: I was deeply depressed for several years after my mother passed away, but eventually felt like I had fully recovered. However, a few years later, during graduate school, I noticed the depression creeping back in. I also experienced intense anxiety episodes, often centered around fears that I had rare or deadly medical conditions, something I've struggled with for much of my life. I started waking up very early in the morning, and eventually, the anxiety became so overwhelming that I had to take a semester off.
\nDuring that time, I was diagnosed with Obsessive-compulsive disorder (OCD) and generalized anxiety disorder. I took Lexapro for about seven months, which helped reduce the anxiety but also left me emotionally numb, so I decided to stop. Since coming off Lexapro, my anxiety has been much lower, but I still feel emotionally flat and numb in a way that’s unfamiliar to me. I also occasionally experience dizziness and early morning waking.
\nOn top of that, I believe I developed a dependency on both masturbation and caffeine. I’ve stopped masturbating, but I'm still heavily reliant on caffeine. Now I’m worried: is it possible I’ve permanently damaged my brain’s reward or pleasure pathways? If the effects are reversible, what can I do to recover as quickly and fully as possible?
\nThanks for taking the time to read this.
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Answer
Allan Schwartz, Ph.D.There is nothing you describe in your email that causes me to believe that you have done any physical damage to yourself. Of course, if you are really worried about that, you should see a medical doctor and have a complete examination. It appears that you experience a lot of anxiety in the form of worry and thoughts about your health, but also experience a good deal of depression. Anxiety and depression almost always go together.
\nIn the past you’ve tried Lexapro but with limited success. I find this to be a common problem for the simple reason that antidepressant medication is not the solution for anxiety and depression. What you needed then, and now, is psychotherapy. Psychotherapy can come in the form of cognitive behavioral therapy or psychodynamic therapy. If you and your therapist deem medication to be necessary then you can start that in conjunction with your therapy. If Lexapro did not work in the past you can try one of the other antidepressant medications. Please remember that the key ingredient is psychotherapy and not the medicine.
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The fact that you mention a lot of masturbation indicates that a source of your depression might be social isolation. In other words, you really need to find a meaningful and intimate relationship. The lack of such a relationship can lead to feelings of depression. As an adult, a deep relationship including sexuality is necessary for anyone to feel well.
\nYou can ask your medical doctor about your caffeine intake. If you are able to sleep at night despite your caffeine intake and as long as you do not suffer high blood pressure I don’t see why you cannot drink coffee and tea. Yet, I am not a medical doctor and that is why you should have a consultation about that issue.
\nI want to add one more suggestion. Your email implies that you are fairly young, perhaps in your 30s or 40s. If your medical doctor or tells you that you are in good health then you should add a regimen of exercise to your daily routine. We know that a aerobic exercise helps reduce depression and can even reduce anxiety.
\nTo summarize, I urge you into psychotherapy, exercise, finding a meaningful relationship and a consultation with your medical doctor.
\nBest of luck.
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