I am experiencing difficulty experiencing pleasure. Little things that I used to like, such as, taking walks in the evening, looking at a nice view, eating dessert, are just much less intense. My sex drive is also greatly reduced. I want to know what to do about this.

My history: I was depressed for several years after my mother died, but seemed to make a full recovery. A few years later, though, when I entered graduate school, I felt myself becoming somewhat depressed again. I had several severe episodes of anxiety in which I became very worried that I had various rare and deadly medical conditions. I have always been a hypochondriac in this way. I started waking up early in the morning. Eventually, one of these anxiety episodes was so severe that I had to take a semester off of school. During this time I was diagnosed with OCD and generalized anxiety disorder, and used Lexapro for seven months.


Lexapro reduced my anxiety but was emotionally numbing, so I stopped it. Since then, I have felt a lot less anxiety but I do feel emotionally numb in a way I never felt before. I also have occasional dizziness and early waking. In addition, I feel that I became addicted to both masturbation and caffeine. I have stopped masturbating, but am still addicted to caffeine. What chance is there that I have permanently burned out my reward-pleasure pathways? And if the damage is temporary, how can I make the most speedy recovery possible? Thanks!

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There is nothing you describe in your e-mail 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.


In 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. Instead, what you needed then as now it 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 Lexpro 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.

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.

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You can ask your medical doctor of bad 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.

I want to add one more suggestion. Your e-mail 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.

To summarize, I urge you into psychotherapy, exercise, finding a meaningful relationship and a consultation with your medical doctor.

Best of luck

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