Coping with Anhedonia
Question
I’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.
Some 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.
During that time, I was diagnosed with 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.
On 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?
Thanks for taking the time to read this.
- Dr. Schwartz responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
- Dr. Schwartz intends his responses to provide general educational information to the readership of this website; answers should not be understood to be specific advice intended for any particular individual(s).
- Questions submitted to this column are not guaranteed to receive responses.
- No correspondence takes place.
- No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Schwartz to people submitting questions.
- Dr. Schwartz, MentalHealth.com, LLC make no warranties, express or implied, about the information presented in this column. Dr. Schwartz and Mental Help Net disclaim any and all merchantability or warranty of fitness for a particular purpose or liability in connection with the use or misuse of this service.
- Always consult with your psychotherapist, physician, or psychiatrist first before changing any aspect of your treatment regimen. Do not stop your medication or change the dose of your medication without first consulting with your physician.
Answer
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.
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. 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.
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.
You 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.
I 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.
To summarize, I urge you into psychotherapy, exercise, finding a meaningful relationship and a consultation with your medical doctor.
Best of luck.