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Suffering from depression, lack of confidence, poor sexual performance and social dysfunctions. Any treatment?

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Psychiatrist
Practicing since : 2004
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Hi Dr. I've entered a wave of extreme depression and loss of self confidence which is self feeding itself. I believe it is being driven 100x by sexual health issues.

I had been mostly abstinent for most of my life and am 29 years old now because I went to an almost all guys college where I had to work every night and weekend to get my major only partied a little. And then had to work in a rural area (engineering) where everyone was twice my age because of my line of work. I had a couple of one night stands in my mid 20's while traveling but didn't have any relationship opportunities. Age 25-26, I suffered bad physical health problems from work and couldn't have sex if I wanted to, thanks to some great doctors and experimental therapy I was back on my feet. I quit the job that was making my life miserable and went back to school at 27, I finally had friends my age and started dating here and there - I was learning enough to boost confidence but most girls in my age group were already settling down and this is just something I cannot relate to and am not attracted to they all talked about how they were past their peak. That was one source of social pressure. I felt I needed to try and socialize with those in the undergraduate age range. I went overseas for 2 months to study in a foreign language program and easily made friends with both sexes and all the sudden found many, many younger and attractive women pursuing me - age 19 to 23 and single and from all over Europe and Asia. It felt right, it felt natural, my stress dropped, I was the happiest I had been since I can remember. I dated at least half a dozen girls there but was too slow to bring any to bed despite having the opportunities, it was only a 2 month program. Now with the opportunity gone I feel societal pressure judging me for dating in this range and I don't see myself moving to older women for a few more years despite my own age increasing... There is one 25 year old (still a little intimidating for me) modelesque girl I was dating last year and I failed to finnish things in bed (despite her willingness to sleep with me) with which made her turn me into only a friend. I failed to perform because the intimidation of her being far more experienced killed the self confidence. I want to turn that around but need to kick the depression and put my self confidence where it belongs. I have a great new job on the horizon with pay well into the 6 figures (I'm in final rounds for roles as high as the VP level), but I could care less because my mind is fixated on my personal problems the career wasn't worth the sacrifice. I feel I could miss out on an entire life stage. I know that I can only change the future not the past, but I am under pressure to make the future not only good but so great it makes up for the past... Not sure if that makes sense. I just can't skip those early dating years I need them.

I'm not here for relationship advice, I need reassurance and to get things sorted out but most importantly assistance treating the depression so I can have a good quality of life. I've been going to the gym almost everyday but my social life is again in deterioration. Between moving around geographically and my friends being pre-occupied with with their significant others, it's once again becoming difficult to keep my head on my shoulders.

Thank you
Posted Sat, 17 Nov 2012 in Mental Health
 
 
Answered by Dr. Ashish Mittal 2 hours later
Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     29 year old male
•     Complaints of: depression, lack of confidence, worry for past, poor sexual performance and social/occupational dysfunctions.


Depression is not always situational (because of stress or life circumstances). Many times it is biological due to biochemical changes in brain. Such Depression does not improve by exercise or guidance or lifestyle modifications only but all these measures help in recovery with treatment. Your depression appears to biological to me due to its severity.

In biological depression, depression occur without stress or not in proportion with the stress in life. Such depression occur most commonly due to lack of serotonin in brain, apart from other neurotransmitters. Around 4-5% of population suffer from biological depression.

Depression also lead poor sexual performance due to lack of confidence and it improve only after treatment. Depression also lead to cognitive distortion in form of, thinking negative about past, current and future.

For treatment:
1.In drug treatment two types of medicine used. For immediate relief of anxiety symptoms benzodiazepines group of medicines are used and for long term relief most commonly SSRI (selective serotonin reuptake inhibitors) are used. SSRI takes around 3-4 weeks to show its effect.

2.Non drug treatment like cognitive behaviour therapy (form of psychotherapy) also takes weeks to show its effect.

All these process is complex. I have just simplified it to make you understand it.

Apart from above advice following simple measures will help you:
-Healthy diet: Milk and fruits in diet.
-Daily morning walk, aerobic exercise and breathing exercise.
-In life, Frustration= Expectation-achievement. So frustration is life can bring down by lowering expectation from self/others (it is easier) and increase your achievement level. Depression also give rise to false sense of underachievement.
-Depression is very much treatable and persons life changes within few weeks of treatment.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,
Above answer was peer-reviewed by
 
Follow-up: Suffering from depression, lack of confidence, poor sexual performance and social dysfunctions. Any treatment? 8 hours later
Dr. Thank you so much, I had a few questions and concerns I want to note:

1. First of all you are correct in introducing the word anxiety there. That is exactly what I am experiencing and it is overloading me. It runs in my family.

2. In terms of benzodiazepines, I believe both my mother and brother take these or have in the past. My father is a physician so I can discuss getting an Rx through him. I am concerned about two side effects; namely it says it can cause sexual disfunction I thought we were trying to go the other way and difficulty thinking and remembering (this is already a problem because I am fixated on this issue in my life).

3. You mention my depression and or anxiety is biological not situational. I have family history of this so I believe it could be part biological. However when I am in extremely stimulating social situations, living in an urban area and am dating I am extremely happy. When my social life starts dropping off however or if I am living somewhere suburban or rural, these concerns about missing out on life get the best of me. Please clarify any notes on biological vs situational.

I'm able to fly to foreign countries by myself where I barely speak the language and live there for extended periods of time. Even normal people would develop a lot of anxiety doing this kind of thing but for me, the anxiety stays at a healthy level and I thrive in those situations. It's when my life gets boring or lonely that I get terrible terrible episodes of this.

A sentence or two on the biological vs situational aspects of my anxiety would be very helpful.

Thank you
 
 
Answered by Dr. Ashish Mittal 13 hours later
Hello again,
Thanks for follow up.

1. First of all you are correct in introducing the word anxiety there. That is exactly what I am experiencing and it is overloading me. It runs in my family.

2. In terms of benzodiazepines, I believe both my mother and brother take these or have in the past. My father is a physician so I can discuss getting an Rx through him. I am concerned about two side effects; namely it says it can cause sexual disfunction I thought we were trying to go the other way and difficulty thinking and remembering (this is already a problem because I am fixated on this issue in my life).

Answer: For immediate relief of anxiety symptoms benzodiazepines group of medicines are used. But these are not used for long term due to risk of dependance. Long term relief most commonly SSRI (selective serotonin reuptake inhibitors) are used. They do have sexual side effects in 20% of cases (not all), infact improve sexual functioning in rest of the cases (80%), if it is due to anxiety and depression. Difficulty thinking and remembering is also a symptom of anxiety, which occur due to poor concentration. Certain medicine like Bupropion do not have sexual side effects.


3. You mention my depression and or anxiety is biological not situational. I have family history of this so I believe it could be part biological. However when I am in extremely stimulating social situations, living in an urban area and am dating I am extremely happy. When my social life starts dropping off however or if I am living somewhere suburban or rural, these concerns about missing out on life get the best of me. Please clarify any notes on biological vs situational.
I'm able to fly to foreign countries by myself where I barely speak the language and live there for extended periods of time. Even normal people would develop a lot of anxiety doing this kind of thing but for me, the anxiety stays at a healthy level and I thrive in those situations. It's when my life gets boring or lonely that I get terrible terrible episodes of this.

Answer: People with anxiety are one of the successful population in society because they take precaution in advance. Family history points toward biological predisposition. Biological predisposition enhances chances of developing anxiety in minor situational change like in your case. People with anxiety are one of the successful population in society because they take precaution in advance.

Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.

Wish you good health.
Regards.
Above answer was peer-reviewed by
 
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