How to overcome the symptoms of OCD, depression, and sexual dysfunction?

Question

Hello doctor,

I am struggling with obsessive thoughts, low mood, social withdrawal, and sexual difficulties, and these issues have been affecting my daily life for several years.

Regarding OCD, I have experienced different types of obsessions over the past four to five years. Earlier, I had excessive suspicions and repetitive sexual thoughts. More recently, I have been troubled by intrusive blasphemous thoughts, including unwanted thoughts about disrespecting religious figures or sacred objects. I also find myself engaging in negative self-talk and mentally criticizing myself. These intrusive thoughts make it difficult to focus on my studies and complete my work.

I have also been feeling depressed for some time. I spend a large amount of time online, often procrastinate, and struggle to keep up with my responsibilities. As a result, I frequently feel unmotivated and disappointed in myself.

In addition, I am concerned about sexual dysfunction. I have practiced prone masturbation for about 14 years, and the frequency has increased recently. I believe this may have caused mild injury or irritation to my penis. I now find it difficult to achieve an erection or ejaculate during regular hand masturbation, which has made me worried about my sexual health.

I have also noticed that I tend to isolate myself from others and avoid social interactions. I rarely share my problems with family or friends, even when I am struggling.

Previously, I consulted a psychiatrist who diagnosed me with OCD and prescribed Fluoxetine 20 mg. I took the medication for about one month but stopped it on my own because I felt that my memory was getting worse. Looking back, I realize I should have discussed these concerns with my doctor before discontinuing the medication.

I would like guidance on the following:

How can I better manage OCD, especially the intrusive thoughts?
Could my sexual difficulties be related to prone masturbation, OCD, anxiety, or something else?
How can I overcome my fear of socializing and improve my relationships with others?
Do I need medication again, and if so, what treatment options are available?
Can OCD medications affect memory, and should I be concerned about this?

I would appreciate your advice and guidance.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Thank you for sharing your concerns so openly. I understand how distressing it can be to deal with intrusive thoughts, low mood, social withdrawal, and worries about sexual function at the same time. The good news is that OCD and depression are treatable conditions, and with the right approach, most people experience significant improvement.

Based on the history you have provided, your symptoms are consistent with OCD along with features of depression. Intrusive thoughts, including blasphemous or unwanted sexual thoughts, are common manifestations of OCD. Although these thoughts can be upsetting, they do not reflect your true character, beliefs, or intentions.

In addition to medical treatment, several lifestyle and behavioral measures can help reduce symptoms and improve your overall well-being:

Avoid pornography, as it may reinforce compulsive behaviors and increase distress.
Try to gradually reduce and gain better control over masturbation habits, especially if they have become excessive or are causing concern.
Avoid isolating yourself. Staying connected with family and friends can provide emotional support and help reduce negative thinking.
Keep yourself engaged in meaningful daily activities rather than spending long periods alone or online.
Exercise regularly for at least 30 to 45 minutes a day. Even a brisk walk can improve mood, reduce anxiety, and support better sleep.
Practice meditation or mindfulness for about 20 minutes daily. Sit comfortably and focus on your breathing. If intrusive thoughts arise, do not fight them or try to suppress them. Simply acknowledge them and bring your attention back to your breath.
Maintain a healthy diet with nutritious home-cooked meals and limit junk food whenever possible.
Stay well hydrated.
Spend quality time with people you trust and enjoy being around.
Make time for hobbies and activities that give you a sense of accomplishment, such as reading, writing, drawing, learning a new skill, a language, or a musical instrument.
Aim for seven to eight hours of sleep every night and try to maintain a consistent sleep schedule.
Avoid tobacco, alcohol, and recreational substances, as they can worsen anxiety, mood symptoms, and sleep problems.

Remember that recovery is a gradual process. Try not to judge yourself harshly because of your thoughts or symptoms. Focus on taking small, consistent steps toward a healthier routine and a more balanced lifestyle.

Regarding medication, since you were previously diagnosed with OCD and responded by seeking professional help, it would be advisable to follow up with your psychiatrist rather than restarting or stopping medication on your own. Fluoxetine is commonly prescribed for OCD, but concerns about side effects, including memory-related symptoms, should be discussed with your treating doctor so that the treatment plan can be adjusted if needed.

I would also recommend the following investigations to rule out medical factors that can contribute to low mood, fatigue, or concentration difficulties:

Complete Blood Count (CBC).
Thyroid Profile.
Vitamin B12 Level.

I hope this helps. Please feel free to provide an update or ask any further questions.

Thank you.