Long term symptoms of depression

Patient

Q: Over the last 20 years, give or take, I have been diagnosed with everything from PMS to Bipolar Disorder. I have been on several types of anti-depressants and mood stabilizers, none seem to work very well. Since I can't seem to get answers from my doctors, I did some research of my own. I know that a little bit of knowledge is a dangerous thing, but I think I'm handling it ok. I seem to fit into several categories. Major Depressive Disorder fits, although I wouldn't classify my symptoms as 'mild'. Dysthymia also seems to fit, although I have more symptoms and again, not 'mild. Seasonal Affective Disorder, my symptoms seem to get worse starting in the fall and get mildly better in the spring. And Atypical Depression also has commonalities. My symptoms have gotten steadily worse over the last 20 years. And now, for about the last 5 years, I can't even hold down a job. So I guess I'm asking, What now? Where can I go, who can I contact, any advice you could give.

Symptoms:  Symptoms: loss of energy; loss of interest in most things; sad 90% of the time; I'm tired all the time, but I can't sleep, my thoughts go 100 mph and they focus on everything that could go wrong in my life; I feel worthless; I feel guilty for no reason; my future is hopeless; most of the time I'm just sad, blah, but once in a while, maybe once or twice a year, I completely blow, I scream and yell, throw things, I can and have gotten physical, I'm angry, uncontrollably angry, for little things; I have zero control over my temper; when I'm angry/frustrated I can't find words to express it which can lead to a blow up; I have a hard time making decisions; other people affect my mood, if they're sad or angry especially; I can't deal with criticism, rejection, failure in any form, makes my guts churn and at its worst, I can't get enough air, I throw up, my arms and legs feel odd; If I'm around a lot of people, like at the grocery store, I panic, I can't get out, they surround me, I sometimes hyperventilate, throw up; and finally, I have had suicidal thoughts, 'If I didn't have my children, I would...'
Doctor

A:   Hello
Thanks for using "Ask The Doctor" for posting your query.

The symptoms that you have mentioned suggest that you could be having a depression. Further considering the duration of this illness and the resistance to various therapies, it is probably a treatment resistant depression. The mood swings that you are describing are occurring due to an imbalance of neurotransmitters in the brain. The neurotransmitters like serotonin, norepinephrine, and dopamine. This condition can be corrected with the help of medicines such as fluoxetine, mirtazapine or venlafaxine. These medicines start showing improvement in 2-3 weeks and the illness requires a treatment of 6-8 months. During this period, try to do regular exercise and eat healthy food and try inculcating some hobby. As your illness is resistant, along with the above strategies, it would be wise to start you on lithium or lamotrigine etc. Further if nothing works then electroconvulsive therapy can be a good option.
You may meet your doctor and get these medicines prescribed, or you can request for a psychologist consult.
Do meet your Doctor.

Hope this helps,
Wish you a good health

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