Years with depression and anxiety

My name is Mariano. I am 28 years old. I have been experiencing depressive episodes since I was 17 or 18. My first one happened during my final year of high school, and the most recent one was six months ago.

I have been through several different medications. The first one was sertraline. At 50 mg, I felt great. That was during my third depressive episode. Both my first episode, which was mild, and my second one, which was already quite severe, eventually went away on their own. During the second episode, I spent more than six months dealing with intense anxiety and depression. The third one was similar, and that was when I finally realized that what I was experiencing was depression and anxiety.

A little over a year after my third episode, I stopped taking the medication under medical supervision because I was doing better. Around that time, a three-month work contract had ended, and a few weeks later my symptoms returned. Since I already knew what was happening to me, I went back to a psychiatric emergency department that I had previously visited during my third episode. Once again, 50 mg of sertraline worked very well for me. However, after taking it for a little over a year, it stopped working.

From that point on, I spent about two years living with depression and anxiety, believing that this was simply how I was going to feel for the rest of my life. I had started working in 2023 at a very good job, where I still work today, but I was functioning in that state. During those two years, my sertraline dosage was increased, aripiprazole was added as an adjunct treatment, and later I tried fluoxetine and escitalopram. I also took a benzodiazepine for a while, but I stopped taking it because it made me feel mentally dull and did not relieve the emotional distress. I continued taking SSRIs, though.

Eventually, I found a psychiatrist who prescribed an antidepressant from a different class, desvenlafaxine. It worked extremely well for me at 100 mg. Everything was going very well until a little over a year later, when it stopped being effective. We increased the desvenlafaxine dosage and later added aripiprazole, but there was no positive response.

I have now gone back to sertraline because my psychiatrist told me it is one of the medications most commonly used for social anxiety. I am currently taking 150 mg. I only started this dosage one week ago, so there have not been any positive effects yet.

Almost every time I have gone through one of these episodes, another person has somehow triggered it. Suddenly, I begin idealizing another person or other people to such an extent that I start feeling extremely inferior, as though there is nothing valuable about me. I find it difficult to speak or have conversations, even though I have always been a very sociable and funny person.

It is unbearable because my mind is never at peace. I desperately want to go back to having a quiet mind, without constantly feeling that I have to prove to other people that I am interesting or intelligent.

For many years, I also repressed my sexual preferences, and I know that this was one of the causes of my distress. However, one or two years ago I was finally able to tell the people who raised me, more than ten years after I first became aware of those preferences myself. My friends had gradually found out about it from the time of my first depressive episode onward. Therapy also helped me enormously with this process.

My greatest fear, apart from the possibility that this condition may have become chronic, is that there may simply be no solution. I do not even necessarily need it to stop being chronic, although of course that would be ideal. What I really want is to be functional again.

I want to return to activities that I currently cannot bring myself to do. I do work five days a week. My job is very calm and not particularly demanding, but in my current state even that feels unbearable, although I still manage to go through it every day.

In general, I keep doing it because of my family. If I were to find some painless way to stop living, I would do it, because I do not feel like myself in the state I am currently in, and I want the suffering to end.

A few months ago, I took fifteen days of medical leave. Those two weeks went by incredibly quickly, and when they were over everything was still more or less the same.

What I want most is for some medication to at least restore a certain degree of calm so that I can gradually return to my hobbies, interests, and everyday activities.

What I experience is a constant sense of emotional pain and anguish that manifests as both depression and anxiety. It leaves me feeling incapacitated from the very beginning: I feel as though I cannot do or say anything, or can only do so with great difficulty, because I constantly feel extremely inferior to everyone else.

What options would you recommend for moving forward?

Going to the gym is difficult for me because I come home tired from work, and my social anxiety also makes it very hard to go. I would therefore like to know what other possibilities there might be.

Are there any other medications, types of therapy, homeopathic treatments, or supplements that might be helpful?