Hello,

Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     60 year old male
•     Known case of chronic depression
•     Exacerbation and poor response to treatment in last 5 year
•     Complaints of: headaches, nausea, chest palpitations, peeling hands, dizziness, extreme fatigue and easy bleeding
•     Exacerbation of symptoms in morning hours
•     Currently on treatment with Cembulta
•     Past history of treatment with Zoloft

First and most important thing in your case is presence of suicidal tendency. I would strongly advise you to discuss these feeling with your family members and psychiatrist. You need immediate medical attention.

All your symptoms like headaches, nausea, chest palpitations, peeling hands, dizziness and extreme fatigue are symptoms of severe depression. But presence of easy bleeding needs evaluation.

As you mentioned about treatment with Zoloft, but currently you are receiving Cembulta. Zoloft may be more suitable if you improved with this in past.

If one medicine fail then according to guideline following steps are taken: increasing the dose, change of anti depressants, addition of antidepressant, addition of mood stabilisers and electro convulsive therapy.

Final message to you: inform your psychiatrist about suicidal tendency and get admitted in hospital.

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,

---