Brief Answer:
Depression it is

Detailed Answer:
Hello,
Thanks for choosing health care magic for posting your query.
I have gone through your question in detail and I can understand what you are going through.
From what you have stated it is quite clear that you are having a depressive episode. Depression can occur with regular stress and it can also occur biologically without any stress as well. You need proper treatment for the same. There are various effective therapies for depression like fluoxetine, venlafaxine, bupropion, mirtazapine or escitalopram and they are all very effective and mostly safe. However it seems you have tried plenty of them with no relief. But you have not explored the combination of medical treatment with cognitive behavioural therapy. This therapy is taken by either a psychologist or a psychiatrist in which the therapist identifies impaired cognitions (Thoughts) and try to correct them. They are 15-20 min weekly session and there should be around 8-10 sessions to help you with your illness.
Fort sleep you need to have a good sleep hygiene:
1) Have some aerobic workouts during day preferably in the morning.
2) Have a light dinner.
3) Completely avoid coffee/tea/alcohol/energy drinks/coke/smoking.
4) Have a warm water bath before going to sleep.
5) Dont try very hard to go to sleep. If you are not sleepy then sit on a couch or sofa and do some reading and go to the bed only when you are sleepy.
6) Avoid watching tv or working on laptop/computer or bright screens at night.
7) Keep the lighting of your bedroom dim and make your bed every morning after you wake up so that you get a cozy bed to sleep at night.
8) Use your bedroom only for sleeping and resting and do not do any other work there.
9) Avoid afternoon nap for any reason.
Also it seems you have not tried the option of low dose quetiapine. You may take a low dose of quetiapine at 25mg or 50mg and this will give you a good sleep.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
bit.ly/dr-srikanth-reddy
                                                                                                                                                                                                                                                                                                                                               
Wish you good health,
Kind regards
Dr. Srikanth Reddy M.D.

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Brief Answer:
Clarifications

Detailed Answer:
Hello
Thanks for the follow-up.
As health care magic is an online forum, legally we are not supposed to prescribe medications without physically examining you. Such regulation are primarily meant for the safety of the patients as well as the Doctor. Sincere apologies for the same.
However for the patients I see in my clinic I prescribe with a start dosage of 25mg and then gradually increase it to 50mg to be taken with water every night after dinner. I tell them they can drive the car the next day morning.

For getting a bowel movement every morning, I would suggest you to take Isabghol every night . At least 2 spoons of powder with plenty of water.
In case if you have any doubts in future you may contact me on the link:
bit.ly/dr-srikanth-reddy
In case if you need to talk to me urgently, then you may contact the customer care of the health care magic to connect the call to me (Dr. Srikanth Reddy) and they would be more than happy to assist you in connecting the call.
kind regards,
Dr. Srikanth Reddy

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