Severe Depression: A Patient's Journey and Treatment Options - Psychiatry

Inquiry about Depression Symptoms

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Hello Dr.
Lee! In 2012, I experienced my tenth episode of depression.
My first suicide attempt was at the age of 9, but it wasn't until my ninth episode in 2012 that I was formally followed up by the hospital.
In January 2014, I suffered a perforated appendix, which exacerbated my condition.
On August 27, 2014, I started taking 10 mg of Citalopram, but due to severe side effects, I switched to 25 mg of IXEL on September 29.
I increased the dosage to 50 mg on November 3, 75 mg on December 1, and finally to 100 mg on July 13, 2015.
Is my condition considered severe? In March 2012, I experienced genuine hallucinations while on the upper deck of a bus, where I saw myself falling from the rooftop.
This was followed by a series of suicidal thoughts, including jumping into the sea, jumping off buildings, self-harm, and overdosing.
There was also an instance of auditory hallucination where I heard my supervisor calling me, but when I turned around, she was busy with her work.
Since 2012, I have been dreaming every night, which leaves me feeling exhausted.
At least twenty nights a month, I have dreams, with 3 to 4 nights being nightmares, while the others are filled with anxiety and fatigue.
However, after starting medication, there has been no improvement.
Besides dreaming, I often wake up early, even though I am not working.
I wake up around 6 or 7 AM and can only fall back asleep after one or two hours, but not for long—just an additional 2 to 3 hours.
I feel tired every day, and interacting with others makes me feel drained and anxious.
Even if I go to bed at 2 AM, I still wake up early.
Sometimes, I experience insomnia due to exhaustion, which causes me great distress.
I also have experienced pseudohallucinations, where my mind is filled with suicidal imagery.
Before taking medication, these would last an entire month, but now they only occur for four days.
Is my condition considered severe or still unstable? Doctor, is there any medication that can help me sleep longer without making me aware that I am dreaming? Given my condition, am I suitable for employment? In 2014, I rushed to complete work for my company to ensure they received payments by the end of the year, which led to my appendix becoming severely inflamed and requiring surgery.
This painful experience has made me fearful of re-entering the workforce and has caused me to develop a fear of clerical work.
The surgical site still hurts, especially when standing for long periods, walking, or lifting heavy objects, which makes it difficult for me to find a job goal.
Additionally, my poor sleep quality, fatigue, foot pain, and medication side effects have diminished my motivation to seek employment.
Therefore, I am reluctant to look for work.
I appreciate your response.
Below is my medical history:
In third grade, from first to third grade, my classmates avoided me because they saw a dark mole on my left hand, which made me feel an overwhelming sense of loneliness, leading to a suicide attempt by hanging.
However, I was interrupted by a teacher who came to the restroom looking for me, which scared me into opening the door and not going through with it.

In fourth year of high school (1996), I was in the same class as two friends and a disabled classmate.
Initially, everything was fine, but later I noticed that my two friends only cared about talking to her, ignoring me.
I felt neglected.
Soon after, the vice principal who taught us English selected students for extra classes but did not choose me, only my two friends and the disabled girl.
I was very angry and kicked her in the leg before Chinese class.
Although she did not fall, our homeroom teacher saw it and scolded me.
Afterward, I locked myself in a restroom stall and cried.
A teacher who had previously taught me accounting came in and encouraged me to come out, but I ended up crying all the way home.

The next morning, I went to school and, as a prefect, I went into the girls' restroom and drank some cleaning fluid.
I was soon discovered by classmates and taken to the hospital.

After graduating from high school in 1998-1999, I struggled to find work and could only get part-time jobs that didn't last long.
I had no qualifications, and my mother would often scold me for not finding a job and for not doing well in my exams.
I often felt overwhelmed and resorted to self-harm and even attempted to take rat poison because I wanted to die.

In 2000-2001, while learning painting in the construction industry, I was scolded by a church member and developed feelings for a supervisor who did not love me.
I was bullied by classmates at school, which made me very unhappy.
I would often go to the back stairs to cry or harm myself in the classroom.
My mother did not support my studies, and I felt all the pressure was on me.

In 2002, I had been in the youth group at church for two years.
At that time, the youth pastor said I was not growing up and that if I had issues, I should go to the youth group leader instead of her.
This comment echoed in my mind, and the next day, I attempted suicide by taking a large number of painkillers.
I ended up vomiting and spitting up blood, which led my mother to take me to the hospital.
I told the doctor the truth and asked him to tell my mother that I had eaten something that caused my stomach issues.

In 2006, after my aunt passed away, I was treated poorly by people at work and was diagnosed with polycystic ovary syndrome.
My mother scolded me over the phone for not contributing to the household and for feeling alone after my aunt's death.
I sought comfort from a pastor and church sisters, but it did not help.
I attempted suicide again by taking a large number of painkillers, losing 20 lbs, and being in a state of confusion, constantly vomiting blood at home.
Eventually, I couldn't take it anymore and took a taxi to the emergency room, where I stayed for three days.
When I was discharged, I didn't want to leave and wished I could stay longer because I was so afraid of facing the outside world.
Shortly after being discharged, I attempted suicide again by taking a large number of antihistamines, but unfortunately, I did not die; instead, I ended up sleeping excessively.
At that time, I felt trapped in a cycle of problems.

In 2008, many things happened, including the loss of friends, leaving my group, leaving my beloved ministry, and my mother being injured in a car accident.
After leaving the group, I had to bear everything alone.
My suicide attempt was triggered by my cousin not believing me and trusting a disabled friend I had just introduced.
Both my cousin and the disabled friend wrote long blog posts about how bad they thought I was, which hurt me deeply.
I felt betrayed by my cousin, who I trusted the most, and she blamed everything on me while ignoring my feelings.
I felt extreme heartache and, in my distress, took four painkillers, which caused me to vomit blood and led me back to the emergency room, where I stayed for two days.

In 2010, joining a new group caused me to carry the pain from my previous group into the new one.
I became overly sensitive to the actions and words of the practice group leader, which made me want to harm myself.
However, after developing a fever on May 27, I became clear-headed and did not go through with it.

In 2012, I switched to a new watchman, but we had many issues, and the pressure he placed on me exceeded my capacity to cope.
Additionally, I was under significant stress from my third attempt at the LCCI intermediate exam and was affected by comments from a certain sister, which caused my stress to boil over.
For the first four months, I only slept four hours each night and had many dreams.
The first month, I had dreams every night, the second month, half the nights, and the third month, a third of the nights.
In the first couple of months, my mind uncontrollably produced images of suicide.
By the fourth month, I had daily suicidal thoughts for two consecutive months and did not dare to tell my friends for fear of being judged.
I couldn't cry and felt immense pain.
I had initially planned to take medication to commit suicide, but a sister's invitation to meet stopped me.
Although I did not go through with it, the thoughts of self-harm and suicide still lingered, and her words caused me great emotional pain, leading me to self-harm in hopes that the physical pain would overshadow the emotional pain.
However, it only worsened my condition.

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Yu Yan, 30~39 year old female. Ask Date: 2015/10/01