What is the cause of my hopelessness and severe insomnia?

Question

Hello doctor,

I have felt hopeless and empty for the past eight months. I have lost interest in everything I once enjoyed and struggle to get out of bed most mornings. I either sleep up to 14 hours a day or have severe insomnia, getting only three to four hours of sleep at night. I have lost 18 pounds without trying, feel constantly worthless and guilty, and have recurring thoughts about not wanting to live, which has terrified my family.

I find it difficult to concentrate or make decisions at work, and my relationships are suffering. My doctor ruled out possible medical causes; my lab results showed normal thyroid function (TSH 2.3 mIU/L), vitamin B12 (485 pg/mL), and complete blood count (CBC).

Could this be major depression?
What causes it?
What antidepressant medications are available, how long do they take to work, and what are their possible side effects?
What happens if the first medication does not help?
Is therapy necessary, and what are the roles of electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS)?
Will medication be needed for life, and can depression be completely cured?

Kindly advise

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

This appears to be a case of major depressive disorder, as common medical causes have already been ruled out.

Multiple factors contribute to the development of depression, such as family history (genetics), adverse childhood experiences, harsh parenting, physical or sexual abuse, academic or job stress, and substance abuse, among others.

Most patients show improvement with proper treatment. Both options, medication and psychotherapy, are available. The choice depends on the severity of symptoms. If the symptoms are mild to moderate, psychotherapy alone may be sufficient. However, in moderate to severe cases, a combination of medication and psychotherapy is recommended.

It is a common myth that antidepressant medicines must be taken for life. This is not true. These medicines are usually prescribed for about six to nine months after the symptoms improve. They are not addictive. The reason for continuing them during this period is to prevent a relapse of the illness.

Most side effects are short-term and tend to improve over time. The benefits of treatment outweigh the risks. Common side effects include gastrointestinal symptoms such as nausea, vomiting, diarrhea, sweating, or temporary worsening of anxiety, which usually resolve in a few days. Less common side effects include sexual dysfunction, hyponatremia (low sodium levels), bleeding tendencies, and bone-related issues. Doctors usually monitor these effects closely to minimize risks.

Antidepressants such as Fluoxetine, Sertraline, or Escitalopram are commonly prescribed. These medicines generally start showing effect within two to four weeks and reach their maximum benefit in about eight to 12 weeks.

If antidepressants do not work adequately, other options such as Ketamine, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS), or deep brain stimulation (DBS) may be considered. These are highly effective but are usually reserved for resistant cases due to their invasive nature or limited long-term data.

In some cases, Olanzapine or Lithium may be added to enhance the effectiveness of antidepressants.

Lifestyle modifications such as a 30-minute evening walk, maintaining proper sleep hygiene, and reducing caffeine, nicotine, or other substance use can also be beneficial and should be incorporated into your treatment plan.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.