### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have been diagnosed with depression in 1999. I have noticed average improvement on 40 mg citalopram, but still felt moody in the evenings. I used to be depressed for 2-3 weeks continuously and used to feel better f0r 2-3 weeks. My doctor added lithium 450 mg. I did 0 not notice any improvement for 1 yr. Then he increased citalopram to 80 mg. My depression was cured completely in 2 months time. I never took citalopram 80 mg contnuously for more than 2 months. I used to decrease the dose to 40 mg once I felt i am doing good. Within 3 weeks after being on 40 mg, I used to get mild depression symptoms. Then I used to increase the dose to 80 mg. I used have mild depression symptoms for couple of hours a day for a week and other week totally fine and again experienced mild depression  a couple of hrs a day. This happens for a total of one month when i get back on 80 mg. And again i used to cut back the dose to 40 mg. From 2010 jan i took 80 mg citalopram continuously for 8 months. It suddenly stopped working. I tool effexor 300 mg (increasing from 37.5 mg). After 3 months, I felt a little bit improvement in depression, but terrible increase in anxiety and crazy thoughts like why people live, why people do what they do and fear of killing myself etc. I used to experience these anxiety thoughts every alternate week. I have stopped taking effexor. Started taking lexapro (40mg) since 1 month. I am again experiencing a similar thoughts ( thoughts experienced during on effexor) since 3 days . is this common to experience those for a while even after I stopped effexore.

### output:

Inconsistant compliance with treatment enhances the chances of non-response. Citalopram worked initially, but later it failed possibly for the same reason, and then you had problems with venlafaxine and Escitalopram. But, don't loose hope. There are so many treatment options. You have had depression since last many years with poor response with some medicine. You need a combined approach for your treatment including medicines, psychotherapy and lifestyle modification medicines- many newer options mirtazapine, milnacipram, sertraline, venlafaxine etc. can be used along with short term use of benzodiazepine for control of anxiety. Many depression medicine cause mild anxiety initial which subsides later on It's own also try relation techniques under professional supervision regards, Chat Doctor. 