I've been suffering with this on and off for 14 years ive been through loads of different meds. I'm currently on cymbalta, trazadone and provigil. The provigil was just added and i'm anxious aabout whether it will work for me. I really think that cymbalta may not be the best for me. I'm trying to give it a thorough try. I've had wonderful periods on prozac, wellbutrin, lexapro and lithium but they all seem to run their course. Anyone out there with similar situation? I feel like I can barely hold on although to some degree I feel better. When I begin the downward spiral I become overly concerned with the way I look. I think I look really bad. I am almost obsessive about this. I looked at a photo of me taken in october when I was doing great and I don't look that way now. For me it was physical evidence that i'm not imagining this. I wonder if this preoccupation is just a symptom of my depression. I don't feel good about any of my achievements. In fact I feel as though i've accomplished nothing. I am married with children and I work, though not during the summers. Is there anyone out there with similar situation who could provide some insight?