Thank you for choosing this website with your question concerning depression and anxiety.
I realize that 50 you have begun to understand the full affect of depression on a person. You also realize that you've been very anxious and that has been affecting you all your life
Yyour question is what is the most important thing to focus on
While depression normally includes a lack of energy and lethargy, agitated depression (also known as "mixed mania") causes a person to feel restless and irritable. Agitated depression is a relatively common type of depression, and frequently accompanies bipolar disorder. Major depression is characterized by a feeling of sadness that lasts for at least two weeks. The depression aspect of agitated depression is often accompanied by crying, suicidal thoughts, and a feeling of hopelessness. The agitation component of agitated depression is usually displayed in a general restless attitude of the person affected. Restlessness causes pacing, handwringing, and unconscious movement. Mental distress is displayed by the affected person complaining, yelling, or having fits and outbursts. Someone suffering from agitated depression will usually complain of an inability to concentrate and may describe feelings of agitation and racing thoughts. Talkativeness is closely related to the mental distress component of agitated depression. When the affected person experiences racing thoughts and mental distress, she often verbalizes her irritable and uncomfortable feelings. Some talk quickly, seeming to lose track of what they have said and may repeat themselves several times. Restlessness and agitation may cause the person to try to keep their hands busy to use up their excess energy.
Since you've already been in therapy, have tried antidepressants and have attempted such alternatives as meditation I will assume that none of these have helped you resolve your agitated depression. Studies have shown that a combination of exercise, healthy living, psychotherapy and brief interventions with antidepressants have been the most effective means of reducing one's depression and resolving anxiety to normal levels.
Dr. Beck wrote an excellent book called "Up From Depression" in which he describes the depressive cycle. He says that depressive thoughts lead to inactivity which further reinforces depressive thoughts. His book suggests a very thorough and clear plan to break that cycle. As a psychologist I have firmly believed that a combination of the treatment that I had suggested above is the most effective way of coming to terms with her depression and resolving much for your anxiety. I see that your currently off-line and I would be very interested in your response to my answer. If you have any further questions I would be glad to go into detail about each of these aspects of treatment. I will be available online almost every day.