Hello and thanks for writing to us. My name is***** am sorry to hear you have been on this tough rough. I assume in the hospital you have been getting coaching on skills to help keep your anxiety at bay, is that correct? things like mindfulness, mediation, square breathing, progressive muscle relaxation, journaling, worry windows, etc? Now is a very important time to put the skills into practice that have been taught to you so they become a regular incorporation into your daily life. they don't completely resolve anxiety but they can greatly impact your control over you thoughts and feelings.
Unfortunately, it sounds like two of your primary coping mechanisms have been taken away from you - your Xanax and your alcohol. This can really cause a upset to your patterns for how you handled stress, anxiety and depression. the key is tor filling this void with a new and healthier coping mechanism. the activities I mentioned above can do this as can exercise. It can be hard to figure out the things that you may enjoy that may also be healthy and accessible, but this exploration is an important part of battling these things. You should seek to clarify your goals and values so that you can really come to understand what kind of person you really strive to be. Then find ways to get there.
As far as the Lamictil, this medication can take several weeks to kick in so you may be able to feel relief from this any day. If not, call your prescribing doctor and let them know that the current dose is ineffective. ideally, you can continue to titrate up slowly until you get to a point where you do feel some lessening of your symptoms. So don't give up on this med yet! Give it more time and get to a dose that actually works for you. And if the Effexor has been on board for 12 years and doesn't seem to be helping any longer (assuming it is still prescribed), consider talking to your doctor about switching to a drug that may have better/new found effectiveness as your body may no longer be feeling the gains from the Effexor after so long.
You mention your environment makes things worse so take big step back and use a careful eye to identify what it is about your environment that contributes to your feelings of anxiety and depression. take note of what you can and co't control and seek to change the things you can while coming to accept the things you cannot. Sounds simple, right? i understand completely that this is not. Nothing about tackling these illnesses is simple. But you have to keep fighting. you have to show anxiety that you can handle it and will push through and live life despite it trying to hold you back. you have to show depression that you have the grit to get out of bed, even just to take a stroll outside, to show it that you are stronger than it. Taking a proactive approach to your life and coaching yourself that you hold the power is huge in managing these illnesses. the meds, counselling, exercise, techniques, can all help b ut at the end of the day, grit and push is what will help you keep moving forward.
Lastly, there are a few advanced treatment for treatment-resistant depression that you can explore more about. tehy are not offered everywhere but as last resorts, they can each prove very effective. I do not have expertise in them but wanted to mention them so you could explore them further online...they are ketamine therapy, TMS and ECT. ECT has been around a very long time and the medical system which i work in still practices ECT for grave depression.
I hope this answer helps some today. Have hope and faith that you can continue to fight and that there will be better days ahead for you. And definitely ensure you are established with outpatient care. If you need help finding places to set this up (psychiatry and therapy), please let me know and I can help find some resources...