i am sorry to know that despite the best efforts you are not responding with current antidepressants and there are active symptoms. i suggest the following treatment given a diagnosis of diabetes with depression. tablet duloxetine (duzela m) 30 mg in the morning and 30 mg in the evening. the reason for recommending this medicine is because it is quite effective for pain symptoms associated with diabetic neuropathy along with depression. tablet aripiprazole (arpizol) 5 mg in the morning. although it comes from an antipsychotic group of medicines my purpose here is to augment the action of antidepressants while addressing anger associated with depression. tablet lonazep (clonazepam) can be continued as per the current level if there is adequate sleep. in case sleep has been an issue despite the medicines i will recommend upping the dose of lonazep to 0. 5 mg at bedtime. regarding vilazodone i think it should be removed as it is causing intolerable side effects. also this particular antidepressant has little role in pain associated with neuropathy and i think duloxetine will be a better option. there is need to stop tobacco. this is because many of the medicines mentioned above have poor efficacy when tobacco is consumed. you need to consult your diabetes doctor as poor control of diabetes could be a significant reason for the poor response. consult your specialist doctor discuss with him or her and start taking the medicines after their consent. in case you have more questions feel free to write back to me. for further queries consult an andrologist online --> <link>
can diabetes make my hands itchy and numb?