Hi, Thanks for the question I do believe in your symptoms or sufferings you are going through. Sleeplessness can occur in both depression and familial fatal insomnia. But, you have additional symptoms that do not match with that of familial fatal insomnia. Moreover, the course and progression of your symptoms also do not match clearly with familial fatal insomnia. Most importantly, hopelessness, worthlessness, nihilism up to delusional level can very well occur in psychotic depression in which patient do not believe in doctor rather than believing in his belief. Sometimes, in treatment resistant depression, one medication after need to be tried, thyroid function test can help, Taking tablet regularly in adequate dose and duration is the key for relief of depression. Genetic testing will help for diagnosing familial fatal insomnia. Below is the presentation about familial fatal insomnia. The age of onset is variable, ranging from 35 to 60, with an average of 50. However the disease tends to prominently occur in later years, primarily following childbirth. The disease can be detected prior to onset by genetic testing.[5] Death usually occurs between 7 and 36 months from onset. The presentation of the disease varies considerably from person to person, even among patients from within the same family. The disease has four stages, taking 7 to 18 months to run its course: The patient suffers increasing insomnia, resulting in panic attacks, paranoia, and phobias. This stage lasts for about four months. Hallucinations and panic attacks become noticeable, continuing for about five months. Complete inability to sleep is followed by rapid loss of weight. This lasts for about three months. Dementia, during which the patient becomes unresponsive or mute over the course of six months. This is the final progression of the disease, after which death follows. Other symptoms include profuse sweating, pinprick pupils, the sudden entrance into menopause for women and impotence for men, neck stiffness, and elevation of blood pressure and heart rate. Constipation is common as well. I wish and I am confident that if you persist with regular treatment with psychiatrist, it will definitely help. Thank you in anticipation.