Hello thanks for asking from HCM You have to take care of addicted husband, a child with Tourette syndrome. Both these things are significant stress and are precipitating the depression. The symptoms like feeling nothing good about yourself (worthlessness), nothing good about future (hopelessness), poor self esteem, change in weight, suicidal thoughts, sleepiness all the time etc are symptoms of severe depression. You are on Duloxetine, Bupropion and Clonazepam for anxiety. But the symptoms are severe and causing loss of work and social life and are persisting even with medicines. So there is need to consult your psychiatrist again. SSRIs like Paroxetine, Escitalopram etc are relatively more efficacious than duloxetine in such symptoms. Medicines like Mirtazepine etc are also used in moderate to severe depression. Consult your psychiatrist for prescription of these drugs. Apart from that try to engage yourself in constructive work. Cognitive behaviour therapy sessions will help to improve symptoms. Thanks, hope this helps you.