Third antidepressant not working — what to expect next from GP

I have long term anxiety and depression. I've had anhedonia my entire adult life (now in my 40s) and go through episodes of extreme hopelessness, worthlessness and hopelessness. I am currently in a bad episode and have been pressured to explore medication by my family even though I have tried it before and always found that a) it ahs no effect on anhedonia and b) the side effects and withdrawal are always extreme.

I have tried two SSRIs (Sertaline and Citalopram) — both made me worse — and have been on 15 mg Martazapine for four weeks. Mentally, I don't feel worse but I still feel pretty much the same. The sedative effects have worn off (which is good for me as I don't like feeling zonked first things). But, I now have an unhealthy appetite. Although my mental health is poor, I am in physically good shape (I do this as it offsets the symtpoms of the depressive episodes) and have been a perfect weight, mainly eating whole foods.

However, having never had a sweet tooth, Martazapine makes me crave junk food: sweets and refined carbs I wouldn't have touched before. An hour after eating, I feel as though I've run a half marathon on an empty stomach. I have put on over a stone since going on 15mg and have an underlying feeling of anger that wasn't there before.

When I was desperate I got a Livi appointment as I couldn't get in at my GP. That GP presribed Martazapine and said if that doesn't work I could try Nortriptyline. I have since seen my actual GP (who I am seeing next week) who gave me more Martazapine and is reviewing it next week and he seems off at the idea of Nortriptyline. I understand some doctors don't like tycyclics. I have also looked at Trazadone so not sure whether to mention that.

I had a terrible time coming off Sertraline and am worried an SNRI will be even worse to come off of.

Given my experience with reuptake inhibitors, my weight gain and lack of change with Mirtazapine 15mg and the fact tycyclics have fallen out of favour, is there a protocol that GP will follow? Will I just be sent away as having treatment resitant depression?

Just last week I read about katamine and it looks perfect for me but I eould imagine I am more likely to get struck my lightening that get that on the NHS. There is a private clinic in my city that I have emailed but not heard back yet. I am so deperate I might be tempted to get a bank loan to cover the costs if it's a possibility.

To give you an idea of how I am currently, I score 25 out of 27 on that depression test.

I have had success with mindfulness and exercise. I'm not against medication, I just want something that is tolerable and I can use on a fairly short term basis to break the loop and esablish non-pharmacological coping machanisms.

Thank you.