It sounds like you may be conflicted about either asking for help, or having your doctors know that you want/need help.
Shame may be a significant factor in many. There are other possibilities as well. I see that you're on pristiq (desvenlafaxine). There are better outcomes in depression, when antidepressants are combined with psychotherapy also. Hoping you'll speak your heart to those wishing to assist you.
Would you like to video or text chat with me?