I hope you will consider discussing ECT with your therapist/psychiatrist. It has its own stigma in this day and age of Big Pharma’s next anti-depressant with the odd names. ECT helped me greatly on several occasions. Its downside for a writer of your caliber is that it may so gravely impact your short-term memory prior to and for several months after the therapy program. You certainly are a fantastic writer and I cannot express enough admiration for your work as you struggle with not only depression but your multi-spectral physical pain and what I am sure you feel is pure, relentless agony.