I wonder if a change in meds would help right now. You sound seriously depressed and/or burned out.
I am not a doc but I went thru a lot of meds - the ones that picked me up made a big difference when I needed them.
The problem with that for me was I am an addict and eventually I took more than prescribed, etc., but for a while it was helpful.
Provigil, Welbutrin and Concerta were the ones that gave me a lift when I needed it when I was super bad. These were given to me at different times. I couldn't sleep on Welbutrin at all but I could with the other.
I don't want to be pushing drugs but sometimes a person needs meds to function and if you are not the addict type, maybe you could ask for a med that would give you a little lift. They didn't make me high, but I could get up in the morning.