Dysthymike

What are your thoughts on treating looooong term depression/anxiety (20+ years) where therapy and many different pills, exercise, good diet, normal sleep schedule, and moderate social interaction didn't help?

What do you say to someone who has lived with major depression and terrible anxiety among other things for 20+ years who has seen many doctors and has been on many medications and still has not gotten better to the point that they actually want to live their life, and instead are only going through the motions so as not to upset other people?