Thanks everyone for the good advice. Part of the problem is that when you're down, you just don't see the way out even when there's a ladder right the fuck in front of your nose
A couple of things -
1. Perspective helps, and I often lack that. Spent a few minutes in Grace Cathedral yesterday, and there's something about being in that space that makes me feel simultaneously really peaceful and connected to my "higher self", and really small and like my problems are not so big when you really think about it.
2. I will be monkeying with my meds under a doctor's supervision - upping the dosage on the Paxil. Sorry this thread turned into an "evils of medication" battle. My guess would be that most of the people quietly judging me for being on meds have either never been so depressed that they needed meds, or have tried meds and they didn't work. They're not a magic bullet, they're supposed to take the edge off so you can find the damn ladder. For me, for a long time the Paxil kept the self-loathing at bay so I could work on the cognitive behavior therapy. I stopped being vigilant about that, and I also had a few things happen in my life that made things a lot more stressful - my grandfather died, my brother died, I started a polyamorous relationship, etc. I just might need a little more time - and a little more chemical bolstering - before I'm ready to stand on my own two feet, mentally speaking.
3. I'll be going back to exercising regularly so I can regulate my own neurochemistry and eventually get OFF the Paxil. I know what is effective, I'm just not doing it.
4. Sometimes I just need to wait for the black mood to pass. Maybe I'm always going to have these automatic self-loathing impulses (like this afternoon when one of my perfectionist bosses implicitly criticized me) but I don't have to give in to them, and if I do, the resultant mood is not necessarily permanent.
5. I'm really lucky to have so many people who care about me. Thanks to all of you
