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So for seventeen years I've had pain depression. It especially feels like it's squeezing my heart. It hasn't historically been *about* anything. I've just chalked it up to biochemistry, heredity. And I've thought about suicide, most days, for at least fifteen years - because pain sucks. Ups-and-downs. Roller-coasters. Probably every person on here has done time at the worst torture theme park in the world. Two years ago, my cocktail started working. There was some CBT and DBT in the mix too. I decreased my daily Ativan from 3mg to 2mg. Plus 20mg Latuda, 300mg Sertraline, 100mg Topamax. I actually felt happy, for about two years, until this October. Then it stopped working. And I stopped working. I work in a level I trauma center, where I identify cancer, anemia, and the effects of the coronavirus on the human body. I feel like I have a front row seat to human suffering, without being empowered to ameliorate it, and it's another kind of torture. I am very tired of fighting. If there was a euthanasia travel agency, where I could just walk in, plan my funeral and end-of-life arrangements, plan my ideal death, and just call this thing at 38, that would be a somewhat attractive option (not telling, The Tallest Man on Earth, flaming-Viking-burial-at-sea.) I'm tired of fighting this disease, personally. And I'm tired of coming up against the tsunami of "world suck" (H/T Vlog Brothers) which seems to be hate-fucking itself ad astra. So the strain theory, which I haven't read much on yet, is that we consider the termination of our lives when under one or more types of strain. I personally find this theory hopeful, as targeting the sources of strain, i.e. "world stuck," could reduce the inducements to terminate one's life. The General Strain Theory, according to one Wik I. Pedia cites loss of positive stimuli, addition of negative stimuli, or the inability to reach a desired goal, as three possible sources of strain. I will follow up on this with my tdoc on Wednesday. I think work is introducing negative stimuli, and I have a shit ton of unreached goals, but am starting to care about goals less and less. Basically, it pisses me off that I've had to dramatically reduce my goals due to my diseases, and it's kind of tempting to just leave the party. Please feel free to weigh in if you have personal and or academic experience with this. I'm also meeting virtually with my pdoc tomorrow... to tweak the cocktail. Would love recommendations. My current rx mix, dxs and rx, failures are in my signature. Lamictal induces hives and vomiting. Depakote causes dyskinesia. Lithium ruined the thyroid and causes acute renal failure. Medicine. Ha ha. Organ roulette. So the observation about different species of depression is that while for a decade-and-a-half I experienced what seemed like purely biochemical, chains-around-my-heart, tar-and-shark-filled, basements-beneath-basements depression. This feels more like a rational(?) depression, which has me concerned about whether it will be responsive to biochemical therapy.