Co-founder of a mental health group practice here. There is so much to unpack in this question and with all of the comments below. I will do my best. Disclaimer, we are a cognitive behavioral therapy "shop" and not medical doctors who prescribe medication. We do, however, specialize in the treatment of anxiety and depression. Also, I am not a licensed professional and am not giving any advice. I just employ the professionals that do.

Medication obviously has a place in the treatment of mental health disorders, but if you, for example, are in a toxic relationship with a spouse, parent or child, have experienced death of a loved one, are suffering from drug or sex addiction, an eating disorder, suicidal ideation, or are in an emotionally or physically abusive home environment, then meds are just going to treat your symptoms and not help you change the circumstances of your life that are causing your condition.

> Life has taken me on ups and downs but as far as I can can tell I'm fairly lucky, well-off and have every reason to be happy.

Details really matter here. You can have every good thing in the world, but it only takes one instance of trauma, grief or loss to harm your long-term mental health.

> I usually end up using all my effort just to be a functional member of my team at work.

A person's life is much more than just their work. If all of one's energy goes into work, it's likely that their personal life is suffering as a result and thus either causing or exacerbating the underlying condition.

> I wake up with a pit in my stomach that I carry around all day and no matter how hard I try I just can't shake it.

This can be a symptom of anxiety. You cannot make it go away by force of will. There are medications that reduce feelings of anxiety, but if the cause is that you're worried about losing your job, getting sick, being left by your partner, etc. then medications will not help resolve those problems, though they may make them more tolerable.

> I have tried therapy, I have tried all sorts of coping mechanisms but nothing solves the problem permanently.

This sounds like a cognitive distortion. Details really, really matter here. One of the challenges in scaling the therapeutic treatment of mental illness is that a great deal of the efficacy of therapy depends on a person's willingness to actively engage with the circumstances of their life that are causing their condition as well as the therapists ability to effectively communicate and guide a patient to a state of mental well-being. Learning to cope with a problem is different than solving a problem.

For example, if you have a toxic parent, you can try to cope with that toxicity, try to communicate how you're being harmed by the toxicity and hope your parent responds positively, or cut off all communication with that parent. Sometimes the painful decision is the right one for your mental health. Are you willing to take that step? Could you find a therapist to even make the suggestion?

Many therapists, I venture to guess, would not make that suggestion but believe it to be the right one (as it sometimes is). Making that kind of honest, practical and effective guidance widely available is hard because the "industry" is trained to refrain from expressing personal opinions and unfortunately oriented in a much more passive fashion; partly due to concerns over liability and partly because the personality types attracted to the field are generally not assertive and direct.

> So HN, what has your experience been with depression? Have you tried the drugs? What worked or didn't? Have you been able to triumph without chemical assistance and what did that look like? Is my utter terror of these drugs warranted or should I just bite the bullet and try them?

DO NOT ask the internet to tell you which medications to take. If you are jaded by the field of psychiatry, then start with your primary care physician who can also prescribe those same medications, evaluate you for depression and anxiety, and ask them for a referral to a mental health professional that specializes in cognitive behavioral therapy (CBT). Different states have different titles and licenses for these professionals, but if you are in the state of California, some titles and licenses to look for are the following:

- Licensed Marriage and Family Therapist (LMFT)
- Licensed Master Social Worker (LMSW)
- Licensed Clinical Social Worker (LCSW)
- Licensed Professional Clinical Counselor (LPCC)

https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
https://en.wikipedia.org/wiki/Cognitive_distortion
https://en.wikipedia.org/wiki/Reality_therapy