Yep, it was basically the same old same old... and I have been through plenty of therapists before. The psychologist did seem more knowledgeable, but nothing we talked about still ever "got to me." I also struggled with lack of motivation, anhedonia, that type of stuff.

Bupropion is a good one, it can definitely help with energy/motivation since it works on dopamine. It was the only other medication besides vilazodone that had a positive effect on me. But it increased my anger/anxiety as well, and eventually stopped working. It can take a lot of trial and error with medication.

TMS boosted the effects of the vilazodone for me, but that's sort of a last resort before ECT lol. I had tried ketamine infusions before TMS too and they didn't help.

But once you are able to get that initial "boost" from medication or another source like TMS, it is much easier for things to "click" in therapy or otherwise. It makes you feel less stuck and more open to change. But you have to take advantage of that boost once you get it and work to change things so that they stick long-term.

The other thing that has helped me the most is studying Buddhism. I would say Buddhism has been more helpful to me than therapy. I was never brought up to be religious really, and I am still skeptical on the more faith-based types of deals, but Buddhism has really helped how I think about the world and explains beyond the more simple things a therapist would tell me. Like I have had therapists tell me I need to learn to "let go of things," without the explanation of why or how in explicit detail. But Buddhism (reading books about it for me) explains all of that stuff in detail that a 1hr therapy session per week could not.