So what did work?
When I was younger, I "solved" the issue by moving. I would move cities, move apartments, move jobs, and so on and so forth. And that worked! Such significant external changes forced a coming out of sorts, forced me into action that kicked me out of my spiral. It also lead to new experiences and a lot of learning! Great for young me. But as I get older and have more responsibility and weight outside of myself in my life (now including wife, children, dog, and house), I cannot in good conscience keep doing the same.
I know how this may come off, but I did try micro-dosing more recently and found it supremely helpful, not as a long-term solution, certainly not as a means to enhance my ability to achieve more in any particular task, but supremely helpful in terms of kicking me out of a vicious and unrelenting downward spiral. Enough to find my footing and make my way out, replacing it for a more upward trajectory. Once footing is found, I can stop and, on my own, work my way up. The last time I did this was several years back, and we'll see how the cycles go from here.
All that to say I have found no perfect solution. I still search, though not as desperately as before. And time, more than anything, has its sway.
Why write this? Perhaps I'm just feeling introspective in the new year.