Incidentally, I had been nagging him about trying ANYTHING (in addition to the therapy we were doing to find a life goal he believes in) that might help him get SOME help. Be it Adderall or Ozempic. But people are complex, and at best, a person is a Venn diagram with massive overlapping "biological susceptibility," "life situation," "negative thinking style," and inertia. The best one can do is to pull at as many threads as possible to hope the suffering unravels. So one of the threads one can pull at are medication.

Not to give advice, but just for shits and giggles, look into "vulnerable narcissism." Many describe stuff like you do and fit those traits. And don't give a shit about the negative associations and stereotypes regarding this personality. I love narcissists! It's one of the coolest personalities there is! But when you are not allowed to be proud of yourself, and all the desire for status and power gets refocused onto self-hate and learned helplessness, then it's a monster of a situation. Had so many people become awesome versions of themselves when they stop being so afraid of being arrogant :) .

Just to remember when you read about it, that the descriptions are only in the context of things having gone wrong. Every trait can manifest as something good or negative. Even psychopaths can have good and prosocial lives. For instance, some of the best ambulance workers often have high loading on psychopathy, and that makes them better at their job. Because they don't get scared. I’d rather be picked up by an ambulance worker that is curious and thinks the situation is interesting than one that is panicking and losing due to anxiety and empathy overload.

This is just a long-shot association/pattern I noticed, though. It's not worth a dime more than the sentences you put into the machine. :P