medications help at all, in any way? have you tried them all? it took me quite a while and a big chunk of perseverance to get a combo that helped me to think clearly, not cry hysterically constantly, and to muster up the energy to get out of bed every day. now ok, thats not flowers and rainbows, but its a wicked chance to get working on the other stuff. when did you last try medications? there have been some decent new drugs and strategies developed recently. i got me a nice combo of things going on- its a jugglign act sometimes, but when it works, it works, and it can
have you tried any kind of cognitive behavioural therapy? you've said that having a support system helped you- so muster all your willpower and motivation and get yourself one. it might not be your old friends, it could be group therapy, or some other kind of structure in your life like a regular volunteer position with animals (very non-judgemental and theraputic little people, they are). having someone depend upon you, who enjoys your company unconditionally and gets value out of time spent with you is a good thing. it contradicts all the crap you're telling yourself about your self worth, but honestly, if you're screwed up mentally and a dog isn't, you gotta trust his judgement when he thinks you're ok to hang out with and worthy of friendship.
i know you said hospitalisation doesn't help you, but it clearly helps to some extent- in that it prevents you from becoming dead while you're there, hmmm? it might just be what you need right now- a chance to get your head a bit clearer, in a safe place. if you build the right support system around yourself, and get the right plan in place, you should be able to catch yourself down the road when you start to backslide- before you're way back in the hole. thats the hard bit for me, cos my reflex is to cycle back through negative thought processes, and then just embrace the self pity and misery and/or apathy, cos its familiar and therefore safe- and in a sick way, comfortable. but you gotta decide that you're not gonna do that any more- its not got you anywhere that you want to be, has it? do something else- anything else apart from sitting in your room bemoaning your situation. call a helpline, call a shrink, call and get yourself hospitalised, do what you need to do to get through the next few hours and break the cycle.