Your comment about self destruction is interesting. You're aware of what you are doing, and what you "should" be doing differently. You've posted this in the Depression forum, so I'm guessing that's the root of the problem.
When I am very depressed, I can't help myself. I simply can't. I know, in my rational mind, what I "should" do, but I have no motivation/ability/will to do them. I agree with sophiesmom that you have to get to a level of being okay before we can really work on improving.
If that means upping my meds, I do it. You mentioned your sexuality is affected by medication. I understand that. Mine is too, but as I'm female, it's obviously quite different!
Could not wanting to be on medication, when it might be the answer, be another self-destructive behaviour?
Feel free to argue and have another angsty rant!
Hugs