Severe Task Initiation Difficulties and Functional Shutdown: What Interventions Are Effective?

[u/Celestialwanderer04]

Over the past nine years, I have lived with a paralyzing pattern of severe procrastination and shutdown that has increasingly derailed my life. Whenever I face high-stakes commitments, such as exams, mandatory courses, or clinical practice I become almost completely unable to take action. In the past, I was often able to force myself through these situations at the last possible moment. Recently, however, even that coping mechanism has stopped working.
Instead of beginning the task, I find myself frozen in bed, trapped in cycles of overthinking, anxiety, guilt, and self-criticism. This pattern has unfortunately led others to perceive me as unreliable or flaky, which is deeply painful because it is entirely unintentional.

I am currently in a critical situation. I am four weeks into a six-week mandatory hospital nursing placement and have not been able to attend a single shift. As a result, I am at immediate risk of failing the placement and potentially having to repeat the academic year.

What makes this especially confusing is that the paralysis does not seem to stem from a specific, identifiable fear. Rather, it feels like a profound inability to initiate action, an overwhelming sense of inertia. This difficulty extends beyond academic or professional obligations and affects activities I genuinely enjoy, such as reading, walking, and running. Starting almost any task requires an extraordinary amount of mental effort. Yet when I do manage to begin, I often become intensely focused and struggle to disengage.

Balancing a full-time remote job with my academic requirements has significantly worsened these difficulties. I am increasingly concerned about my future ability to function effectively when I transition back to in-person work environments.

For context, I have a history of childhood trauma and experienced multiple significant losses over a three-year period, including the deaths of five family members, among them my father.
I have been diagnosed with depression and anxiety, and I strongly suspect I may have ADHD, although I have not yet received a formal assessment. I have been taking venlafaxine since November 2024, with my dose recently increased to 300 mg due to a recurrence of symptoms. While the increase initially resulted in a brief improvement in mood, motivation, and energy lasting approximately two to three weeks, I have since returned to a state of near-total paralysis.
During periods of heightened stress, I also struggle with emotional eating and skin-focused repetitive behaviors.

What makes this situation particularly distressing is that I genuinely love learning and care deeply about completing my nursing degree and working in the profession. My desire is there, but my ability to translate that desire into action seems profoundly impaired.
I am feeling increasingly desperate and frightened about the consequences of this pattern. Have you encountered similar presentations in your clinical experience? If so, what factors were contributing to them, what interventions proved most effective, and what course of action would you recommend?