[tl;dr: Psychiatrist refuses to treat or diagnosis ADHD without a separate evaluation to differentiate from depression.]
Just decided to pop into my old psychiatrists' office to see if I could get ADHD meds ahead of my neuropsych eval a little later down the road (which will also evaluate for autism, but there's no meds for that so I don't care if my psychiatrist thinks I have it or not).
I talked to an intern, who was very nice, and then we connected to the psychiatrist that had treated me through my bipolar and depression.
She told me she couldn't treat me for ADHD because my PHQ-9 score, an inventory to measure depression, was too high and she wanted to wait for a neuropsych evaluation before she prescribed medicine for ADHD. She also was really pushy about getting me into therapy, which I had started coincidentally a few weeks ago.
My thoughts on that:
-
This is the trap: because you are neurodivergent, you fail at work, you fail at society, and you fail at your own self-designed goals. The natural result is that you get depressed. You see the professionals that are supposed to help you, but they are always treating you for depression. By treating you for depression, which is a perfefectly natural response to your situation as a neurodivergent individual living in a neurotypical world, you learn that you are the problem. And since, for some reason, you keep getting fired, people keep not being your friend, and you keep having unfinished projects scattered throughout your house, you never stopped being depressed. And because you never stop being depressed, even though the entire medical system is trying to help you be not depressesd with therapy and medicine, you eventually conclude that you are irretrievably broken. And the results: you are in ineffective treatment for depression for years, decades, or your entire life and you are miserable and feel terrible about yourself the entire time.
-
How is a trained and paid professional looking at a single number (PHQ-9) than reflects depressive symptoms without reference to depressive situations and punting on something so basic as distinguishing between depression and ADHD, which can cause depression and is in the DSM? Isn't doing a differential diagnosis in her wheelhouse? Is she stupid? [rhetorical]
-
Why does she think there is some objective way to distinguish between depression and ADHD? I could go to 10 different psychologists and there is a 0% all of them would agree. So if it's essentially a crap shoot, why is she deferring to someone else, unless she's obviously incompetent or, more likely, a total coward that doesn't want accountability.
-
Why does she think therapy is going to help? I've been in therapy on and off the 30 years and I'm in exactly the same place as I was when I started. I know it does not work, at least not if the focus is on depression. It's like I'm saying, "I want do try something different because what I've been trying for 30 years and she's yelling no! keep doing the same thing!
Seriously. If anyone has any suggestions on how to navigate this. I'm borderline thinking I need to mask my depressive symptoms if psychiatry is going to be so fucking ignorant about the relationship between situation and mood.
OK. It sounds like you suspect you are AuDHD? I mean, lets just say maybe. The way the post is written kind of gives it away, IMO.
Rather than putting so much enevergy into seeking external help (which is useful if you find the right help), you might put more energy into integrating autism into who you are. That can be a self-led activity and, if living that way feels natural, a valid way to become less depressed and feel better.
None of that needs to be qualified by a professional, but some people find the formal assessment helpful in navigating doubts and internalized ableism. Access to autism supports as an adult is kind of non-existent.
One of my first posts in this community was exactly about the limited utility of a formal diagnosis as an adult. As you point out, there are no services anyway, so if you think you have it, just pretend you do have it and explore what it means.
My problem is financial. I need to work to live and I've never worked for more than a few years without having a hellish time followed by extended burnout and recovery. Now if I was just autistic, I'd drill down on whatever special interests I had and figure out how to make something work, or just find a job that doesn't deal with people. But that avenue is closed to me while I have ADHD, because I cant really drill down on anything consistently, and most jobs that don't involve people are either boring or repetitive.
So ADHD is really the biggest problem, and I'd would like to try meds to help with that.
I'm also going to try to go back on disability, and I do need to have a diagnosis to do that. Formerly I was on it for bipolar disorder, a dx I garnered because my brain did not get along well with the anti-depressants which I was taking because I was depressed I couldn't make anything of myself even by own low and quirky standards because I have ADHD.
Could you do me a favor? Could you make a separate post about internalized ableism with your thoughts on it? What it means, what it looks like, etc.
Well i can understand having a misdiagnosis of bipolar. Its not an uncommon detour along the road to autism diagnosis as a grown adult.
Internalized ableism isnt so hard to understand once you’re on the other side of it. The idea that you should be able to do what others do under the same conditions and expectations and that related failures affect your idea of value as a person. Your challenge as a neurodivergent person is to define your own standard and reject tje normal template.
It doesn’t change your financial situation but you can have more energy to direct to that when you stop putting energy into being accepted and acceptable.
Yeah, and to be honest, I think this is part of it that a formal diagnosis does help with. Because otherwise I have a strong socially-mandated temptation to think of myself as lazy malingerer and chronic fuckup.
Yeah. That energy holds you back, and I found a formal diagnosis helpful in accepting and forgiving myself (and others)