Autism

[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:

0. 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.

1. 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]

2. 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.

3. 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.