[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:
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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.
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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]
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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.
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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)
From what I have heard, it is a well known cycle. Inattentiveness causes a patient to have productivity issues which leads to depression. The depression caused anxiety when asked to perform. The anxiety is distracting and leads to productivity issues. It is a self perpetuating spiral.
From what I understand, the only way to find the root cause is to figure out what started first and/or trying to treat one after another until you find which one the patient responds best to. In some countries, stimulants (to treat ADHD) are more controlled than antidepressants, so it is possible that your doctor first needs to make sure that an antidepressant will not help you before they can justify trying a stimulant.
Like you, I am caught up in the cycle. After years of my doctors trying treatments, we found a solution that works for me: a stimulant that makes my inattention a bit more manageable and therapy to slowly break the cycle.
Thanks for confirming my sanity.
In my case, there’s no need to do anti-depressants even if there were a requirement, which I don’t there is, because I suffered from depression most of my adult life was ultimately referred for ECT exactly because the medicines were ineffective.
I don’t know any good suggestions for you. I got lucky and found out I have undiagnosed, heavily masked AuDHD only 3 years into unsuccessful treatment of depression and cPTSD. Switched a lot of psychiatrists and psychotherapists in the meantime, until I stumbled on an AuDHD psychiatrist, who diagnosed me, and refered to a neurodivergent therapist.
But I agree with you totally this medical system is a mess, most mental health professionals have zero clue what they are doing. Neurodivergence awareness is in the negatives.
I was treated for cPTSD and negative beliefs about myself like incompetence or or unlovability or hiding emotions for so long, without me or therapist understanding true cause or treating it.
Psychiatrists also had really big aversion towards diagnosing me with more than one illness. Although comorbidity is like very common. Everyone just slapped “depression” and prescribed SSRIs, because that’s simplest, meanwhile the full, complex picture of my problems is cPTSD/borderline PD, OCD, AuDHD, depression, and anxiety.
Yeah, I’d like to have Autism and ADHD if it makes sense, but thats just for a more thorough neuropsych eval. If I just need meds, it’s fine that I just have ADHD. And I do just need meds, and I do have an appointment scheduled with someone who treats depression and ADHD so hopefully she knows the difference…
What kind of talk therapy did you do? Any specific modality? Or just an informal kind of self-investigation?
CBT. But I never really thought about it, I just went to whatever therapist my psychiatrist recommended, and she happened to be CBT-qualified.
I did schema therapy for cPTSD previously, but unfortunately it made my mental health worse, because therapist wasn’t neurodivergence-aware, and pushed me to do stuff that caused me autistic shutdowns (like socializing or exercising. We didn’t know those were autistic shutdowns) until those accumulated into autistic burnout with executive dysfunction.
By the way, autistic and ADHD burnouts look very similar to depression, but are treated very differently, and unfortunately most psychs/therapists don’t know that, and are unsuccessfully keep treating the wrong thing.
Yes, you got doubly-lucky because CBT can be quite horrible for not recognizing legitimate causes, tends to 100% patient blame. I would probably flip the fuck out if someone tried to blame my way of thinking for my problems when my way of thinking is the result of other problems I had.
Funnily enough, the classic one I have in mind is continually second-guessing conversations you’ve had. A generic CBT therapist would try to convince you that there really isn’t anything to worry about, but a neuro-aware cPTSD therapist might try looking for all the times you’ve been rejected or say the wrong thing…
Anyway, CBT is extremely flexible and diverse to the point of being meaningless; it’s incorporating all kinds of therapy under its umbrella. Imagine if Kleenex (the tissue company) started making paper towels and cardboard boxes and copy paper… it’s kinda like that.
And, yes, my revelation of the past few months has been all my instances of Major Depressive Disorder were really just burnout. So far, I haven’t seen a way to treat it, everyone just says take it easy, which I can do while my parents are alive, but that’s not going to be much longer. I need to find a life that doesn’t trigger burnout, because I’m not going to survive another one.
everyone just says take it easy, which I can do while my parents are alive, but that’s not going to be much longer. I need to find a life that doesn’t trigger burnout, because I’m not going to survive another one.
Yeah, I am in a similar situation right now. I have been a NEET for over a year at this point, because of the executive dysfunction caused by autistic burnout.
I am sustained only by my mother. But I realize this is an unsustainable lifestyle. And risk of future consequences catching up to me for burning through my savings instead of building capital, skills, and relationships makes me anxious.
Although technically nowadays I am relatively well off, and could probably live this way for another year.
So far, I haven’t seen a way to treat it, everyone just says take it easy
I didn’t manage to successfully treat it yet.
But I think the main idea is reducing stimulation as much as possible, and live a more boring life. Autistic burnout is a product of sensory overwhelm, so to fix this you need sensory deprivation, like lying with closed eyes with ear plugs in complete silence and darkness.
Less extreme ways would be less socializing, less meeting new people, less sunlight, less notifications, less emotionally loaded content online.
Overall just listen to yourself what you find exhausting or too difficult right now, and don’t do it.
The issue with following through though is that ADHD demands constant stimulation, because of severe lack of baseline dopamine. So sitting in complete silence and darkness is physically painful for ADHD brain.
And I guess that’s the curse of being AuDHD, unfortunately.
I think there’s a reason the young me was drawn to the Greek story of a man so vile that when he was finally thrown off a cliff, he was merely suspended in mid-air because the ocean did not want to take him and the land, having gotten rid of him at him, refused to take him back.
That’s basically what AuDHD is.
Because most people are overworked and incompetent. In short, yes, they are stupid.
Most of the time, they’re not doing it out of malice.
When you’re dealing with stupid people, you can’t expect them to magically be non-stupid. You then have to be smart yourself.
How far away is the neuropsych evaluation?
Which country is this?
US. Neurospych consult is this week, and then the actual eval a few weeks out from that.
In the meantime, I do need a prescriber, so I have something scheduled for that, too, beforehand, because I like to think that psychiatrists should be competent to diagnose common issues.
As for people being stupid, yes, they certainly can be, but they’re the gatekeepers.
What happened to you now that you didn’t get your ADHD meds this week, and only get them afterward? Did you have any withdrawal symptoms or similar? Where have you been getting them so far?
I haven’t taken ADHD meds in years, so I imagine what happens is I will continue to be unproductive and the depression loop will continue.
Because I thought my lack of productivity was caused by depression, I took some ADHD drugs but never really was treated for ADHD, it was never a focus.
Separate issue: I have a really reactive emotionality around work. I think it’s rooted in all the rejection and failure, but it’s also just as easily diagnosed as anxiety. But my pattern is to work low-level jobs for several years and then completely burning out and being unemployed for a year or two before trying again: my life set to “rinse and repeat.”
So I really have to figure out how to get help as a neurodivergent person if I’m going to get this lens a real shot (both for medication and therapy), but I’m worried I’m just going to keep getting sucked in neurotypical mood disorders as an explanation which I already know is untreatable in my case.
[This person also recommended a job search service which I’d used for years and they were absolutely useless outside of helping apply for jobs. Any kind of self-exploration and values-clarification and job-evaluation? Absolutely nil. They just had me apply for jobs all the time. For years. They do not give a fuck.]
What country are you in, can you see a different psychiatrist, maybe get a referal to one from your therapist? Ive experienced this before from certain psychiatrists that are leery of writing scripts for stimulants (or even non stimulants for some reason). Seeing a different one had been my way around it.
Yeah, seeing a different one. ADHD is a lot easier to get diagnosed with than autism, probably because autism is not treated with medicine, so why bother diagnosing it if you’re psychiatry.
