I have a similar situation in my history. I made it to age 30 without a diagnosis, mostly because I had learned to cope, but also because ADHD PRESENTS DIFFERENTLY for a lot of people. This leads to a lot of missed diagnoses as children. To top it off, the DSM-V requires evidence before the age of 12 and who, at 30 remembers? (note: this is the diagnostic handbook for psychiatry and has the criteria for every possible condition in the book...literally). When I started medical school, I was struggling a lot and chalked it up to spending six years out of school. Old brain, "cleaning out the cobwebs." I was having some difficulty with my clinical skills class and one day my instructor confronted me and, to paraphrase the long conversation said she thought I had ADD. I was incredibly upset by this mostly because I didn't want to have it! But by the end of the year, I was in the student health center crying my eyes out to a therapist because I was so depressed. I knew I couldn't focus, my grades were terrible when they'd never been before, I was feeling really worthless and pathetic, and feeling like I was never going to be a good doctor and was going to fail miserably. Thankfully, this was the end of the year, and once I was on summer vacation (my last ever), magically my depression symptoms melted away. They, of course, returned when the next year started and I was finally in a place where I was willing to entertain the idea of ADD. I went through the process of setting up an appointment at the same clinic, asking for references, and calling a number of people to see who would be able to take me (hard shit for someone with ADD, amiright?). I finally got an appointment with a PsyD. I had to set up a two day session which was around $350. This included a general IQ-type test, the equivalent of an exhaustive mental status exam, along with some "attention testing." Out of the eight hours, the attention testing was me staring at a screen for 20 min while pushing a button every time a certain thing happened. That was the basic gist. And the results? I got a letter from him MONTHS later saying essentially that med school was hard, harder than college (where I'd excelled), and this caused me anxiety that was keeping me from focusing. His recommendation was to go to a psychiatrist to and try better study habits. I was DEVASTATED. I hadn't fully appreciated until that testing that I was hopeful for the diagnosis because then I would be able to get the help I needed. I would have qualified for services at the school as well as accommodations for testing, and both therapy and medications. This accessibility meant both availability and affordability (shit is expensive). So basically I went BACK to student health and negotiated with a new psychiatrist to try me on Venlafaxine. This has been used as a non-stimulant medication for people with ADD as it can be activating and also works on inhibiting the norepinephrine reuptake in synaptic clefts much like amphetamine medications like methylphenidate (which also increases dopamine - these are the actions of most stimulant meds). Some therapists will use Wellbutrin, but the impression from the PsyD that I had "anxiety" made this less desirable for fear that it would be TOO activating and worsen my "anxiety." I'll be honest. It helped.

There's this whole "chicken and egg" thing with a lot of co-morbid mood disorders that affect people with ADD. Yes, anxiety and depression can affect your ability to focus. That whole DSM thing? One of the main "SIG E CAPS" criteria for major depressive disorder is the C for concentration and cognition. But are you anxious or depressed inducing ADD-like symptoms, or are you depressed or anxious because ADD absolutely takes a toll on your mental health, worsening any predisposition to the disorders or even inducing them in an otherwise mood-disorder-free mind?

That's the question you have to ask yourself. When I started venlafaxine it was like a fog had lifted from my brain. I could suddenly hold multiple thoughts in my head at one time. Trying to focus on even one thing wasn't drowned out but this chatter and din of what I needed to do that day, what everyone around me was doing/saying, what I'd seen on tv last night, thoughts/feelings I'd had for the last month, and god knows what else. I could finally keep an order in my mind to begin to piece together a differential diagnosis AS I was talking to a patient. I could even manage to squeak out a half-decent presentation in the appropriate order instead of "OH yeah! I forgot they said x, y, and z..."

But when I started my third year and was in clinic and writing notes and seeing patients all the time, some of my preceptors started to take notice that I'd show up late, sometimes forget about a note that wasn't done or turn one in three days late, or be distracted by every person that walked by. Not to mention the awesome pressured and tangential speak I did with my patient presentations. Anecdotes abounded. There's another three pages of story between that and today, but suffice it to say, I finally got my PCP here to prescribe me Adderall. I'm only a month into this quest, and I'll admit things aren't perfect (30 years non-medicated will teach you some super bad habits that aren't easy to break), but I at least feel better that I'm on the path to management. What finally helped me was an extremely lucky situation where one of my preceptors was willing to talk to my PCP to explain in ways that my tangential mind couldn't why I absolutely had the worst case of ADD she'd seen in a long time, maybe ever in an adult.

So I share that long story with you to say this: mental health isn't easy. ADD isn't easy. Could you have another diagnosis like anxiety or depression? Absolutely. And if so, I hope you can find a provider that you can trust and that is empathetic, helpful, and compassionate. If you can find a combination of appropriate medications and CBT, you'll be amazed at how much better you'll feel and how little it matters that it's not ADD. Could you have ADD? Absolutely! We've historically made this diagnosis like crazy in children to the point that we have handed Adderall out like candy and now we're worried that parents want the diagnosis because they think it will "fix" their child who is just, well, a child. Maybe one who is a little defiant and rambunctious and certainly not perfect, but one who DOESN'T have ADD. So now we're so guarded in making it that we've swung the other way, and a lot of providers aren't willing to look beyond a classic, slam dunk case of ADD to find that while there are statistics that help guide a diagnosis, we are all individual people who have our own unique ADD life and brain.

The other thing I want to share is that the diagnosis won't cure you, and stimulant medication isn't a magic-pill, wonder-drug for everyone. There is still the trial and error process and patience to find the right med. And there is nothing harder once you start than being willing to try a new one, even when the old one isn't working fantastically because you don't want to go back to square one. Not only that, but being an adult with ADD is different than in children. They really do show fantastic improvement with medications. My belief is that it is because they haven't had the time to build up horrible coping mechanisms and habits of procrastination like we adults. We need medication and LOTS of patience to do CBT or whatever crazy shit we have to do or try on top of it to teach an old dog new tricks. I would freely carry 20 children for the person who had a magic pill that would cure my horrific trouble with initiation, even if it meant I had to keep every other little aspect of my ADD (I don't plan on having children of my own, anyway). I am highly skeptical that trying Vyvanse, Intuniv, Dexedrine, Focalin, Ritalin, Concerta, Strattera, Wellbutrin, Clonidine, or anything else will ever fix that without some effort...nay...TONS of effort on my part. I don't say this to discourage you. I say this because I really hope for your sake (to god, allah, whomever) that you don't actually have ADD. I really hope you have a mood disorder that is easier to treat and that isn't something you have to deal with the rest of your life (ADD is not "curable" and often depression and anxiety are something with which people struggle their whole lives, but they can also be something for which you eventually don't need meds or therapy and you don't carry with you forever).

But I'll say this last thing. I have to say that it feels INCREDIBLE to be able to label what I have, to at least know what I'm up against and not fight something in the dark without knowing what I need to fight it. I can read books, I can find communities of people like this, I can forgive myself when I am beating myself down (at which I am AMAZING). So I completely understand the pain you're going through. I've been there. And thankfully I've found my way to the other side. Again, I still have a LONG road ahead. Perhaps you can soon share on here your story of your own diagnosis and how things are going. Until then, you can always try all of the non-medication things that are recommended and helpful for people with ADD. Practice sleep hygiene. Limit your screen time. Exercise. Eat a healthy diet. Try to avoid added and processed sugars. Don't drink caffeine (dear god, I switched to decaf, what is wrong with me!?). All of those things are beneficial to the world at large. But most importantly, don't give up and don't get discouraged.

Is this all a little melodramatic? Is it really late at night? Yes to all. But good luck to you. I hope things get better as I'm sure they will. Please share your story. I'm really excited to hear you're doing better.