The day my GP finally agreed to a psychiatric referral, while a relief after years of being only offered another spin on the medication merry-go-round every time rock bottom rose up to greet me, has so far led to more questions than it has answers.

That NHS mental health services have barely survived the economic pointlessness of austerity became alarmingly apparent when I was pointed in the direction of Right to Choose for my referral options. The wait for psychiatric assessment (and particularly ADHD assessment) for children can be longer than a year. For adults I was told waiting lists were simply closed, and I should try again towards the end of the year.

Given that it was only February, the options seemed to be: go private or give up (I cannot stress strongly enough just how lucky I am to have a choice).

When faced with the next set of choices: a General Psychiatric Assessment or an ADHD Assessment, no real advice was forthcoming other than the (erroneous) assurance the latter would still look at the whole picture, so I opted for that.

One psychiatrist appointment, sandwiched between two psychologist appointments, later and it was confirmed that I do have ADHD (with mental rather than physical hyperactivity – so please don’t expect any skipping, bouncing or, god forbid, running). I was assured that it would almost certainly account for the depression and the anxiety, as well as offering a more sympathetic explanation for character traits I had previously put down to just being a bit shit.

A new medication was prescribed (alongside my current anti-depressant), and a type of talk therapy advised. The first ten days of the new medication were a revelation: no anxiety, no feelings of utter dread, a clear mind… But around day 11, the former two returned with a vengeance. I reported all this at my one-month medication review, and the dosage was subsequently increased.

No change.

Ten days into the second month, anxiety and the feelings of utter dread were joined by an all too familiar period of rock-bottom darkness. So at the next review, I made the most of having a real live psychiatrist trapped in a Zoom screen, to ask whether she held any opinions on the lack of obvious anti-depressive qualities of my anti-depressant. Oh! And was I right in thinking that particular anti-depressant should also be staving off anxiety?

She fully agreed that it was indeed failing on both counts, and given that my anxiety and depression didn’t seem to have been significantly minimised by the ADHD medication either, she wondered whether I had ever undergone an ASD assessment.

For those of you who don’t know, ASD stands for Autism Spectrum Disorder.

No, I said. My GP did send me a questionnaire when the subject of ADHD arose, but as it only asked: whether I had been a late walker/talker/potty user in childhood (no), whether I had lined things up, resisted eye contact or done a lot of stimming (no) or whether I coped very badly with change (I didn’t especially like change – what child does? but it didn’t send me over the edge), I hadn’t thought for a minute it might apply to me.

She declared those to be a positively prehistoric list of criteria: modern ASD assessments covering far more than the stereotypical issues that spring to most minds when thinking of Autism.

Did I struggle to make and maintain friendships? Yes. Did I struggle to make small talk? Yes. Did I feel ill at ease in most environments and with most people? Yes. Was I sensitive to loud noises, bright lights, touch or smell? Yes. Did I collect information about specific subjects that I would never use? Hell, yes. Did I feel a sense of joy learning about niche interests? OMG, yes.

But there is also a lot that doesn’t apply to me: I don’t struggle to understand how other people think, I don’t struggle to read a room, or speak with an emotionless tone. I don’t pace, or crave deep pressure. Food textures don’t unnerve me.

And yet I was told that ASD often goes hand in hand with ADHD, especially in females. Girls and women are also, apparently, far better at masking symptoms of neurodivergence – I don’t know whether this is because we are exhorted to: not make a fuss, smile, sit nicely, be nice… from a young age, without a “girls will be girls” pass to just being ourselves, or whether we are naturally more inclined to mimic those around us. But the stress of such masking can often lead to anxiety and depression.

So the plot thickens, and although I would have declared myself always up for a thickened plot, it turns out it only applies to murder mysteries. This unexpected twist just made the wasps in my head buzz even louder, and left me with the panicky and hopeless feeling that I was right back where I started. Or perhaps not right back – I did have a brand new label to keep me warm at night, but in practical terms I had made no progress resolving my mental anguish, and as such, was no closer to finding out whether such a resolution would positively impact my physical ailments.

And while I could believe myself to be an anxious depressive with ADHD, I had a harder time believing myself an ADHDer on the autistic spectrum. And anyway, I was not looking for diagnoses or labels for the sake of diagnoses or labels, I was looking for solutions. So, if a mild form of ASD was discovered, how likely was it to be the underlying cause of the mental anguish? And even if the answer to that was “very likely”, was a diagnosis really imperative to start examining possible solutions? And if I did undertake an ASD assessment, would the whole picture be looked at? Or was I likely to go through another string of appointments, only to emerge with yet more questions in need of an answer?

It is lot to take in for someone who has spent a large portion of the last 47 years as nothing fancier than an anxious depressive with a bit of a shit personality.

But the psychiatrist insisted she could offer no further advice on either medication or therapy until further diagnoses had been explored, so an ASD assessment it will have to be. In the meantime, I am being revisited by my dear old friend, Trigeminal Neuralgia, for which the therapeutic advice (along with medication that makes me feel as though I have taken up residence at the bottom of a swamp) is: avoid all stress.

Ha.