Really discouraging appointment with a new psychiatrist, and I'm not sure what to do next
TL;DR when I told my new psychiatrist I performed well academically in school and can focus better at night, she said the problems I'm experiencing now at work are routine-based, and suggested instead of trying new medication, I get up at 5am every day to work.
I'm not sure what to do. I'm not sure if my diagnosis is wrong, or if my medication is wrong, or if my lifestyle is wrong.
For context, I (26F) have been seeing a psychiatrist since January, who diagnosed me with ADHD after I took a QB test. (I went to the psychiatrist on recommendation of my therapist who I had been seeing for two years, who suggested I should consider looking into getting tested for ADHD.)
After my first psychiatrist left the practice (pausing work to take care of young kids), she referred me to her coworker at the same practice. And their practice styles are very different.
When Psych 1 ended our final meeting, she said we would try strattera for one more month at a higher dose, and if it still wasn't making a difference, we would switch to a different medication.
When I started my meeting with Psych 2, I explained I still felt like I wasn't seeing the improvement I wanted to see and was still struggling with symptoms. (I work a remote job for 30 hours a week. I struggle to work longer than 4 hours a day, and I consistently miss deadlines unless they are URGENT. I worry that my performance is going to be harmed, because I put things off so much.)
I mentioned I'd found I was most productive from 10pm to 12am when working on projects in bed (since I feel more urgency with deadlines, and since there are fewer distractions around me), and that was the time when I could really lock in. I said I wanted to be able to do that during normal work hours, when there wasn't an URGENT deadline pushing me to finish things, since it was hurting my evening and family time.
She asked me what my performance was like when I was in school. I explained I did very well in school, because there were clear, hard deadlines with strict consequences. (I struggled with anxiety and intense perfectionism, and the thought of getting anything else than a high A sent me spiraling. I still had serious issues with procrastination, but when push came to shove, I would lock in and finish the work I needed to to perform well.)
At that point, it kind of felt like she was questioning an ADHD diagnosis for me (but she didn't outright say that so I don't know?). She said, "ADHD doesn't turn on and off like that, so it seems like the solution for you would be establishing a solid routine like you had while you were a student. Since you can work from 10pm to 12am fine, it seems like the issue isn't focus related. As humans, when we have a lot of time to work on things, we naturally put them off. You mention you want to get work done during the hours of 9 to 5--that's 8 whole hours. Instead of starting work at 9, get up earlier and start work. Our minds are sharper and more focused in the morning. Instead of switching to a different medication, this month, get up at 5 am every morning and start work then. When I was in school, the only way I could work on projects was by getting up at 4am--in the afternoon, my mind was fuzzy and distracted, but in the morning I could work straight until 9am. Of course, you don't have to get up as early as I did--5 am would work just fine."
I was holding back tears the whole time she was talking, and just felt really really invalidated. She had known me for less than five minutes, and hadn't asked any follow-up questions to dig deeper into how I was feeling, my life history (aside from schoolwork), or my family history.
I responded (and started sobbing while I was talking, which was also really embarrassing, and my words were much more disjointed than I explain here), "I'm going to be honest. Hearing that I should try more routine changes feels discouraging to me. If the answer is that I should work primarily on lifestyle, then what's the purpose of me being here? I'm been working with a therapist for two years on lifestyle changes, and while some recommendations have helped, I'm still really struggling. I feel like I've been trying to do lifestyle changes already, and the thought that I'm still not doing enough just feels overwhelming. I can go off my medication and go back to working on lifestyle changes in therapy if that's what I need to do. But I just want to get what I need done at work done."
She brought up again how I excelled in school. I responded (again) that the reason I excelled in school (I feel) was because of unhealthy perfectionism and anxiety. Now that I'm working, I don't feel pressure in the same way I did (which I am VERY grateful for). But I want to find a solution that doesn't rely on me being in the same headspace that I was in during high school and college. I mentioned I'd considered changing jobs to an in-person career or to something where I wasn't in charge of organizing so much, but I was worried that these problems would follow me wherever I went (as they have the past two years that I've been out of school).
I think when she saw how emotional I was, she felt bad and backtracked a little bit. She ended up reducing my strattera and prescribing wellbutrin, and setting a follow up for two weeks. She also mentioned how some other clients she had couldn't get through the psych meeting without standing up and walking around, so at least I was able to function well there.
Anyway, now I'm just feeling kind of drained, and wondering if I even have ADHD. There are some routine changes that have helped me in the past, but I'm just so tired of having to go through a whole song and dance to get work started, especially on tasks that should be easy and that I ENJOY DOING.