Diagnostic Mismatch, Treatment-Resistant Depression, and Therapeutic Curiosity

Serving a predominantly neurodivergent adult population, I frequently treat adults with co-occurring conditions such as OCD, ADHD, and/or high-functioning Autism (ASD). 

Notably, my clinical experience reveals a higher comorbidity rate than the general research attests. 

I see about a 75 percent comorbidity between individuals who present with both OCD and ADHD, and about 50 percent exhibiting among all three diagnoses, ADHD, OCD, and ASD.

General research suggests a much lower number, perhaps 30 percent comorbidity between OCD and ADHD, and closer to 6–10 percent where individuals present with all three diagnoses. 

This seems far off base.

The only conclusion I can make is that perhaps the individuals did not meet the criteria for the specific diagnosis, however in the room, it can all look the same, and these are gifted individuals, often brilliant in their atypical way. 

I find most of these people to be charming, sensitive people.

Over time, this discrepancy between what the research reports and what I encounter in the room has forced me to sit with an uncomfortable question: what else are we missing?

When patterns repeat themselves this reliably, yet fall outside accepted frameworks, it is not the patients who feel wrong, it is the framework.

That same question would later become painfully personal.

My journey through treatment-resistant depression led me to exhaust conventional treatments—numerous medications, top treatment centers, many analysts, off-label prescriptions like opiates for depression, and Electroconvulsive Therapy (ECT). For whatever reason, perhaps lack of hope, life had become beyond agonizing. And essentially, I had given up and longed for long naps. 

Looking back, despite some incremental gains, these methods largely failed to work with any sustained traction. Alternative medicines, however, offered a different path. Fortunate to still have the drive and the will to live (through the grace of . . .?), and through various serendipitous meetings with people, I found myself immersed in the study of ayahuasca and other plant medicines, MDMA, cannabis, ketamine, and others. 

It was a crucial time in life. My daughter was only 6 months old, my mother had died 5 months earlier, my father was ill, I had a full practice that I took a pause from, and my wife was overburdened.

Quite aware that I was needed back home, but unable to hold it together, with intention, I booked a flight to Mexico. I was desperate. In a mountainous refuge, a few hours outside of Mexico City, having experienced some relief from these medicines, it was only natural that I would research the matter further. 

I believe both traditional medicines such as Prozac, Adderall, Abilify, and the like and alternative medicines such as ketamine, MDMA, ayahuasca, and others can coexist. 

It is not an exact science, and trial and error hold the key to the huge therapeutic potentials available to us.