Was told today that I may have Schizoaffective Disorder, I need advice please

I (23 F) have been diagnosed with Bipolar, ADHD, and social anxiety for a few years now, starting Sophomore year of college. I never really agreed with the Bipolar diagnosis. I didn’t feel like what I had was mania, though I did relate to a cyclical type of depression and periods of higher mood and motivation, not as much with the super fast talking or no sleep. I do get really bad irritability (just in general, but it gets unmanageable when I’m depressed). I’m also very prone to isolation, impulsivity, and rumination, and have avoidant tendencies. Since the start of the year, I’ve had 3 social outings that lasted a few hours each. I work remotely,and rarely leave my house.

For context, I was always very motivated in school and went to a really good university for an engineering degree. I recently graduated and I’m now a Software Engineer. As soon as I started college, the ADHD symptoms and other mental health struggles started taking a toll on my grades, which was really debilitating. At 19, I got on Adderall for ADHD, and was smoking weed heavily, and for a period I was abusing my adderall, which I now greatly regret. At the height of this, I had a bad case of persecutory delusions that were scary as hell. Typical “CIA is after me”. I got off adderall for about a year, and it was so hard to feel motivated to do anything, and studying was very difficult. I was still having suspicious thinking, but I was smoking weed a lot less and not taking any stimulants, and it didn’t reach a full-blown delusional state.

I finally started with a new psychiatrist, and today we had our second visit. I explained that I’m scared to go on an antipsychotic because they can cause cognitive issues and in my career, I can’t afford that. He concluded that what I have sounds more like a thought disorder, along with a mood disorder — He said it possibly could be schizoaffective disorder. He said since Adderall helps a lot, we could switch to Ritalin which has a lower chance of psychosis, and add on Vraylar. He said Vraylar is good for my concern with a lack of motivation, and fear of cognitive decline with other antipsychotics.

I’m scared because this thought disorder thing feels spot on. My whole life, my intellect is the only thing I feel has gotten me through life. And now I have this thing that is basically characterized by “illogical thinking”. And it’s true. In those heightened delusional states, I can feel my mind connecting dots that have no business being connected. And it’s getting worse. And Adderall, the thing that feels helpful, may have exacerbated this. I’m only 23, I’m only just starting my Software Engineering career, and the thoughts that “I’m getting dumber” since I was 19 are proving to be true. I’m honestly terrified. I feel unable to function without Adderall, but I’m also scared that I’ll just become more psychotic if I keep taking it. What do I do… I’ve been considering going back and getting my master’s in Computer Science because I want to work in AI, but I would feel incapable doing it without Adderall. And now I feel like either way, this “thought disorder” thing will worsen and I won’t be able to do any job that requires logical thinking because my brain is just broken. I broke my brain. And I’m only 23. I’ve always been an intellectually curious person, I feel so hopeless right now like what is the point of living this way?

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