Most people with ADHD also have at least one co-existing mental health difficulty - as high as 80%. Among these, depression and anxiety are the most prevalent. While I have heard the idea of misdiagnosis of depression and/or anxiety when the real culprit is ADHD, for a lot of people, two or more of these difficulties exist together.
When significant depression and/or anxiety exists alongside ADHD, they may well need treatment in their own right. ADHD medication is not a panacea for depression and anxiety, so it isn't wise to assume that these issues will go away when ADHD is treated, or that pre-existing antidepressant medication will be able to be stopped once ADHD medication is on-board. Many, or even most of my adult ADHD therapy clients take medication for a co-existing mental health problem as well as ADHD medication. With many, a focus of therapy is co-existing conditions. In this blog post, I'll explain more about depression and anxiety and their relationship with ADHD.
What is Depression?
A Major Depressive Episode (the formal name for a period of significantly depressed mood) is more than just occasional sadness or a passing mood. It's a persistent mood disorder (present for at least two weeks) that involves emotional, physical, and cognitive symptoms. Individuals may experience deep feelings of sadness, irritability, or worthlessness that last for weeks, months, or even years. Symptoms also include fatigue, sleep disturbances, and changes in appetite. Cognitively, depression often affects one's ability to concentrate and make decisions, and it can lead to thoughts of death or suicide. The condition significantly impacts daily functioning, including work performance, social interactions, and general well-being.
A dysthymic mood, associated with Persistent Depressive Disorder (dysthymia), is characterised by chronic, low-level depression that lasts for at least two years, with a gap in symptoms of no longer than two months within that period. Individuals with a dysthymic mood experience persistent feelings of sadness and low energy, but the symptoms are not as numerous or severe as those of major depression. Periods of major depression can happen within or outside of a period of dysthymic mood. I have met many clients who appear to experience this pervasive dysthymic mood in addition to discrete periods of major depressive episode.
What is Anxiety?
Anxiety is characterised by an overwhelming sense of worry, nervousness, or dread that can manifest physically through symptoms like a rapid heartbeat, sweating, and trembling. Anxiety can take several forms, each with its own set of symptoms, some of which are presented below:
Generalised Anxiety Disorder: Involves chronic, excessive worry about various and any aspects of daily life and the future.
Social Anxiety Disorder: Characterised by a crippling fear of scrutiny by others, often leading to avoidance of social situations.
Panic Disorder: Characterised by recurrent, unexpected panic attacks—sudden episodes of intense fear or discomfort—accompanied by persistent concern about having more attacks and significant changes in behaviour to avoid them.
Obsessive-Compulsive Disorder: Involves persistent, unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) that an individual feels driven to perform to reduce distress or prevent a feared event.
Post-Traumatic Stress Disorder: Triggered by experiencing or witnessing a traumatic event, characterised by intrusive memories, avoidance behaviours, negative changes in thinking and mood, and heightened arousal or reactivity.
These disorders often exacerbate the symptoms of ADHD, making daily tasks even more challenging to manage.
Prevalence in People with ADHD
Studies have found that adults with ADHD face a higher risk of experiencing both depression and various anxiety disorders compared to the general population. While different studies find different prevalence rates, approximately 30-40% of adults with ADHD have a coexisting anxiety disorder, while around 20-30% deal with depression. These conditions not only coexist with ADHD but also interact with it, potentially worsening the symptoms of each.
Treatment Options
Medication
Medication often plays a significant role in treating ADHD, depression, and anxiety. Stimulant medications, such as methylphenidate and amphetamines, are commonly used for ADHD. Antidepressants like selective serotonin reuptake inhibitors (SSRIs), among others, can be effective for treating both depression and some forms of anxiety. A person should talk with their prescriber about medication options for ADHD, depression and anxiety for a tailored treatment plan.
Psychotherapy
Cognitive Behavioural Therapy (CBT) is a widely accepted, evidence-based treatment effective for ADHD, depression, and anxiety. It aims to identify and change negative thought patterns while teaching practical coping mechanisms. Other forms of therapy such as Acceptance and Commitment Therapy (ACT) can also be effective.
Related Blog Post: Evidence-Based Talk Therapies for ADHD
Lifestyle Changes
Changes in lifestyle, including regular exercise, good nutrition, and adequate sleep, can complement medication and psychotherapy to improve overall mental health.
Integrated Treatment Approach
An effective treatment strategy often involves a combination of medication, psychotherapy, and lifestyle changes.
Summary
Understanding the interplay between ADHD, depression, and anxiety is important for effective diagnosis and treatment. Adults with ADHD face a higher risk of these coexisting conditions, which can exacerbate symptoms and complicate daily life. A comprehensive approach that includes medication, psychotherapy, and lifestyle changes can help many people significantly.
Related Resources:
6 Unexpected Signs of Depression by psychiatrist Dr William Dodson from ADDitude
6 Types of Anxiety by clinical psychologist Dr Thomas E. Brown from ADDitude
Anxiety? Depression? Or ADHD? It Could Be All Three by clinical psychologist Dr Roberto Olivardia from ADDitude
