Can ADHD cause anxiety and depression?

One in three people with diagnosed ADHD have also experienced depression, and almost one in two have anxiety. This strong correlation between ADHD, depression, and anxiety is largely caused by the symptoms of ADHD which can make life a real struggle.

According to Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD), one in three people who have been diagnosed with ADHD have also experienced depression, and nearly one in two have anxiety disorders. Several studies also show that people with ADHD are five times more likely to try taking their own life.

The relationship between ADHD, depression and anxiety

Attention deficit hyperactivity disorder (ADHD), depression and anxiety are often referred to as comorbid conditions, meaning you can have more than one at the same time. However, this description can be misleading because this suggests that these conditions all occur independently of each other.

"Comorbid conditions are nevertheless usually independent conditions that exist at the same time in a patient. In contrast, depression and anxiety features that occur in patients with ADHD are frequently a direct result of the ADHD and continue to exist only by virtue of untreated symptoms of ADHD," argues Dr David Feifel in ADHD in Adults: The Invisible Rhinoceros.

While it is possible that for some people, ADHD, depression and anxiety just happen to co-exist, for many people depression and anxiety are directly caused by the negative impact of ADHD in daily life.

ADHD as a cause for depression and anxiety

The main symptoms of ADHD centre around inattentiveness, hyperactivity and impulsiveness. These can make coping with life really difficult, especially when left untreated.

An inability to focus for people experiencing the 'inattention subtype' can lead to problems in both school and work. Unfortunately, this can make it hard for people to reach their potential and often they are left feeling like underachievers. For those with the 'hyperactive-impulsive subtype', acting in a way that is considered either inappropriate or rude can hinder and damage relationships.

People with ADHD can have either or both of these subtypes, the latter commonly known as the 'combined subtype'. These are just some examples of the many problems that can make life overwhelming. This in turn can be really damaging to someone's self-esteem and can create feelings of hopelessness and despondency, which are common symptoms of depression. The stress of trying to fit the mould also increases the risk of developing anxiety disorders.

Misdiagnosing ADHD

There is overlap in the symptoms of ADHD, depression and anxiety which can make these conditions difficult to diagnose and treat. If someone with unrecognised ADHD is treated for depression or anxiety, the treatment has limited effectiveness, as the root cause of the symptom is not being addressed.

Research has shown that other factors also influence misdiagnosis. Younger children and those born closest to the school start age are more likely to be diagnosed with ADHD, and boys are also more likely than girls to be diagnosed.

This may be because boys are more likely to have hyperactive symptoms, which make them disruptive, while girls may be more prone to inattention. They may sit at the back of the classroom and 'daydream', but they're less likely to cause problems for others which demand action.

Although it is now thought that in up to around 65% of cases ADHD symptoms continue from childhood into adulthood, adults who haven't been diagnosed as children are less likely to receive a correct ADHD diagnosis later on.

Dr Feifel points out that a failure to diagnose ADHD can lead to prolonged suffering in patients and increase their risk of developing depression and anxiety disorders. He believes that an effective solution is for doctors to screen all patients displaying the signs of anxiety or depression for ADHD as well.

In 2018, this was also made the recommendation in England in the National Institute for Health and Care Excellence (NICE) guidelines.

Identifying a connection between ADHD, depression and anxiety

What happens when you have a dual diagnosis of ADHD and depression or ADHD and anxiety, or even all three? Doctors then need to determine if the conditions are comorbid or if the ADHD is causing the depression or anxiety. Doctors may ask a number of questions in order to determine the difference.

Has ADHD caused your depression?

According to Dr Feifel, if you are experiencing depression as a result of your ADHD, you may not display all the main features of major depression. Instead, you may believe that you would not feel depressed if you had been able to accomplish certain goals that were instead made hard by ADHD. Sometimes this distinction can become apparent as your doctor asks you a range of questions.

Has ADHD caused your anxiety?

If you are dealing with anxiety as a result of your ADHD, your anxiety is likely to be triggered by circumstances that your ADHD symptoms impact. For example, you may have anxiety only around exams because your ability to focus and accomplish high results is affected by your ADHD. Doctors will be asking questions that determine if outside of ADHD-related concerns, your outlook is relatively more positive and calm.

Treating ADHD, depression and anxiety in combination

If you have both ADHD and depression and/or anxiety, many treatments work well with each other. Cognitive behavioural therapy (CBT), a talking therapy where the brain is coached to better deal with mood disorders, can be used to ease the symptoms of all three conditions.

Implementing a few lifestyle changes can also help to manage your symptoms. Establishing a good routine that includes getting good sleep, eating a balanced diet and incorporating stress-relieving exercises can make managing ADHD, depression and anxiety a lot easier.

Prescription medications can also help, but certain medications for ADHD may affect your sleep and appetite, which may negatively impact your depression. Your doctor can create a treatment plan that works best for your diagnoses, which may involve a combination of stimulants and non-stimulant drugs.

If you believe that you may be experiencing depression or anxiety alongside attention deficit hyperactivity disorder, consult your GP. They will be able to discuss the best treatment plan for you.

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