Understanding the Overlap of ADHD with Depression and Anxiety
Dr. Nelson M. Handal, MD, DFAPA, is a distinguished child and adolescent psychiatrist with over 20 years of experience. He is the Founder, Chairman, and Medical Director of Dothan Behavioral Medicine Clinic in Dothan, Alabama, where he provides care for patients with autism, ADHD, OCD, depression, and bipolar disorder.... more
Nelson M. Handal, MD, DFAPA
June 28th, 2024
Depression and Anxiety in the Context of ADHD
Depression and anxiety disorders often occur alongside attention deficit hyperactivity disorder (ADHD) at significant rates. Estimates suggest that about 18% of adults with ADHD also experience major depressive disorder, while nearly half suffer from anxiety. What accounts for these high comorbidity rates?
Several factors contribute to this overlap, but a key point to emphasize is that ADHD does not exist in isolation. Its impact is significantly more impairing when the condition remains undiagnosed, untreated, or improperly managed.
Untreated ADHD and Feelings of Inadequacy
Undiagnosed and untreated ADHD leads children, teens, and adults—who may otherwise be bright and capable—to feel deeply inadequate. This is understandable given that the symptoms of ADHD, such as impulsivity, emotional instability, and poor planning, can severely undermine one’s ability to succeed in various areas of life, including school, work, and relationships. Persistent challenges and failures, especially when the root cause is unidentified and untreated, result in individuals feeling like they are not trying hard enough, causing a significant drop in self-esteem.
These ongoing struggles can also lead to emotions like anger, resentment, and worthlessness. Emotional sensitivity and reactivity, particularly strong reactions to failure, are not uncommon. Such feelings often lead to depression and anxiety, with irritability and worthlessness being key symptoms of depression.
Living with ADHD and Depression
Living with both ADHD and depression poses additional challenges. For instance, children with both conditions experience greater impairment in social and academic functioning compared to those with just ADHD or those without the disorder.
Adolescents, Self-Esteem, and Suicidality
In adolescents with ADHD, recognizing feelings of worthlessness is crucial. One study found a direct link between these feelings and suicidal thoughts and planning.
Women with ADHD and Depression Risk
ADHD generally persists into adulthood, and the longer it remains undiagnosed, the more issues it can create as life’s demands increase in complexity. This is particularly evident in females with ADHD, who are often diagnosed later than males. Women with ADHD are more than twice as likely to develop depression compared to their non-ADHD counterparts. This delay in diagnosis may be due to the less obvious presentation of ADHD symptoms, like hyperactivity and impulsivity, in females. Often, women are diagnosed while in college.
Depression tends to affect women with ADHD more severely, with earlier onset, longer duration, more severe symptoms, higher suicidality rates, and a greater likelihood of requiring psychiatric hospitalization compared to women without ADHD.
Recognizing and Treating ADHD, Depression, and Anxiety
Despite the significant comorbidity between ADHD, depression, and anxiety, these conditions are treatable. Early identification and proper management through comprehensive evaluations are essential. Measurement-based tools can aid clinicians in this process. For instance, Clinicom®, a psychiatric assessment tool I have developed, helps identify a range of psychiatric conditions, taking into account environmental stressors as well. Research on epigenetics underscores the importance of considering environmental factors, which are linked to various conditions, including ADHD.
Case Studies and Clinical Insights
I recently treated an 18-year-old female college student who initially presented with depression. After completing the Clinicom assessment and a thorough evaluation considering personal and family history and stressors, we identified symptoms of ADHD and generalized anxiety disorder, which had previously gone undiagnosed.
I have numerous stories of patients who, unaware of their ADHD, believed they were destined for failure. One patient, diagnosed with ADHD during high school, returned years later as a medical school graduate to express gratitude for the treatment that changed her life.
Through proper diagnosis and treatment, individuals with ADHD, depression, and anxiety can overcome these challenges and lead successful, fulfilling lives.
