Anxiety? Depression? Or ADHD? It Could Be All Three
Can You Have ADHD, Depression & Anxiety At The Same Time?
Many adults with ADHD have a diagnosed or undiagnosed mental health condition. The most common mental health conditions present are depression and an anxiety disorder such as OCD (obsessive-compulsive disorder).
If a person has ADHD and they do not have a mental health disorder as well, they are the exception to the rule. Many people with ADHD struggle with the challenges of their condition, in addition to the challenge of other disorders at the same time. Sadly, for many of those people, their ADHD or mental health disorder may be diagnosed, but their comorbid disorder is missed until later years. They may spend years suffering from an undiagnosed condition and this lack of diagnosis can result in their lives being hugely impacted.
What Happens When ADHD & A Mental Health Disorder Coexist Without Diagnosis For Both:
In some scenarios, ADHD is diagnosed, but the mental health condition has not. Because of the ADHD diagnosis, doctors may then assume any anxiety or depression symptoms are because of ADHD. What many doctors don’t realize is that whilst anxiety can be a result of ADHD, it can also exist independently of the ADHD, as a primary disorder. If anxiety is diagnosed but categorized as secondary, it does not detract from how difficult it is for the person to live with. Compare this to substance abuse and you get a different story. Most people with a substance abuse problem will suffer from anxiety or depression, and yet their substance abuse is treated as a completely separate issue that needs its own care. Underlying causes, like mental health disorders, are also dealt with. One is not diagnosed whilst the other is ignored.
In some scenarios, depression or anxiety has been identified, but ADHD remains undiagnosed. Doctors may see the ADHD symptoms as a result of the mental health problem. Doctors providing treatment may also question whether a person is committed to their treatment, as they struggle to take medication on time, or turn up for therapy on time, when in fact this happens as a result of undiagnosed ADHD.
Of course, in the ideal scenario, ADHD and the mental health condition are diagnosed and treated. The doctor recognizes how both conditions will have separate symptoms, and how they can affect the other condition. They can check the intensity of the symptoms, which tend to be experienced to a higher degree because both conditions are present.
To avoid being in the scenario where one condition remains unseen, your doctor must diagnose you correctly. To help you, here is a checklist of symptoms that you and your doctor should be checking for, questions your doctor should be asking, and some tools your doctor should be using for their assessment:
Depression & ADHD
A lot of people with ADHD suffer from depressive episodes at least once during their lifetime. Depression can be separate from ADHD, or it can form because of ADHD symptoms. ADHD can significantly impact the path of depression, and lots of science suggests that those with ADHD will have more depression symptoms compared to those who do not have ADHD. More severe ADHD symptoms are also linked with severe depression symptoms. When you have both conditions, the symptoms are always more intense than if you had one condition or the other.
To make a proper diagnosis of depression, your doctor will check the following points, and should correctly distinguish between the ADHD and depression symptoms you are experiencing:
A Consistent Irritable Or Sad Mood - When a person only has ADHD, the sad or irritable emotions they’re experiencing are in contact with their environment or a particular scenario. Your doctor should investigate as to whether or not these symptoms are constant, or if there are certain scenarios when they show themselves.
Not Being Interested In Activities You Enjoyed Before - With ADHD it is normal for a person to enjoy something a lot, and then get quickly bored with it before moving onto something new, and more exciting. With depression, you don’t find enjoyment in anything.
Appetite Or Body Weight Changes - When you are depressed you may lose or gain weight. You may be unengaged when you have food around you, struggling to find an appetite even for your favorite foods. With ADHD you may have a loss of appetite because of stimulant medication, or because you are hyper-focused on something else.
Sleeping A Lot, Or Not Enough - Your doctor should look at your sleep patterns over a longer period of time than a week. With depression, feeling tired does not directly relate to how much sleep you get per night. You can have a huge amount of sleep and still feel very tired the next day. Many people with ADHD will not sleep much, or they may sleep too much. A depressive type of sleep issue tends to be episodic.
Feeling Agitated Or Slow - Your doctor will question as to whether you struggle with feeling agitated, or slow, even if you are doing something you like. They will want to know if there is a trigger for these feelings, or if it is caused by other things going on inside.
Fatigue - Are you only fatigued at the moment, or have you always suffered from fatigue. Have you been sleeping well recently? Have stressful things been going on in your life? Have you been eating well? Have you had a sleep study? Are you very overweight? Your doctor should be asking you things like this to find out if your fatigue is caused by a lack of food or sleep issues, or by depression.
Feeling Worthless Or Guilty For No Reason - Many people with ADHD feel guilty when they don’t get something done in time, when they interrupt somebody who is speaking, or lose focus when talking to you. With depression, the feeling is one of overall guilt and not being good enough.
Struggling To Concentrate - This is commonly an early symptom of depression, but it can get banded in with ADHD struggles with concentration. Is this concentration issue new to you, even with your ADHD? Is it constantly a problem? Do you have it when you are doing activities you enjoy? Is it a problem because of daydreaming or lots of surrounding noise? Are you unmotivated because you’re bored or because you have no energy?
Suicidal Thoughts - It is serious when any person is suicidal or is thinking a lot about death. It should never be ignored. Whether you experience thoughts like this because of ADHD struggles, or not, is irrelevant. Your doctor needs to know right away if you are struggling with thoughts like these. Depression can cause you to think that it is rational to take your life, something nobody should have to go through. If you or someone you know is at risk of suicide, please seek help. You or someone you know can also call the National Suicide Hotline at 800-273-8255
Psychosis - Seeing things that aren’t there, being paranoid, delusional and hearing things that aren’t there, are all signs something else is going on besides ADHD. These things can form part of severe depression as an episode of psychosis. It is important you do not feel ashamed of this and speak to your doctor about these symptoms.
As well as the criteria above, your doctor will speak to you about your family history. Depressive disorders and ADHD can be part of family history. In many cases, depression in those with ADHD can be a result of difficult relationships or being socially isolated in relation to ADHD symptoms.
Finally, your medical practitioner should check whether your symptoms are a result of the medication that you are taking. You should also have a physical examination and tests to rule out any other medical conditions that could be causing the symptoms.
Depression Evaluation Surveys
Doctors tend to use special surveys to add information to your individual history. These surveys are:
The Beck Depression Inventory/ Automatic Thoughts Questionnaire/ Children’s Depression Inventory - Quick surveys that are reliable and able to help with the diagnosis of depression.
SCID-5 (Structured Clinical Interview For DSM-V Disorders/ Diagnostic Interview For Children And Adolescents Revised - Instruments relied upon to assess depression and other clinical conditions.
Anxiety & ADHD:
There are lots of studies to suggest that a large portion of children with ADHD suffer from anxiety, compared to neurotypical children. The likelihood of an adult with ADHD suffering from an anxiety disorder at some point in their lifetime is also very high.
Having ADHD as it is, can be stressful. Struggling with various aspects of day-to-day function can be incredibly impactful on everyday life. Being disorganized, struggling to manage time, procrastinating, and getting frustrated over plans or goals failing, all-cause anxiousness in people with ADHD.
Learning disabilities, which can affect a lot of people with ADHD, have a common relationship with academic anxiety.
Anxiety is something that is defined as being nervous, tense, or uneasy in events that are considered (potentially only by the patient) as stressful, or uncertain. Many people have gone through anxiety to some degree (without depression) at some point. The diagnosis of having an anxiety disorder tends to be made when the problem gets so bad that it interferes with life day to day.
Getting a diagnosis for anxiety can be challenging, especially as so many anxiety symptoms can look like ADHD symptoms, or they may be seen as in some way related to ADHD. Your doctor should do a physical exam or tests to check for any other medical condition causing the problems. You should also tell your doctor about any medications you are taking, or their side effects that could bring on anxiety symptoms. Your doctor should also ask about the following symptoms and problems to formulate a proper diagnosis:
Worrying Constantly - Worrying about getting a plane, or paying off a bill are pretty standard worries for many people. However, if worrying is happening all the time and it causes you a lot of distress, it is something your doctor should know about. If the stress comes from the symptoms of ADHD, the treatment tends to revolve around the ADHD itself. If the anxiety, however, clearly exists beyond ADHD, then an anxiety disorder may be present and require treatment.
Physical Issues - Anxiety can show itself in a wide variety of ways, including physical symptoms. You can get sweaty, cold, you can struggle with breathing, you might get dry mouth, flushes, tingling hands, nausea, headaches, tics, and more. Your doctor should enquire about any physical symptoms you mention, and check your history of phobias and any panic attack problems.
Sleep Issues - Anxiety makes sleeping a real challenge. If you find it hard to get to sleep or to get your mind to stop working, this can happen without anxiety being present. With anxiety, sleep problems can happen because of being worried all the time and experiencing intense fear and irrational thinking constantly.
Fears That Are Not Rational - A person with anxiety may well be aware that their fears are not rational, but that doesn’t prevent them from being taken seriously.
Avoiding - One of the things that anxious people tend to do the most is avoid. They may avoid social situations, germs, or things that are considered scary (depending on the anxiety type). This avoidance is a desperate attempt to avoid feeling anxious. The problem is that avoidance then leads to feeling more anxious overall because there is no tolerance to the situation being avoided.
Struggle With Focus - With anxiety you may find it very hard to be focused because you are worried, fearful, and distracted by obsessive thoughts. With ADHD, feeling anxious thoughts can cause distraction, and they might even be considered pleasant by the person experiencing them.
Problems With Change - People with ADHD tend to enjoy change because they can get bored so quickly. However, they can also find change difficult because it means they have to adapt to a new situation, which can be hard. Those with anxiety can be strongly attached to routine because it is the only thing that is certain in their life. Your doctor should be enquiring as to how you can deal with change, to find out more about the origin of the anxiety you experience.
As well as the above points, as part of the process of diagnosis, your doctor should enquire about your family history because anxiety can run in families.
The following tools are commonly used to help diagnose anxiety. Your doctor is likely to use at least one of the following methods to help with their diagnosis:
SCID-5
Revised Children’s Manifest Anxiety Scale
Beck Anxiety Inventory
Hamilton Anxiety Rating Scale
Y-BOCS (Yale-Brown Obsessive-Compulsive Scale)
No particular measuring scale is completely perfect, and none can replace a full review by your doctor, along with tests and physical examinations.
In all cases, knowing what is going on is so important. Coping with ADHD symptoms is difficult enough, and dealing with a mental health disorder too is quite overwhelming for many. Only with a full diagnosis for both ADHD and a mental health disorder, can proper treatment be possible.
If you speak to your doctor about experiencing common anxiety or depression symptoms they may well begin treatment for those symptoms as a starting point. As well as talking therapies, they may prescribe you with common medications such as: Lexapro, Prozac or Xanax. They may also recommend you consider some natural supplements to help first such as:
St John's Wort - St Johns Wort cannot be used in conjunction with most prescription medications because it changes the way they work. On its own, it can be a great natural remedy to try for depression and anxiety.
Ashwagandha - This ancient herb can help reduce anxiety and stress, along with the symptoms of depression.
Valerian - Valerian can help reduce anxiety and stress in some people, and is a commonly recommended herbal remedy for mental health struggles.
Chamomile - Chamomile is great taken as tea, and is thought to help reduce the symptoms of anxiety. It should not be taken for a long time if you are taking blood thinners.
Lemon Balm - Lemon Balm is thought to help with symptoms of anxiety. It is also thought to help with ADHD symptoms because it can reduce excitability.
L-Theanine/ Tyrosine - Widely used to treat anxiety and depression, with a particular emphasis on being effective for anxiety symptoms. L-Theanine can also help with sleep and common ADHD symptoms.
