Attention deficit hyperactivity disorder (ADHD) and depression are two different mental health conditions. ADHD is a neurodevelopmental disorder, whereas depression is a mood disorder. However, there is a significant link between them: roughly
Therefore, it is essential to assess all patients with ADHD for the co-occurrence of depressive disorders. It is also necessary to assess the symptoms thoroughly and make an accurate diagnosis so that both the primary and secondary conditions can be treated effectively.
Read on to get a deep understanding of both disorders, their co-occurrence risks, and interconnections.
Understanding ADHD and Depression
Before diving into the details of how ADHD and depression can be interconnected, it’s essential to know the nature and occurrence of these disorders independently. Below is a brief overview of these conditions and their symptoms.
What Is ADHD and What Are Its Symptoms?
ADHD can manifest itself through hyperactivity, impulsiveness, inattentiveness, or a few ways at once. It can affect focus, communication, and impulse control, which influences various areas of life, from schoolwork to relationships.
ADHD was typically considered a childhood condition. However, modern data states that even though its symptoms generally emerge in childhood, it can persist into adulthood. In adults, ADHD may cause difficulties with time management, organization, goal setting, and consequently challenges with employment.
As with many conditions, the symptoms of ADHD vary from person to person. However, there are also standard criteria and hallmark symptoms, based on which the disorder is classified into three types.
Predominantly inattentive ADHD:
- Difficulty paying attention
- Struggling to organize thoughts
- Becoming easily distracted
- Forgetfulness
Predominantly hyperactive-impulsive ADHD:
- Restlessness
- Interrupting others
- Inability to sit still
- Talking excessively
Combined ADHD is characterized by a combination of both inattentive and hyperactive-impulsive symptoms.
Hyperactive-impulsive ADHD is more common in males, whereas females with ADHD usually exhibit inattention symptoms.
Typical Behaviors vs ADHD
Adults with ADHD are generally inattentive, forgetful, hyperactive, or impulsive at times. They may frequently experience emotional outbursts and mood swings due to difficulty regulating emotions, have varied attention spans and activity levels. However, just because an adult is different from his or her friends or siblings, it doesn’t necessarily imply ADHD. Adults who exhibit hyperactivity or inattentiveness in one setting but not others may suggest something other than ADHD. To diagnose a condition, a healthcare provider assesses the whole medical history and different aspects of daily life, not only personal traits, habits, and behaviors.
What Causes ADHD?
A lot of work and research is done on ADHD, but there is no single agreed-upon reason for the causes of the disorder. Instead, there are multiple suggestions on the
- Genetics: Researchers agree that genes play an essential role in developing ADHD, with a higher risk when there’s a family history of the condition.
- Environmental factors: There are various potential environmental factors that might raise the risk of developing ADHD, including brain injuries, nutrition, maternal smoking or alcohol use, and social environments.
Depression and Its Symptoms
Depression, referred to as major depressive disorder (MDD), is classified as a mood disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. While feeling down is a normal part of life, depression isn’t just a low mood or temporary sadness. It is a severe medical condition that can often cause problems at work and in relationships, social isolation, or even thoughts of self-harm.
Common symptoms of depression include:
- Persistent low mood throughout most of the day for at least 14 days
- Losing interest in enjoyable activities
- Feeling sad, hopeless, and empty
- Frequently feeling anxiety, irritability, frustration, or restlessness
- Changes in appetite and weight
- Having difficulty paying attention
- Negative self-perception
- Sleeping difficulties
- Fatigue and feeling tired
- Recurrent suicidal ideation in the case of severe depression
Depression is further divided into two types:
- Primary depression typically occurs when there is no prior history of other mental health disorders to explain ongoing depressive episodes.
- Secondary depression happens when depressive episodes are connected to another underlying psychiatric condition, such as attention deficit hyperactivity disorder, bipolar disorder, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD).
What Causes Depression?
- Biological factors. Chemical imbalances in the brain (specifically involving serotonin, dopamine, and norepinephrine), issues with mood regulation, and genetic predisposition.
- Environmental factors. Stressful life events, socio-economic difficulties, and a lack of support.
- Medical factors. Side effects of medications or chronic illnesses (cancer, diabetes, or chronic pain).
Can ADHD Make You Depressed?
In some patients, ADHD causes lifelong challenges that may lead to depression, especially in people struggling to manage their symptoms. For example, one may have work-related issues, resulting in feelings of hopelessness and frustration.
While ADHD does increase vulnerability to depression, not all patients experience it. This is particularly prevalent in adults who weren’t adequately treated during adolescence, leading to self-esteem issues tied to social and professional struggles.
Can ADHD Affect Your Emotions?
Individuals with ADHD often experience emotions more intensely than others, which can make it harder to manage emotions overall. Some of the common emotional challenges include:
- Quick frustration over minor issues
- Excessive worrying
- Difficulty calming down when upset
- Sensitivity to criticism
- Feeling excessive urgency to get something they want now
Note that not everyone experiences these effects, and they can be managed by many people with the help of personalized professional support.
Can Untreated ADHD Lead To Depression?
Several
- Children: Untreated ADHD leads to problems at home and school, particularly in emotion control and social interactions. They may struggle with sharing, cooperating, and making friends, which can affect self-esteem and lead to early-onset depression.
- Teens: Untreated ADHD can exacerbate academic challenges which may lead to poor grades and risky behaviors (drinking, smoking, doing drugs, and risky sexual choices).
- Adults: Adult ADHD symptoms can sometimes fade with age, still they can still persist as a lifelong concern. Typically, ADHD causes work-related and relationship issues when left untreated.
Can ADHD Be Mistaken for Depression?
People with ADHD have distinct neural patterns, making them more prone to depression and anxiety. However, even symptoms of ADHD itself may be sometimes mistaken for the signs of depression. This might happen because of similarities between these two conditions, such as difficulty concentrating, restlessness, irritability, anhedonia, and sleep difficulties. Therefore, accurate assessment is crucial to identify the right disorder and plan appropriate treatment.
When ADHD and major depression co-occur, patients have an increased risk of long-term complications. Clinicians carefully assess for comorbid depression in ADHD patients, and should also consider whether depressive symptoms arise due to the emotional impact of ADHD or for other reasons.
Why Can Depression Be Misdiagnosed As ADHD?
While comorbid ADHD and depression cases are common, not all patients experience both conditions. ADHD is sometimes misdiagnosed as depression, and vice versa. This is because they can appear similar on the surface, with ADHD symptoms sometimes mimicking depression. The following are some symptoms that a person with either issue might experience, but for different reasons and with different manifestations.
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ADHD |
Depression |
|
|
SIMILARITIES |
||
|
Decreased motivation |
They may think their efforts won’t matter and so they surrender. |
A depressed person might avoid work because they feel hopeless and can’t see good results ahead. |
|
Trouble keeping up with work |
They may tune out because of having trouble maintaining attention. |
They may struggle to concentrate due to negative emotions and sleep problems. |
|
Poor self-esteem |
ADHD individuals may have poor self-image because they struggle to keep up no matter how hard they try. |
One of the most common depressive symptoms is a persistent negative self-concept that occurs without an apparent reason. |
|
Avoidance of school or work |
They may dread going to school or work because independent handling of complex tasks can be challenging for them. |
They may lack the emotional strength to get through the day. |
|
Despair and hopelessness |
Individuals with ADHD may often be frustrated and angry about their difficulties, but they still crave social interaction. |
Depressed people feel deep sadness, hopelessness, low energy, and can lose interest in socializing for weeks or months. |
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DIFFERENCES |
||
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Emotional dysregulation |
They often experience intense and rapidly changing emotions that are transient and often triggered by daily setbacks or challenges. |
Depressive moods persist chronically, unaffected by external factors, lasting an extended time and impacting multiple aspects of life. |
|
Poor decision making |
They are overwhelmed by deciding what to do first. |
They often feel sluggish, low on energy, and can’t initiate any activity. |
|
Sleep issues |
They struggle to fall asleep and often wake up many times during the night. |
Depressed individuals feel very sleepy during the day and struggle to wake up in the morning after long nights of sleep. |
Signs of Depression Co-existing With ADHD
Patients with both ADHD and depression experience depressive symptoms just like other people with this condition. These symptoms may include:
- Persistently low mood
- Loss of enthusiasm for favorite activities
- Social withdrawal
- Changes in sleep and appetite
- Missed tasks
- Feelings of hopelessness and helplessness
- Thoughts of self-harm
Depression can amplify ADHD-related behaviors, especially inattentive symptoms. Adults with comorbid ADHD and depression can experience disorganization and overwhelm, feel completely out of control and hopeless. Some may even consider stopping their medications, mistakenly attributing their low mood to their ADHD medication. That is why keeping in touch with a healthcare provider during the whole course of treatment and discussing disturbing symptoms is essential.
Medical professionals at MEDvidi are here to support you along the way. Get a personalized treatment plan for ADHD and depression online.
Risk Factors for ADHD and Depression
People with predominantly inattentive and combined types of ADHD are more likely to have associated depression compared to those with the hyperactive-impulsive type. For the same reason, females with ADHD have a higher likelihood of being diagnosed with depression because they more often tend to have internalized reactions to their ADHD symptoms. For example, feelings of guilt, frustration, and loneliness can cause or exacerbate depressive symptoms.
Other risk factors that can increase the chances of depression occurring along with ADHD are the following:
- Genetics: Patients with ADHD who have a family history of depression are more vulnerable to experiencing it. This factor can cause approximately
40% [6*] of the risk. - Recent loss and grief: Grief, as a response to stress or loss, can resemble depression symptoms. While grief usually lessens over time, it can progress to depression, particularly in individuals with ADHD who struggle to manage emotional distress.
- Conflicts: Personal turmoil can trigger depression. It may happen not only because of acute traumatic experiences but also because of persistently increased levels of daily stress caused by conflicts.
- Abuse: Past abuse, including physical, sexual, or emotional trauma, can bring on depression, especially for individuals with ADHD.
- Significant changes in life: These can include both negative and positive events. People with ADHD can experience depression because of job changes, loss of employment, marital changes, retirement, or having a baby.
- Gender: A
review [7*] found increased depression rates in females with ADHD, possibly due to underdiagnosis, particularly of the inattentive type of ADHD. This might lead to untreated ADHD and subsequent depression. - Medications: Depression can be a side effect of some medications taken for another condition, including ADHD. If this happens to you, talk with your doctor about adjusting your treatment
- Prenatal factors:
Research [8*] suggests that maternal depression or serotonin issues during pregnancy can elevate the chances of the child being diagnosed with ADHD, depression, or both. - Early-onset ADHD: Social and academic difficulties in childhood may explain the connection between early ADHD diagnosis and adolescent depression as seen in a
study [9*] . - Other problems: Social isolation, including separation from a family or another social group, can lead to depression.
How Can ADHD Increase Risk for Depression and Anxiety?
ADHD often coexists with other mental health disorders, such as comorbid anxiety and depression, especially when undiagnosed and untreated. ADHD-related impulsivity may push people to take dangerous risks, leading to unintended consequences in various life areas. These problems can overwhelm individuals and cause depression and anxiety.
ADHD is also associated with substance abuse, particularly alcohol, which puts a person at a higher risk of developing depression and anxiety.
ADHD and Depression Treatment
Early diagnosis and treatment can reduce the risk of ADHD and depression. Early treatment interventions can also minimize the risk of suicidal ideation and other associated problems.
Treatment for ADHD and depression can include psychotherapy, medication, or a combination of both. The type of treatment depends on the severity of symptoms, the impact on the patient’s life, personality, and the provider’s recommendation.
Below, we’ve enlisted treatment options and some tips on lifestyle changes that may help overcome ADHD and depression.
Psychotherapy
Therapy is a popular treatment for both ADHD and depression. Several evidence-based approaches have been identified as effective:
- Cognitive-behavioral therapy (CBT) focuses on helping a person identify and change negative thinking patterns. It can also help learn new skills that improve focus, organization, time management, behavioral control, and stress management.
- Interpersonal therapy (ITP) is a short-term approach primarily focused on treating major depression. It centers on improving relationships and recognizing their impact on depression and ADHD.
If you have ADHD and depression (or suspect such comorbidity), seek a therapist specializing in both conditions to get comprehensive treatment.
Medication
Both depression and ADHD can be treated with medication, either by itself or along with psychotherapy. These conditions share a common link to low levels of the neurotransmitter dopamine in the brain, affecting pleasure, concentration, and motivation. Therefore, many medications used to treat depression and ADHD increase dopamine levels.
- Stimulants that include amphetamine (Adderall and Vyvanse) and methylphenidate (Concerta and Ritalin) are commonly prescribed for ADHD as they increase dopamine levels in the brain. These medications are available in two forms: short-acting (few hours) and long-acting (up to 12 hours). Using stimulants for ADHD may also reduce the risk of developing depression in the future.
- The only FDA-approved non-stimulant ADHD medication is atomoxetine (Strattera). It affects levels of norepinephrine, benefiting those with ADHD and depression. Sometimes, it is combined with stimulants.
- Antidepressant medication is used to treat depression and anxiety. They can be prescribed along with ADHD medications to help alleviate symptoms of both. They include:
- selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) and fluoxetine (Prozac);
- serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta) and venlafaxine (Effexor);
- tricyclics like desipramine (Norpramin) and imipramine (Tofranil);
- atypical antidepressant such as bupropion (Wellbutrin).
Lifestyle Tips
Below are some lifestyle changes that may help relieve symptoms (according to recommendations of your healthcare provider, you may need to use these tips along with medication and/or psychotherapy sessions):
- Exercise regularly:
Research [10*] suggests aerobic exercise may promote brain development and function, which can help individuals with ADHD focus better. The same goes for depression: exercise can help you release the negative energy in a more productive way. - Stay connected to friends: Going out and spending time with family and friends can boost your mood and reduce depression, even when it’s tough to do so.
- Challenge negative thoughts: In battling depression, changing negative thinking patterns is crucial. The next time you’re feeling terrible about yourself, challenge such thoughts with logic.
- Good nutrition: People with ADHD may have nutritional deficiencies, including low vitamin D, zinc, ferritin, and magnesium. Discuss going through medical tests with your healthcare provider to define whether you have such deficiencies and if you need to take any supplements to replenish these essential nutrients.
- Getting enough sleep: Proper sleep is vital for managing depression and ADHD as it stabilizes emotions, aids mood regulation, and improves attention and impulse control.
Summing Up
Living with attention deficit hyperactivity disorder can be challenging, affecting various aspects of your life. And if a person also has comorbid depression or another condition, it may cause additional difficulties. Understanding the intricate relationship between ADHD and depression is crucial for effective treatment. Recognize symptoms and risks and embrace a holistic approach to navigate this dual diagnosis with hope, resilience, and a brighter future. Timely help is essential, so consider seeing a healthcare provider if you believe your mental health has worsened.
FAQ
What happens when ADHD and depression co-occur?
When attention deficit hyperactivity disorder and depression overlap, it can be challenging as individuals may experience a blend of symptoms from both conditions. This leads to heightened impairment in daily life and may increase the risk of misdiagnosis.
Moreover, these conditions can exacerbate each other’s symptoms. For example, a lack of focus and impulsivity caused by ADHD can complicate coping with depression, while depression-induced low energy and decreased motivation can worsen attention and organization challenges associated with ADHD.
It’s crucial to be aware that some medications used to treat one condition may have unintended consequences or trigger symptoms of the other. Therefore, a meticulous treatment approach is essential, taking into account both conditions simultaneously. Seeking professional guidance is pivotal for accurate diagnosis and tailored treatment planning.
What do ADHD and depression have in common?
ADHD and major depressive disorder are distinct mental health conditions, yet they share several commonalities. First, they both involve neurotransmitter imbalances: ADHD primarily affects dopamine and norepinephrine, while depression impacts serotonin, dopamine, and norepinephrine.
Second, individuals with both conditions often struggle with core symptoms like difficulties with concentration and decision-making, which may vary in how they manifest. Individuals with either ADHD or depression struggle with insufficient emotional regulation, though the nature of these emotions can differ. Additionally, both conditions impair daily activities, and there is a hereditary component contributing to their development.
What does depression look like in people with ADHD?
The way depression appears in individuals with attention deficit hyperactivity disorder can greatly vary. During a depressive episode, people with adult ADHD may see a worsening of their existing ADHD symptoms. These episodes can bring about persistent feelings of hopelessness and low mood. Also, due to ADHD-related emotional dysregulation, they may experience depressive symptoms more intensely and for longer durations.
During depressive episodes, people with adult ADHD can develop negative self-image leading to self-harm behaviors or suicidal thoughts in the case of severe depression. Social withdrawal is also common. If you experience symptoms of depression alongside ADHD, it’s crucial to seek professional help for proper evaluation and management.
