<strong>The Link Between Depression, Anxiety, and ADHD</strong>

It’s a common misperception that ADHD is only a children’s disease. Though commonly diagnosed in school-aged children, not all ADHD symptoms go away when those children grow into adults. 

Sometimes, a person won’t develop ADHD symptoms until after they reach adulthood. Other times, children with the disorder grow up without a diagnosis and only realize they have ADHD after being treated for a different mental illness.

All told, a conservative estimate places the percentage of adults with ADHD at 4.4%. Out of this population, only roughly 20% have sought treatment for ADHD symptoms. It follows that a large majority—80%—of adults with ADHD do not seek treatment for ADHD but may be seeking treatment for comorbid depression and anxiety.

However, their depression and anxiety might be caused by untreated ADHD.

In cases like this, treating ADHD is crucial for addressing comorbid anxiety and depression.

Mental health can be complicated. If you suspect your comorbid depression and anxiety disorders might be caused by untreated adult ADHD, you’ll need mental health specialists to help you receive a proper diagnosis and treatment.

Klarity makes it easy to connect with board-certified mental health providers in your state who can diagnose and prescribe treatments for depression, anxiety, and adult ADHD.

Meet your board-certified mental health provider today.

What Are Comorbid Mental Illnesses?

Comorbidity is the presence of two or more illnesses in the same patient. ADHD, depression, and anxiety can all be comorbid with one another. However, the presence of two or more of these mental illnesses in one person complicates the relationship between anxiety, depression, and ADHD and makes developing the most effective treatment plan more challenging—

—Do you treat ADHD to alleviate anxiety and depression symptoms? Or do you treat depression symptoms to help people manage their comorbid illnesses? Or both? 

Those are the questions this post will address. 

In truth, there are several ways ADHD, depression, and anxiety can manifest in a patient. Anxiety and depression can exist independently of ADHD, or they can develop due to the stress and challenges of living with untreated ADHD. 

Shared Symptoms of ADHD, Anxiety, and Depression

ADHD is a highly heritable genetic condition. Likewise, there is evidence that both depression and anxiety are heritable. A person with ADHD is three times more likely to develop depression than the general population. Clearly, ADHD symptoms overlap heavily with symptoms of anxiety and depression. 

This makes it more complicated for psychologists and other mental health professionals to discover the underlying causes of symptoms, which is a crucial part of formulating the most effective treatment plan.

First, let’s review the most common symptoms of ADHD, depression, and anxiety. In the following lists, overlapping symptoms will be in bold.

Symptoms of Attention Deficit Hyperactivity Disorder

Symptoms of attention deficit hyperactivity disorder are divided into two categories:

• Inattentive Symptoms
• Hyperactive and Impulsive Symptoms

A person with attention deficit hyperactivity disorder might only have inattentive symptoms and not have hyperactive or impulsive symptoms or vice versa. Sometimes, they could have both. Both symptoms are common in children, but hyperactive and impulsive symptoms don’t always carry over into adulthood.

Inattentive Symptoms

• Possessing a short attention span
• Being easily distracted
• Making careless mistakes
• Forgetting things easily—misplacing items or misremembering directions
• Missing appointments, bills, or other items with a due date
• Difficulty with complex tasks that require focus, time, and attention
• Difficulty listening to spoken directions
• Needing to change activities frequently, trouble staying on task for long periods
• Difficulty organizing tasks

Hyperactive and Impulsive Symptoms

• Unable to sit still for long periods
• Feeling restless or excited when inappropriate
• Fidgeting or moving constantly 
• Poor concentration
• Excessive, improper physical movements
• Excessive, inappropriate talking
• Emotional dysregulation: getting disproportionately angry, irritated, or frustrated over small inconveniences
• Unable to wait their turn, interrupting frequently
• Making frequent, rash decisions without considering consequences or dangers—including excessive gambling, shopping sprees, unprotected sex, or alcohol and drug use

Symptoms of Depression

It’s important to note the difference between primary and secondary depression. With primary depression, the symptoms are most likely inherited and don’t have clear circumstantial causes. This contrasts with secondary depression, which has a clear cause—another mental or physical illness (chronic or terminal illness), life circumstances, or past trauma.

Whether depression is primary or secondary, the symptoms are often the same. Remember, overlapping symptoms between anxiety, depression, and attention deficit hyperactivity disorder are in bold:

• Feeling hopeless, sad, empty, or tearful
• Emotional dysregulation: getting disproportionately angry, irritated, or frustrated over small inconveniences
• Loss of interest in activities that once brought joy—sex, hobbies, sports, etc.
• Sleeping too little or sleeping too much
• Sleep disturbances
• Becoming easily distracted
• Lack of energy, feeling fatigued all the time
• Feeling anxious, restless, or agitated
• Slowed thinking and cognition; slowed speaking or body movements
• Eating too much or too little
• Feelings of worthlessness or guilt
• Rumination about past failures or self-blame
• Difficulty concentrating, thinking, making decisions, remembering events and appointments
• Frequent thoughts of death, suicide, or self-harm 
• Physical aches and pains that have no apparent source 

Symptoms of Anxiety

Several disorders fall under the umbrella category of “anxiety disorders.” General anxiety disorder (GAD), panic disorder (PD), social anxiety disorder, and various phobias are included.

For this post, the focus will be on the symptoms of generalized anxiety disorder, which include: 

• Feeling restless, agitated, or on edge
• Feeling fatigued or tired all the time
• Difficulty concentrating, focusing, or paying attention
• Emotional dysregulation: getting disproportionately angry, irritated, or frustrated over small inconveniences
• Having unexplained pains with no apparent source or cause—headaches, muscle aches, stomach aches
• Insomnia and difficulty staying asleep
• Ruminating or catastrophizing over fears and thoughts 
• Difficulty regulating feelings of worry and panic

Overlapping Symptoms between ADHD, Depression, and Anxiety

People with all three conditions (or some combination of all three conditions) may experience difficulty focusing, concentrating, and paying attention. They may appear restless or otherwise agitated and get distracted easily. 

This symptomatic overlap provides some insight into the links between depression, anxiety, and adult ADHD. But we’ll need to explore a few things in greater detail to see the full picture. 

We’ll look at the following:

• The chemical mechanisms in the brain that cause similar symptoms to occur
• How adult ADHD can cause poor self-esteem and lead to a person developing depression and anxiety
• How emotional dysregulation occurs with each disorder
• The effect of each disorder on motivation

Dopamine, ADHD, Anxiety, and Depression

Dopamine is one of many neurotransmitters (or chemical messengers) that brain cells use to communicate with one another and with other parts of the body. Specifically, dopamine helps regulate (or is in part responsible for):

• Physical movement
• Working memory
• The reward center of the brain (pleasure and motivation)
• Concentration and attention
• Sleep and arousal
• Learning

Dopamine is also critical for creating norepinephrine and epinephrine, which are vital to memory, alertness, learning, and attention in the brain and central nervous system. 

Studies have shown that low levels of dopamine in certain areas of the brain can lead to problems with motivation, attention, and a lack of desire to do pleasurable or joyful activities (due to dopamine’s role in regulating the brain’s reward center). 

However, when dopamine levels are too high, it can lead to aggressiveness and impulsiveness. Therefore, the current research indicates that imbalanced dopamine levels in certain brain areas can cause some symptoms of anxiety, depression, and ADHD.

How Untreated ADHD Increases the Risk of Anxiety and Depression

Below are three ways undiagnosed ADHD can cause adults to develop secondary depression and anxiety.

Self-Esteem and Untreated ADHD

Untreated ADHD can lead a person to develop secondary depression, an anxiety disorder, or both. When untreated, a person with ADHD has difficulty succeeding in school, work, and interpersonal relationships. They might make impulsive decisions like gambling, overspending, and misusing drugs and alcohol. 

A person who doesn’t realize they have ADHD might blame themselves for the poor circumstances they find themselves in. They might develop depression or anxiety because they don’t understand why it is so difficult for them to accomplish tasks that they see others completing with ease.

Because their ADHD is untreated, they’ll have poor self-esteem and are at a greater risk of developing anxiety and depression.

Emotional Dysregulation in People With ADHD, Depression, and Anxiety

A key symptom of ADHD, anxiety, and depression is emotional dysregulation. People with difficulty controlling or regulating their emotional responses to various stimuli might grow angry, irritated, and frustrated at seemingly small or insignificant things.

When any mental illness is untreated, symptoms like emotional dysregulation can make maintaining relationships with others difficult, as the person might appear disproportionately angry, irritable, or frustrated. 

When others who make up that person’s support group are pushed away, it causes more isolation for the person with the mental illness, further exacerbating depressive or anxious symptoms.

If the underlying cause of emotional dysregulation comes from primary depression or anxiety, which are more often diagnosed in adults when compared to ADHD, then treating the depression or anxiety through standard means (antidepressants and psychotherapy) will help reduce symptoms.

However, if the underlying cause of emotional dysregulation is undiagnosed ADHD, antidepressants might only address the secondary depression but not treat the root problem.

How ADHD, Anxiety, and Depression Affect Motivation and Concentration

Low motivation and poor concentration are shared symptoms across ADHD, anxiety, and depression. Dopamine imbalance in the brain is associated with all three mental illnesses. As mentioned earlier, dopamine is a key neurotransmitter that regulates attention, concentration, learning, and motivation.

Most antidepressants and CNS stimulants have a measurable effect on the levels of dopamine or dopamine-dependent chemicals in the brain. 

Antidepressants (Paxil, Prozac, Zoloft, etc.):

• SSRIs affect serotonin and dopamine
• NDRIs (like Wellbutrin) affect norepinephrine and dopamine
• SNRIs affect serotonin and norepinephrine (which requires dopamine to be synthesized)

CNS Stimulants (Adderal, Vyvanse, Concerta, Focalin, etc.): 

CNS stimulants increase catecholamine levels in the brain. Both norepinephrine and dopamine belong to the catecholamine chemical group. 

Addressing ADHD Helps Reduce Risk of Anxiety and Depression

When people get ADHD treatment and experience relief from ADHD symptoms, they can make better, less impulsive decisions, stay on task and organized at work or school, and focus on bettering themselves. 

If ADHD symptoms are causing secondary depression and anxiety, treating them accordingly helps reduce the risk of developing secondary depression and anxiety. 

Can Depression and Anxiety Actually Be Undiagnosed ADHD?

Yes, undiagnosed and untreated ADHD can cause secondary depression and anxiety symptoms. If you fail to get work done on time, constantly miss appointments, make risky, impulsive decisions, and lose important items, your self-esteem might start to suffer—especially if you compare yourself to others who do not seem to have the same issues.

Plus, if other people chastise and demean you for these things, it will only further reinforce your low self-esteem. This negative feedback loop can cause a person to develop depression and anxiety disorders. 

But what’s the fix, then?

Do you treat depression or anxiety before treating ADHD? Do you treat ADHD first? Can you treat both at the same time? 

Doctors Usually Treat Disorders That Cause the Greatest Impairment First

The usual course of action is treating the condition causing the most immediate harm. If a person’s secondary depression has gotten so bad that they are suicidal, medical professionals will prioritize treating the depression over other conditions.

However, if depression and anxiety symptoms are less severe, a medical professional might recommend treating ADHD with medication and seeing how that affects the symptoms. Additionally, it is possible to treat all three simultaneously with a combination of stimulants and antidepressants.  

Medications That Help Anxiety, Depression, and ADHD

When treating multiple disorders at once, medical professionals must be careful in prescribing medication. As mentioned above, many of these conditions result from imbalances where there is too much or too little of a certain neurotransmitter in different parts of the brain.

Because of all the variables—including a person’s unique body chemistry—finding the right mix of medications requires trial and error. However, there are some promising synergies between certain medicines. 

Stimulants and Antidepressants Often Work Well Together

Stimulants can be prescribed off-label alongside traditional antidepressants for treatment-resistant depression. This combination is considered safe. However, there is an increased risk of developing serotonin syndrome. 

Serotonin syndrome is a condition in which too much serotonin builds up in the brain, causing

• Fever
• Loss of coordination
• Nausea
• Rapid changes in blood pressure
• Vomiting
• Agitation
• Restlessness
• Diarrhea
• Rapid or irregular heartbeat
• Hallucinations

Though rare, it can be fatal. Serotonin syndrome usually occurs within the first few hours of taking a new medication that increases serotonin levels, changing your dose, or adding a serotonin-elevating drug to your current list of medications. 

Antidepressants Can Help Treat ADHD, Depression, and Anxiety

Antidepressants that primarily affect norepinephrine and dopamine can help alleviate ADHD and anxiety symptoms. Medical providers may suggest an antidepressant for ADHD if the person cannot take stimulants because of a heart condition or drug dependency issues. 

Antidepressants that elevate norepinephrine and dopamine include

• NDRIs like bupropion (Wellbutrin)
• SNRIs like desvenlafaxine (Pristiq, Khedezla); duloxetine (Cymbalta, Irenka); levomilnacipran (Fetzima); milnacipran (Savella); venlafaxine (Effexor XR)

Medication Misuse Disclaimer

The classification of medications for anxiety, depression, and ADHD as controlled substances varies depending on the specific medication and its potential for abuse or misuse.

 As a general overview, commonly prescribed controlled substances include: 

• benzodiazepines like Xanax and Valium for anxiety 
• stimulants like Adderall and Ritalin for ADHD

Antidepressants are less likely to fall under the category of controlled substances, but be sure to check with your healthcare provider about the specific drug you’ve been prescribed and its controlled substance status. 

Controlled substances carry a risk of dependence if misused or taken in higher amounts than recommended. For safe and responsible use, it’s essential to take these medications exactly as prescribed, carefully following recommended dosage guidelines. 

If you have any questions or concerns, be sure to reach out to your healthcare provider as soon as possible. They can help address your specific needs while minimizing the risk of dependency.

The Risk of Substance Abuse Among People With Comorbid ADHD, Anxiety, and Depression

Adults with mental health conditions such as ADHD (Attention Deficit Hyperactivity Disorder), depression, and anxiety may be at an increased risk of developing substance abuse disorders. Several factors may contribute to this increased risk:

1. Self-medication: People with mental health conditions may turn to substances like alcohol, drugs, or prescription medications to cope with their symptoms or to temporarily alleviate emotional distress. This self-medication can provide short-term relief but often exacerbates the underlying condition and can lead to substance dependence or addiction.
2. Impulsivity: ADHD is characterized by impulsivity, which can make individuals more prone to engage in risky behaviors, such as substance use. The impaired impulse control associated with ADHD can make it challenging to resist the urge to use substances, increasing the likelihood of developing a substance use disorder.
3. Co-occurring disorders: Mental health conditions often co-occur, meaning that a person may experience more than one condition at the same time. For example, an individual with ADHD may also experience symptoms of anxiety or depression. This complex interplay of conditions can exacerbate symptoms and increase the likelihood of turning to substances as a coping mechanism.
4. Biological factors: Research suggests that there may be genetic and neurobiological factors that contribute to both mental health conditions and substance use disorders. Individuals with a family history of mental health issues or substance use disorders may be at a higher risk of developing these conditions themselves.
5. Social factors: People with mental health conditions may experience social isolation, discrimination, or stigmatization, which can contribute to feelings of loneliness or low self-esteem. These factors can increase the likelihood of turning to substances as a means of coping or seeking social acceptance.
6. Stress: Mental health conditions like anxiety and depression can make individuals more sensitive to stress, and stress is a well-known risk factor for substance use. Substance use may initially help to alleviate stress, but over time it can contribute to a cycle of increased stress and dependence.

Klarity Will Connect You To Online Treatments for ADHD, Anxiety, and Depression

Finding the right treatment plan seems like an overwhelming challenge if you have comorbid depression, anxiety, and ADHD. However, you aren’t alone in searching for convenient and fast online treatments.

On Klarity, appointments are always available within 48 hours, so you never have to wait months for treatment when you need it now. Find a provider today to get started.

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