ADHD, Anxiety, and Depression

How do you make sense of ADHD, anxiety, and depression when they may all be going on at once? Dr. Hoey outlines the overlapping symptoms and clarifies their distinctions in this new post.

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February 19, 2023

If you’ve been diagnosed with ADHD or are wondering if you have ADHD you’re probably familiar with the struggle of parsing out your experiences, differentiating between overlapping symptoms, and trying to figure out what means what. This may be even further complicated when struggles with your mood seem to overlap with your struggle with ADHD. A few questions you may be frustratingly familiar with - is this my ADHD, anxiety, or depression? Is it a combination of all three? Which came first? What do I try to treat? In this article, we’ll help differentiate between depression, anxiety, and ADHD and develop some understanding of how these disorders may interact.

People with ADHD are three times more likely than the general population to develop a mood disorder and nearly 50% of adults with ADHD have also been diagnosed with an anxiety disorder (CHADD, 2019; Kessler et al., 2006). If you are wondering about which of these diagnoses may fit your experiences best, you may have found yourself in one of the following situations:

You have been diagnosed with ADHD but it doesn’t seem to sufficiently account for all of your symptoms.
You have been diagnosed with depression or anxiety but something significant still seems to be missing.
You’ve been diagnosed with ADHD and a mood disorder (or two) and have been able to get treatment for all of the above.

Undiagnosed ADHD

Living with ADHD can cause significant stress. Difficulties with executive functioning impact time management, the ability to initiate tasks and activities, organization, procrastination, trouble following up or completing tasks, and sensory sensitivities. Living with undiagnosed ADHD presents unique challenges and can lead to significant struggles with anxiety and depression due to additional stress of confusion, shame, or unrealistic expectations that you should be able to do everything without additional support. Having ADHD and not having treatment for it can be so difficult, in part, because there is no direction on how you can manage your symptoms. Without an ADHD diagnosis, some medical and mental health professionals may misinterpret your symptoms as anxiety or depression. There is often overlap in symptoms between these disorders, but the underlying causes of these symptoms are typically different.

You Have Been Diagnosed With ADHD, But Something’s Missing

Maybe you’ve been diagnosed with ADHD but also experience struggles that feel independent from the ADHD. It is possible that these experiences are better represented by depression and/or anxiety.

Depression, in the form of a major depressive disorder or persistent depressive disorder, is characterized most significantly by persistent sadness, irritability, or a sense of feeling “low,” “blue,” or “numb.” Depression can be an intense experience that lasts a relatively short time (two weeks) or it can show up with less intensity and more chronicity, persisting for years at a time. Anxiety is broadly defined as a feeling of unease, tension, or nervousness related to stressful or uncertain situations. An anxiety disorder is diagnosed when anxious thoughts, feelings, and behaviors become more persistent rather than temporary and cause significant distress and interference in your daily life. Generalized anxiety disorder, social anxiety disorder, obsessive compulsive disorder are anxiety disorders commonly found to be co-morbid with ADHD.

A complicating factor is that for those who grow up with ADHD, whether diagnosed or not, it is common to develop ways of “masking” their natural behaviors to try to better fit in with neurotypical family, friends, and societal expectations. Patterns of masking can lead to hyper-monitoring your own behavior around others and ignoring or hiding your needs or feelings in ways that can contribute to persistent anxiety and depression as well. We’ll dig into the phenomena and impact of masking in ADHDer’s lives in a future blog post. While the difficulties of ADHD and living in a society developed around neurotypical norms can cause mild to clinical levels of anxiety and depression, there can also be numerous non-ADHD-related causes for developing depression or an anxiety disorder. This can get really tricky because people may attribute your anxious behaviors as a part of ADHD-related difficulties with executive functioning and miss an aspect of you in the process. Issues with sleeplessness and a sense of being on edge may be confused with hyperactivity. Your low engagement with things you used to love may be attributed to moving on from a hyperfixation. Without the understanding of the true cause behind these symptoms, they may go untreated.

Let’s compare the symptoms of anxiety, depression, and ADHD and look at differences in the contributing factors of each symptom:

MOOD & EMOTIONS
	ADHD	Anxiety	Depression
Irritable Mood	Irritability may be due to restlessness, impulsivity, sensory sensitivities, fatigue, or feeling demoralized by ADHD-related struggles	May feel stretched too thin at times, which may result in a jumpy or hypervigilant presentation	Irritability may be due to frustration, fatigue, having a “short fuse,” and experiencing everything as annoying
Persistent Sadness	May experience emotion (including sadness) intenesely but the emotion is likely connected to a specific and identifiable trigger that will likely ease with time		Sadness may be connected to a specific trigger and is often generalized so that the reason for the feeling may be hard to identify
Loss of Interest in Activities Once Enjoyed	ADHDers commonly grow intensely interested in something and, after some time, may suddenly lose interest in it and move on to a new interest	Activities that used to be enjoyable may bring on anxiety, leading to avoidance of these events, people, or interests	Little enjoyment is found in anything that was once pleasurable.
Low Motivation	ADHDers may appear to lack motivation but oftentimes, their difficulties in executive functioning is what is inhibiting their engagement. At other times, there is a lack of motivation due to feeling overwhelmed		“I want to want to ____” Depression includes a lack of interest, loss of enjoyment, and a sense of indifference and apathy
Avoidance	May avoid situations, environments, or people due to sensory sensitivities. May avoid engaging in activities that are not interesting or have been difficult to attend to in the past	In attempts to prevent or reduce anxiety, you might avoid certain situations, environments, people, or thoughts	May avoid contact with people if it feels like you can’t match their energy, or if feelings of worthlessness has caused you to withdraw from relationships

THOUGHTS & COGNITION
Persistent Worry	Stress arising from ADHD symptoms (such as worry about missing a meeting or forgetting a bill)	Near constant worry about past, present, and future concerns that causes significant distress
Difficulty Concentrating and Maintaining Attention	Difficulty staying focused due to internal (sensations or thoughts) or external distractions. Other times, ADHDers may become hyper focused on things that are urgent, novel, or specially interesting	Difficulty staying focused due to worry, fear, or obsessive thoughts	Difficulty staying focused due to lack of interest, fatigue, or clouded thinking
Feelings of Worthlessness or Inappropriate Guilt	May be related to difficulties with impulsivity, getting things done, staying present with friends, etc.	May experience self-criticism and self-consciousness	General sense of guilt and inadequacy
Recurrent Thoughts of Death or Suicide	May occus in times of intense frustration, shame, or hopelessness due to ADHD-related struggles	May occur in times of hopelessness due to anxiety-related struggles. Intrusive thoughts of death or suicide may be unrelated to a desire to end their life	Feelings of despair, worthlessness, guilt, apathy and hopelessness my contribute to thoughts of death and dying

PHYSICAL SYMPTOMS
Over or Under Sleeping	It is common for predominantly hyperactive types to undersleep and struggle with insomnia, while predominantly inattentive types may struggle with over sleeping. Also, sleep can be delayed due to bouts of hyperfocus and not wanting to break their motivation	Difficulty sleeping due to persistent worries and fear	Under or over sleeping may happen in episodes that cycle with depression
Changes in Appetite or Body Weight	Loss of appetite may be related to periods of hyperfocus, forgetfulness, or stimulant medication. May eat beyond fullness or when not hungry due to difficulty with hunger and fullness cues as a way stimming	Loss of appetite due to nervousness or nasea. may eat to quell nervous feelings or to distract from anxiety	Loss of interest in food or anything that used to bring pleasure; may eat beyond fullness or when not hungry to try to regulate intense emotions
Physical Agitation or Slowing	May be related to restlessness, difficulty concentrating, boredom, sensory overstimulation, or sensory understimulation	Physical symptoms of anxiety include cold or sweaty hands, shortness of breath, racing heart rate, dry mouth, numbness or tingling in the hands or feet, nausea, constipation or diarrhea, muscle tension, tics, acid reflux, erectile dysfunction, and dizziness	Aches and pains, low energy causing slower movement or reduced movement, irritability causing restlessness or agitation
Fatigue and Low energy	May be related to sleep difficulties or eating difficulties	Related to sleep difficulties, tiredness due to feeling on edge and nervous throughout the day, likely will still feel keyed up even when sluggish	Very low energy, sluggishness, may related to or reflected in sleep patterns

You Have Been Diagnosed and Treated for ADHD and Anxiety and/or Depression

If you have both a mood disorder and ADHD, obviously the ideal situation is to be diagnosed and treated effectively for all of it! Next step is to determine how your symptoms interact and what focus would be most effective for your treatment. At times, your ADHD symptoms may be in the most need of attention, while at other times certain symptoms or causes of anxiety and depression may need the most immediate care. To help manage these symptoms, determine if you are interested in individual or group psychotherapy, support groups, ADHD coaching, or are curious about looking into medication options with a primary care provider or psychiatrist.

Symptoms Are Hard to Differentiate

Differentiating between symptoms of ADHD, anxiety, and depression can be tricky - especially because they often co-occur. We hope this article has helped shine some light on the differences between these disorders and given you a better understanding of how they may interact. While it can be confusing and frustrating to try and figure out you’re experiencing, know that you are not alone in your journey. If you think you may be struggling with any of these disorders, reach out to a mental health professional for help. A great place to start could be speaking with a therapist at Relational Psych or having a comprehensive psychological evaluation!

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

CHADD. (2019, January 4). ADHD and Co-occurring Conditions. https://chadd.org/about-adhd/co-occuring-conditions/

Kessler et al. (April 2006). The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication, American Journal of Psychiatry 163(5):71.

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