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Understanding the Link Between ADHD, Anxiety and Depression

ADHD, Anxiety and Depression

Difficulty paying attention, impulsivity and restlessness are common symptoms for the millions of children and adults who have attention-deficit hyperactivity disorder (ADHD), but signs of anxiety and depression are, too.

In fact, one in three adults and one in seven children diagnosed with ADHD also have depression or have experienced a depressive episode. What’s more, 30 percent of children and 47 percent of adults with ADHD also have an anxiety disorder, according to the nonprofit support group Children and Adults With Attention-Deficit/Hyperactivity Disorder (CHADD).

That's why the latest guidelines from the American Academy of Pediatrics (AAP) stress the importance of identifying anxiety, depression or other conditions that travel with ADHD when making a diagnosis in children. This is also an important consideration for assessing ADHD in adults.

Exactly what causes ADHD isn’t fully understood, but genes, being born too early and brain injury can play a role. Some evidence suggests that moms who smoke, drank alcohol or were under extreme stress during pregnancy are more likely to have kids with ADHD.

ADHD doesn't cause anxiety or depression per se, but the toll that ADHD symptoms can take on daily life and relationships may lead to feelings of depression or anxiety. For instance, if a child with ADHD is constantly being criticized at school or at home, he or she may develop low self-esteem and feel anxious when asked to perform certain tasks or chores. Adults with ADHD may have difficulty at work or in relationships that can foster feelings of depression or anxiety.

The good news is that ADHD, depression and anxiety are highly treatable and often respond to the same types of therapies.

Is it ADHD, anxiety, depression or all three?

There is no specific blood or imaging test to establish an ADHD diagnosis. Instead, your doctor will likely ask about your symptoms, including when they started and how they affect your quality of life. Often, hearing and vision tests can rule out other medical problems that may masquerade as ADHD. Your doctor will have to tease out whether a symptom belongs in the ADHD camp or is driven by a different disorder. This can be challenging, though, because there's so much overlap between symptoms of ADHD, depression and anxiety.

Input from parents and teachers is extremely valuable in differentiating symptoms among children who show signs of ADHD, anxiety and depression. Diagnosing ADHD in adults often involves talking with family members or significant others to help get a better picture of what is going on at home or at work.

    Unraveling ADHD and anxiety

    Up to 30 percent of children and as many as 53 percent of adults with ADHD may also have an anxiety disorder, according to CHADD. One anxiety disorder that's been linked to ADHD is obsessive compulsive disorder (OCD). OCD is characterized by recurring obsessions or behaviors.

    Doctors generally treat ADHD symptoms first because doing so may have spillover benefits on anxiety and stress levels. That said, there are times when the anxiety is causing greater impairment than the ADHD. In those cases, the doctor may opt to treat anxiety first.

    Some common anxiety symptoms include:

    • Nervousness
    • Sense of impending doom
    • Increased heart rate
    • Rapid breathing
    • Trouble concentrating on anything except fears
    • Sleeping difficulties

    Unraveling ADHD and depression

    About 14 percent of children with ADHD are depressed, according to CHADD. By contrast, just 1 percent of children who do not have ADHD are depressed. In adults with ADHD, approximately 47 percent also have depression. ADHD usually precedes symptoms of depression.

    Research suggests that people with ADHD who are depressed are at greater risk of suicide than their counterparts who are depressed but do not have ADHD. Attempts at suicide and death by suicide are often impulsive, which is in line with certain ADHD symptoms.

    Symptoms of depression may include:

    • Feelings of sadness
    • Hopelessness
    • Loss of pleasure in activities you once enjoyed
    • Weight or appetite changes
    • Sleeping too much or not enough

    Other co-existing conditions

    It’s not just depression and anxiety that travel with ADHD. Other potential co-existing conditions can include:

    • Oppositional defiant disorder (ODD), which is marked by defiant and hostile behavior toward authority figures
    • Conduct disorder, which is characterized by stealing, fighting or destroying property
    • Disruptive mood dysregulation disorder, which has symptoms that include irritability and problems handling frustration
    • Learning disabilities. ADHD is not a learning disability, but it can affect how you learn. Some learning disabilities, such as dyslexia and auditory processing disorder, are more common among kids with ADHD
    • Substance use disorders, involving either drugs or alcohol
    • Bipolar disorder
    • Autism spectrum disorder, which can range from the mild to the severe and affect social and communication skills
    • Tic disorders, which involve repetitive, involuntary movements or unwanted sounds

    Treating ADHD, depression and anxiety

    Treatment options for ADHD include behavioral therapy, medication, skills training and school accommodations.

    Behavioral therapy often involves creating structure and routines throughout the day. Parents can play a big role by praising kids with ADHD for what they do well instead of criticizing what they do wrong. The U.S. Centers for Disease Control and Prevention (CDC) recommends behavioral therapy as the first-line treatment for young children with ADHD as it may be as effective as medication. When parents focus on the positive, it can help boost a child’s self-esteem and may ease feelings of anxiety and depression for an added benefit.

    Another form of therapy, cognitive-behavioral therapy (CBT), can help with ADHD, anxiety or depression, particularly in older children. CBT is a time-limited course of psychotherapy that aims to alter behavior by changing the way people think about their anxiety or other feelings and its triggers.

    Adults, too, can benefit from therapy to treat their ADHD or anxiety. Some therapies may focus on developing skills that optimize time management and organization. One-on-one therapy can help adults struggling with feelings of depression. And, other types of therapy — such as family and couples counseling — can be an effective way to reduce the stress that ADHD symptoms can place on a household.

    Getting help via medication

    For many people, medication also has a role to play in treating ADHD, depression or anxiety. The two main types of ADHD medication are stimulants and non-stimulants.

    Stimulants increase the brain chemicals that help with thinking and attention to sharpen focus. But, stimulant side effects may include:

    • Loss of appetite
    • Sleeping problems
    • Tics
    • Anxiety and irritability
    • Stomachaches
    • Headaches

    Non-stimulant medications can be prescribed if stimulants cause too many side effects or are not effective. Non-stimulants can also be taken with stimulants for a synergistic effect. Non-stimulants don’t start to work as quickly as stimulants.

    Sometimes antidepressants are prescribed to treat related conditions, such as anxiety or depression. Older tricyclic antidepressants are seldom used today, replaced by newer drugs that have proved to be effective in increasing the levels of the mood chemicals norepinephrine and serotonin in the brain. The U.S. Food and Drug Administration (FDA) cautions, however, that antidepressant medications can increase the risk of suicidal thinking and behavior in children and adolescents with depression.

    The bottom line

    Working closely with a doctor and therapist, you can develop a comprehensive plan to treat depression, anxiety and ADHD. This will likely include counseling and behavioral therapy along with medication. Certain lifestyle changes — such as engaging in regular physical activity or reducing stress through yoga or meditation, for instance — will also lessen the toll that these symptoms take on your well-being.

    Article references

    1. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), ADHD Overview. https://chadd.org/about-adhd/overview/
    2. American Academy of Pediatrics, Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. https://pediatrics.aappublications.org/content/144/4/e20192528
    3. CHADD, ADHD and Anxiety: What’s the Connection? https://chadd.org/adhd-in-the-news/adhd-and-anxiety-whats-the-connection/
    4. National Institutes of Mental Health, OCD. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
    5. CHADD, Depression. https://chadd.org/about-adhd/depression/
    6. CHADD, Coexisting Conditions. https://chadd.org/about-adhd/coexisting-conditions/
    7. CHADD, ADHD Treatment. https://chadd.org/about-adhd/treatment-of-adhd/
    8. Cleveland Clinic, ADHD Drugs. https://my.clevelandclinic.org/health/drugs/12959-attention-deficit-hyperactivity-disorder-adhd-nonstimulant-therapy-strattera--other-adhd-drugs