Let's take my bed. I haven't made it in a month, and I haven't washed the sheets in two months. This might say something about my personal hygiene, but it says more about my mental state. When I see my bed through the lens of ADHD, I think: "OK, I'm scattered. I'm having trouble keeping track of basic tasks. Every time I try, I get distracted." But my depression also gives a good explanation for my inability to throw my sheets in the washing machine: "I don't feel well. I don't want to get out of bed. I'm going to eat a pizza."
I was diagnosed with ADHD at age 21, which is relatively late in life, considering that most diagnoses are made during childhood, when symptoms first emerge. My ADHD was detected late because many of its symptoms overlap with those of depression, which I'd struggled with for years before the ADHD. I had difficulty concentrating, sleeping, staying organized, accomplishing simple, routine tasks, like making the bed. I'd long been treating the depression with antidepressants and therapy. Yet a piece of the puzzle was missing. Until the ADHD was found, my treatment plan was not complete, as is often the case for girls who aren't diagnosed until later in life.
MANAGING TWO CONDITIONS
ADHD and depression express themselves similarly, resulting in frequent misdiagnoses (or late diagnoses) for both conditions. They rear their ugly heads in the same place — it is estimated that depression is roughly 2.7 times more prevalent among adults with ADHD than without. Whether you are genetically predisposed to depression or not, living with unchecked ADHD can lead to a profound sense of failure, shame, and, ultimately, depression. Before I was diagnosed with ADHD, my chaotic mind and my inability to concentrate — resulting in lost keys, missed appointments, and a cluttered room — caused serious anxiety. These symptoms, common to ADHD, aggravated my already-present depression.
New research shows that there may be more to the ADHD-and-depression connection than similar symptoms. The two conditions are connected on the genome level. A groundbreaking study, published in the online edition of The Lancet, shows that five of the most serious mental health conditions — autism, major depression, ADHD, bipolar disorder, and schizophrenia — share genetic commonalities. Scientists have identified four places in genes, mostly related to the regulation of calcium in brain cells, that lead to an increased risk of having all five of these disorders.
These findings focus on a few genetic overlaps, and there are likely hundreds of genes involved in each condition, as well as forces unrelated to genetics. But this research is a step in the right direction. Identifying common gene variants among these disorders could lead to new targets for prevention and treatment, or at least an improved comprehension of risk factors.
Until we understand the connection between ADHD and depression — and how we can successfully treat both in conjunction — the task of managing ADHD and depression at the same time is overwhelming. Both conditions rob us of the will, energy, and organization to make the effort in getting better.
Women who struggle with both ADHD and depression are particularly at risk. A study in last year's Journal of Consulting and Clinical Psychology showed that women diagnosed with ADHD as young adults, as opposed to during childhood, are more likely to attempt suicide or engage in self-harm. Since many women aren't diagnosed until later in life — keeping their symptoms in check until they experience overwhelming and disorienting life changes, like college or pregnancy — they are at risk for the serious psychological implications of a late diagnosis.
Awareness proved to be my most powerful tool. Once over the hurdle of an ADHD diagnosis — at last! — I understood my enemy better and could devise a precise plan of attack, targeting both depression and ADHD, with the help of medication, therapy, and loads of positive self-talk (the last one felt ridiculous at first, but it helped me disassociate myself from my ADHD).
CONFRONTING THE SHAME OF IT ALL
Combatting depression isn't easy, nor is it easy to reverse years of internalizing ADHD symptoms as personal failings. For most of my life, I've felt stupid, lazy, and incompetent, doomed to fail at school and jobs before I began. Many women with ADHD are overcome with shame when they can't meet society's expectation of the ideal woman, who is tidy, responsible, attentive, punctual, and sociable. On the other hand, the "boys will be boys" mentality minimizes the shame experienced by males with ADHD. If a boy can't sit still during a math lesson or doesn't clean his room regularly, it is considered typical "boy behavior." The inability of girls to meet their gender standard can be crushing, particularly without an ADHD diagnosis explaining why. Indeed, a 2002 study, in The Journal of Attention Disorders, concluded that girls with ADHD internalize their struggles with the disorder more than boys do.
In high school, I lost homework and textbooks regularly, I had trouble following lessons, and I missed club meetings. As a girl who deeply cared about succeeding at school, I blamed myself for my missteps and oversights. I felt powerless and depressed. In order to confront my deep-seated feelings of inadequacy, I needed to challenge the negative self-talk I'd used to separate myself from my ADHD. I needed to change the title of my narrative from "The Perpetual Screwup" to "The Awesome, Smart Lady Who Is Unorganized and Messy but Working on It."
How does this work in practice? Let's say I lose my keys, which is a routine occurrence. Instead of thinking, "I'm such an idiot. I can't believe I lost my keys again! What's wrong with me?" I am gentler with myself. I reason: "It's OK. It happens. I'm going to come up with a new system for keeping track of them — maybe I'll buy a bigger keychain."
Shame and negative thinking are so tempting to indulge, yet challenging these feelings — which takes practice, believe me — is an instant mood brightener. Just as negativity feeds on negativity, positivity feeds on positivity. It must become a habit.
With medication targeting the chemical foundations of both my ADHD symptoms and chronic depression, the rest is up to me. I've found that outdoor exercise, a walk or run in the park, staves off restless energy, boosts endorphins, and gives me much-needed perspective. Journaling, too, helps me to identify patterns of negative thinking and stay motivated.
Although the war against depression is made more brutal by ADHD, it doesn't have to be a losing battle.