Is It ADHD, Depression, or Both?
ADHD and depression can and often co-occur. Depression is nearly three times more prevalent among adults with ADHD. What links the two conditions? And how are they treated?
Can You Have Both ADHD and Depression?
Attention deficit hyperactivity disorder (ADHD) and depression are conditions that can and often co-occur.
Depression is estimated to be 2.7 times more prevalent among adults with ADHD than among the general adult population. Studies also show that about 30 percent of people with ADHD will experience a depressive episode or have a mood disorder in their lifetimes.
What’s more, individuals with ADHD and depression experience symptoms for each condition more acutely than what would be present if they only had one condition. It’s very important for anyone with ADHD and depression to make sure that both conditions are properly managed, and especially for ADHD to be identified and treated — as it can have a significant impact on how depression manifests.
Does ADHD Cause Depression? Can Untreated ADHD Cause Depression?
Having ADHD puts you at four times the risk of depression. The risk is even greater for hyperactive/impulsive types, who are also at a higher risk of suicide.
The nature of ADHD itself, especially if untreated, can sometimes cause depression. This type of “secondary depression” arises as a direct consequence of the chronic frustration and disappointment that many individuals with ADHD experience.
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All the struggles that ADHD symptoms can bring, like troubles with school, relationships, work, executive functions, and the demands of everyday life can lead people with the condition to often feel not good about themselves, making them prone to low self-esteem and negative self-concept.
Making sure that ADHD is properly managed and treated, in these cases, can be key to lifting depression. But by some estimates, 25 percent of adults with the disorder haven’t gotten appropriate ADHD treatment.
“I frequently see depression in adults whose ADHD wasn’t recognized and treated in their younger years,” says Yvonne Pennington, Ph.D., an Atlanta-based psychologist who specializes in adult ADHD. “Having endured so many blows to their self-esteem, they’ve accepted the idea that they’re lazy and stupid-or not good enough to succeed socially or professionally.
Other components of ADHD that can create the conditions for depression include:
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ADHD brains have a dysregulation of dopamine, a neurochemical responsible for motivation and implicated in reward systems and moods. People with ADHD are not accessing the levels of dopamine that their neurotypical peers are because of this dysregulation, making motivation and reward harder to realize, and putting them at risk for not feeling their best.
People with ADHD are more prone to emotional dysregulation — they can and often experience emotions more intensely than non-ADHD counterparts. Individuals with ADHD can take longer to soothe from difficult emotions, and can have a harder time transitioning out of and distracting themselves out of them, all which can contribute to depression.
ADHD rarely travels alone. A significant number of people with ADHD have a comorbid or associated disorder, whether that’s depression, bipolar disorder, obsessive-compulsive disorder, binge eating disorder, a substance abuse disorder, or a learning disability. Certainly, ADHD plus something else can also set someone at more risk for depression. An individual with ADHD and OCD, for example, has to work through a tough combination of conditions — they may be constantly feeling tormented in their heads and ruminating about many different things that can lead them to shut down and feel helpless.
How Do You Treat ADHD and Depression?
ADHD and depression are typically treated through psychotherapies, medications, or a combination of the two. Cognitive behavioral therapy (CBT), for instance, has proven to be highly effective against depression. The first goal of CBT is to enable the patient to identify and reduce frequent, intense negative thoughts — “This is too hard to do,” for example.
Depending on the case, treatments can also range from electroconvulsive therapy to ketamine infusions.
Whether depression is a result of ADHD or not, it doesn’t take away the fact that the individual is still experiencing depression. While there are some factors medical providers consider when treating both conditions, like how ADHD medications and antidepressants may interact with one another, depression is usually treated as its own condition.
“Work first on the condition that causes the greater impairment,” says Lenard Adler, M.D., director of the adult ADHD program at the NYU Langone Medical Center in New York City. “Problems raised by ADHD are real, but depression can be life-threatening.”
Antidepressants that aim to boost levels of the neurotransmitters serotonin and/or norepinephrine are the primary treatment for severe depression. Doctors may also prescribe an antidepressant if mild to moderate depression persists, despite lifestyle changes and treatment of ADHD.
Most antidepressants work well alongside ADHD stimulant meds, as well as with the nonstimulant Strattera (atomoxetine), though minor adjustments may need to be made. Wellbutrin (bupropion) is an antidepressant that can also be useful for ADHD.
Most of the time, depression improves substantially with the first antidepressant tried. If it doesn’t work, a second one probably will. About half of those who take antidepressants achieve complete relief of depressive symptoms.
Minor medication or lifestyle adjustments may make a tremendous difference, too. Aerobic exercise “has a profound effect on the mood level of people with ADHD,” says William Dodson, M.D., a Denver-based psychiatrist. “If you can’t motivate yourself, exercise can normalize your mood.”
Many individuals with ADHD find that their mood darkens when they have nothing to do. “The ADHD nervous system feeds on interest and challenge,” says Dodson. To guard against idleness, he recommends setting up an “interest closet”: Whenever you come across something interesting – a good book, for instance, or a craft project – stash it in a closet. The next time you find yourself looking for something to do, there will be something waiting for you.
Meditation also has its place in treating depression. Sit quietly, with your eyes closed, and focus on your breathing. Each time you exhale, silently repeat a one-syllable word — “one” or “peace” or “om.” Do this for a minute or so, or try it for 10 to 20 seconds whenever you have trouble moving from one activity to another.
The goal is to reduce the frequency and intensity of depressive symptoms. Don’t expect to eliminate them. But you can manage symptoms of depression that once got in the way of living a happy life.