The Link Between ADHD And Depression

Mental health disorders can often be related or may develop alongside each other. When two different medical conditions exist in the same person simultaneously, it's called comorbidity. Depression frequently develops comorbid to ADHD. Comorbidity can have certain clinical implications and may need a specialized treatment plan to address. Read on to learn more about the connection between the two disorders as well as how therapy can help you manage symptoms so that they don’t interfere with your ability to function in daily life. 

What is ADHD? Attention deficit hyperactivity disorder

Researchers at the American Psychological Association define attention-deficit hyperactivity disorder (ADHD) as a neurodevelopmental disorder usually involving inattention or impulsive behavior—with or without the hyperactivity component. Most people are diagnosed with ADHD as a child, but some people may not be diagnosed until adulthood. ADHD symptoms may present differently in adulthood.  

ADHD subtypes and signs: Adult versus childhood ADHD

ADHD can look different for everyone, generally with significant differences between males and females or some differences between adults and children. Studies show that ADHD is often misdiagnosed or overlooked in females because the behaviors differ significantly from the attention-seeking hyperactivity that may often be seen in males. Males and children may be more likely to receive a diagnosis because their symptoms might be more easily recognized. Below are the symptom categories of the ADHD subtypes: 

• Predominately inattentive (ADHD-PI): Most of your symptoms are related to inattention. 

• Predominately hyperactive/impulsive (ADHD-HI): Most of your symptoms involve impulsivity and hyperactivity.

• Combination ADHD: You experience symptoms involving a combination of inattention, hyperactivity, and impulsivity. 

Common signs of ADHD include the following: 

• Difficulty focusing—particularly at school

• Short attention span  

• Trouble controlling impulsive behavior or resisting temptations

• Often forgetting or losing possessions

• Problems following through with commitments or finishing tasks

• Disorganization

• Frequent mistakes, often due to carelessness

• A tendency to be easily distracted

• Difficulty waiting or taking turns

• Frequent unnecessary risks without considering consequences

• A tendency to fidget, squirm, or experience trouble sitting still

Understanding ADHD comorbidity: ADHD and mental health

According to research from the National Library of Medicine, up to 80% of adults with ADHD live with at least one coexisting mental health condition, such as comorbid depression, with common occurrences including mood, anxiety, substance use, and personality disorders. ADHD is often under-recognized and under-treated in adults, especially when comorbid symptoms seem to replicate other conditions. Depression and ADHD symptoms may, in some cases, counteract each other, making recognizing either condition difficult.  

How common is it to develop both conditions?

How common is it for attention disorders and depression to co-occur? According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), approximately 18.6% of adults with ADHD also have depression, compared to 7.8% without ADHD. CHADD researchers said about 15% of children with ADHD have depression, compared to 1% of children without ADHD. For this reason, those with an attention disorder may be at higher risk of experiencing depression. 

Exploring the link between ADHD and depression

Researchers at the University of Chicago report that adolescents with ADHD are about ten times more likely to develop depression than their counterparts without the disorder. Both conditions can affect your emotions, actions, and cognitive functioning—but both disorders also generally respond well to treatment. Antidepressant medication may be taken if you are depressed, but there are many ADHD medications available. There are also many non-medicine treatment options for depressive traits, and coping skills can be learned to help with attention disorders, such as to improve focus.   

The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action (including starting, stopping, or changing medications) without consulting a qualified medical professional.

What is depression?

Depression is a mood disorder that can intensely affect how you think, act, and feel, causing significant distress and functional difficulties in one or more areas of your life. Per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to be diagnosed with depression, you must feel depressed every day for most of the day for at least two weeks. There are different types of depression, such as major depression, which can be more severe. People can experience depression in different ways. Depression can also come and go. You may experience a depressive episode or a depression increase at various points, and you may also start to feel better some days. Below are some of the common signs and symptoms of depression: 

Common signs of depression

• Persistently feeling sad, anxious, empty, or hopeless

• Often feeling irritable, restless, or frustrated, frequently over small or insignificant issues

• Fixation on past mistakes, feelings of worthlessness, or misplaced guilt

• Decreased speech, movement, and thought speed

• Loss of interest in activities you used to enjoy, also called anhedonia

• Social isolation and withdrawal

• Intense changes in sleep and eating habits

• Persistent fatigue

• Unexplained physical pain

• Trouble thinking or making decisions

• Suicidal thoughts or actions

Common conditions occurring with ADHD

Many cognitive and psychiatric conditions develop comorbid with this disorder. Children may be more likely to experience the following: 

In children

• Learning Disorders

• Sleep Disorders

• Oppositional Defiant Disorders

• Anxiety Disorders

• Intellectual Disabilities

• Language Disorders

• Mood Disorders

• Conduct Disorders

• Tic Disorders

• Autism Spectrum Disorders (ASD)

In adults, the following mental health conditions may be more common alongside ADHD: 

• Major Depressive Disorder

• Dysthymic Disorder

• Bipolar Disorder

• Generalized Anxiety Disorder

• Post-Traumatic Stress Disorder

• Panic Disorder

• Substance Use Disorders

• Obsessive-compulsive disorder

Complications for treating ADHD and depression

Below are some potential complications that may arise when treating comorbid ADHD and depression. 

Medication interactions

Treating ADHD and depression simultaneously with medication can be complicated. For some individuals, stimulant medications can increase depression characteristics. In addition, some medications can potentially be used to treat both disorders. Do not start, change, or stop a medication for ADHD without consulting a doctor. 

Suicidal thoughts or actions

Suicidal thoughts and impulsive behaviors can be a dangerous combination. However, some people with ADHD and depression may face an increased risk. According to recent studies, children diagnosed with an attention disorder between four and six years old may have a higher risk of depression and suicidal thoughts as they age. While the study shows that suicide attempts were “relatively rare,” it remains a concern, and caregivers can watch for warning signs. 

Similarities and differences in the two conditions

The traits of ADHD can often mask depression signs, making recognizing and diagnosing the disorder more difficult. Many of the signs overlap between the two conditions. However, you may notice some differences. People with ADHD may make impulsive choices without considering consequences, while those with depression often have trouble focusing or making decisions. The conflicting goals can be challenging to manage. 

Treating ADHD and depression—Depression and ADHD symptoms

“The overlapping symptoms between ADHD and comorbid psychopathologies represent challenges for diagnosis and treatment. Guidelines recommend that when ADHD coexists with other psychopathologies in adults, the most impairing condition should generally be treated first.” — National Library of Medicine

Many of the treatments available for depression and ADHD are effective for both disorders. Explore the various options to manage symptoms.

Psychotherapy

Talk therapy partners patients with qualified therapists to examine the links between how they think and the way they feel. Cognitive-behavioral therapy (CBT) is frequently used to treat ADHD and depression. This therapeutic approach helps you identify unhealthy or harmful thoughts and behavior patterns so you can consciously work to shift them to healthier habits. A therapist must often study postgraduate medicine and follow clinical practice guidelines in administering treatment. They may also make use of a consensus-derived diagnostic algorithm to determine if you have depression and an attention disorder, and they can take a look at your family history to gain insight into your current conditions. They may use the following treatment methods, among many others: 

• Acceptance and Commitment Therapy (ACT)

• Interpersonal Therapy (IPT)

• Dialectical Behavior Therapy (DBT)

Medication

Some evidence suggests that ADHD with comorbid depression may present treatment challenges. Pharmaceutical treatments for attention-deficit hyperactivity disorder often involve stimulant medications, which affect ADHD brains differently. Depression may be treated with anti-depressants or a variety of other medications. If you think medicine fits your situation well, contact your doctor or healthcare provider to discuss your options. 

Coping skills

While you can develop practical coping skills independently to help manage your stress, many people learn new coping strategies while working with a licensed therapist, either online or in person. 

Lifestyle changes

In addition to working with a qualified therapist and taking medication as prescribed, you can make lifestyle changes to minimize the impact of symptoms of depression and ADHD. Practice self-care regularly, ensuring all your physical, mental, and emotional needs are met to the best of your ability. Eat nutritious meals, maintain healthy sleep hygiene, and exercise regularly. Relaxation techniques like yoga, deep breathing exercises, meditation, and journaling can also make these conditions easier to manage. 

Risk factors for depression and ADHD

Below are some of the common risk factors for developing depression and ADHD: 

• University of Chicago researchers said males are more likely to develop ADHD, but females are more likely to develop depression with ADHD. 

• Attention disorder subtype can affect comorbidities. People with predominantly inattentive ADHD and the combined subtype are more likely to develop depression with ADHD. 

• Recent studies show that a mother’s mental health during pregnancy can affect whether someone develops depression with ADHD. Mothers who experienced depression or other serotonin-impairing conditions during pregnancy were more likely to have children diagnosed with depression, ADHD, or both. 

When to reach out for help

If your ADHD and depression persist for longer than two weeks, affect multiple areas of your life, cause impairment, and lead to distress, it may be time to contact your doctor or mental healthcare provider for professional help to manage your conditions. 

How therapy can help manage depression and other mental health conditions

Living with ADHD or depression can be challenging, and the task becomes more complex if you're managing both disorders. Working with a licensed therapist online through a virtual therapy platform such as BetterHelp can help you learn to handle your symptoms and minimize their impact on your mood, behavior, and thinking. If you're a parent or guardian seeking online therapy for kids from 12-19, contact TeenCounseling for assistance. With flexible appointment formats, the support and guidance of a mental health professional and you can attend therapy anywhere you have an internet connection. 

According to multiple recent studies, online psychotherapy can offer comparable results to in-person treatments, often at lower costs and with shorter wait times. Many patients said attending from home made it possible to participate in sessions more reliably, and others said divulging personal details was easier with the physical separation. Building a strong, trusting relationship with your therapist and regularly attending sessions can increase therapeutic outcomes' duration and effectiveness.