ADHD and depression are separate disorders but tend to have much overlap.
If you’ve been diagnosed with attention deficit hyperactivity disorder (ADHD) and depression, you might wonder what this means for you in terms of prognosis, treatment, and lifestyle changes you can make to improve your situation.
What Is ADHD?
Before we start to disentangle the complex relationship between ADHD and depression, it’s important to understand individually what is involved with each diagnosis.
ADHD is a neurodevelopmental disorder, which means that it is present from childhood and persists throughout your lifetime. People diagnosed with ADHD have what is called an executive function deficit: they struggle to follow tasks through to completion and easily become disorganized, missing appointments and losing their things.
ADHD is usually diagnosed in childhood and can be categorized into three different types.
People with inattentive ADHD have difficulty sustaining attention for tasks that they find boring, have trouble organizing their thoughts and following conversations, and may be easily distracted by what’s going on around them or their own internal dialogue.
People with hyperactive-impulsive ADHD have a constant feeling of being restless, may say things spontaneously without thinking first, and find it hard to stay still (such as sitting in a classroom for lessons).
Combination of Inattentive and Hyperactive-Impulsive
People with the combined type will experience both inattentive and hyperactive-impulsive symptoms.
What Is Depression?
Depression is more than just sadness or a case of the blues. While depression is not a lifetime diagnosis, many people experience recurrent episodes that can last anywhere from weeks to months.
Below are the most common symptoms of depression:
- feeling sad, hopeless, or empty
- being irritable, frustrated, or restless
- loss of interest in things you used to like doing
- having trouble concentrating
- eating too little or too much
- having trouble falling asleep or waking up through the night
- feeling overly tired or fatigued
Depression can make it hard to do everyday tasks like going to work or school, taking care of your personal hygiene, and eating healthy meals. It is also a life-threatening illness when it is severe and leads to suicidal ideation.
Overlap of ADHD and Depression
How do ADHD and depression overlap? We know that these are comorbid conditions, which means that when you are diagnosed with one, the odds of you also being diagnosed with the other are higher.
It’s also important to understand that there are different ways ADHD and depression can be related. This is most easily understood in terms of “primary depression” and “secondary depression.”
Primary depression occurs without any trigger and is thought to have a genetic component. Thus, if you have ADHD, you may also have a genetic risk for depression.
Secondary depression refers to depression that results because of living with ADHD symptoms. This means that while trying to cope with struggles related to ADHD, you develop depression.
Whether it relates to primary or secondary depression, we know that the relationship between ADHD and depression is strong.
Below are some facts on the overlap of ADHD and depression:
- Teens with ADHD are 10 times more likely than their peers without ADHD to develop depression
- Depression is 3 times more prevalent in adults with ADHD compared to adults without ADHD.
- People diagnosed with depression tend to have rates of ADHD diagnosis of about 30 to 40%.
- 70% of people diagnosed with ADHD may also experience depression in their lifetime.
Furthermore, in a study that examined data from the Netherlands Study of Depression and Anxiety, it was found that rates of ADHD were higher among those who had severe depression, chronic depression, early onset depression, or comorbid anxiety. This suggests a strong relationship between ADHD and depression.
With respect to suicidal ideation, a study of 627 undergraduates showed that a diagnosis of ADHD was related to increased suicidal ideation. This relationship was affected by various factors such as management of negative emotions, emotional awareness, and goal-oriented behavior.
Is It ADHD or Depression?
Sometimes it can be hard to tell ADHD and depression apart. This is because there are overlapping symptoms, but also because some ADHD medications can cause side effects that mimic depression such as loss of appetite or sleeping difficulties.
Your doctor may also mistake one condition for another or miss diagnosing you with ADHD. While both ADHD and depression involve issues related to mood, concentration, and motivation, they do differ.
A person with ADHD may experience temporary mood instability all the way back to childhood, while a person with depression tends to have chronic mood issues, beginning in the teens or later, that last weeks or months.
A person with ADHD can be motivated when something feels interesting to them, whereas a person with depression finds everything hard, regardless of whether it is interesting or exciting to them normally when they are not depressed.
A person with ADHD has trouble falling asleep because of an active mind and not feeling tired, while a person with depression may feel tired but unable to sleep due to negative thoughts and insomnia, may wake up through the night, or may sleep too long.
The symptoms of ADHD are lifelong while major depression symptoms tend to last for a certain period before eventually improving to a normal level of functioning.
Risk Factors for Comorbid ADHD and Depression
What are the risk factors for having comorbid ADHD and depression? Below are some of the risk factors that have been identified.
- Being female: Although ADHD is more common in males, females are more likely to have comorbid ADHD and depression.
- Inattentive type: Those diagnosed as inattentive type are more likely to also have a diagnosis of depression.
- Mother’s mental health: When a mother has depression during pregnancy, this is linked to a higher likelihood of giving birth to a child who is later diagnosed with ADHD, depression, or both.
- Early onset: Being diagnosed with ADHD during childhood is related to an increased risk of depression and suicidal thoughts later in life.
- Hyperactive type: For those with hyperactive type, specifically, suicidal ideation is more common.
- Not receiving treatment: People who have untreated ADHD are at higher risk for depression due to secondary issues such as low self esteem.
Treatment for Overlapping ADHD and Depression
What types of treatment are offered if you have overlapping ADHD and depression? It really depends on your particular situation.
If your depression is secondary to ADHD, then it’s likely that the focus will be on treating your ADHD in the hopes that the depression will naturally resolve. However, if your depression is severe, you might receive treatment for that first.
In general, the approach is to work on the condition that is most impairing first. While therapy can address both issues at once, often medication is prescribed for one condition and then the other.
What medications might you be prescribed? Below is a list of some options you might be given:
Stimulants such as Adderall (amphetamine/dextroamphetamine) may be prescribed for ADHD. Stimulants help to increase brain chemicals that improve focus. However, they can have side effects such as loss of appetite or trouble sleeping.
Nonstimulants such as Strattera (atomoxetine) may also be prescribed for ADHD.
Antidepressants may be prescribed for depression including Wellbutrin (bupropion), which can also help relieve symptoms of ADHD. Antidepressants can take several weeks before you will know if they are working.
Therapy for ADHD aims at improving focus and building self-esteem, while therapy for depression may target identifying and replacing negative thoughts (which may also be helpful for ADHD).
In one study of 77 adults with ADHD, those who had received extensive treatment and were less likely to have ruminative thinking were shown to be more resilient to episodes of depression.
What can you do on your own to improve your ADHD and depression? The basics are most important: eat healthy meals, exercise regularly (aerobic exercise is important if you have ADHD), and practice good sleep hygiene.
Another good strategy is to prevent yourself from becoming bored if you have ADHD, as this can worsen your mood.
One way to accomplish this is to keep an “interest closet” or another spot in your home where you store activities that you can do when you are feeling bored. Add things like books you want to read, crafts you want to do, etc. so that there’s never a time that you’re at a loss.