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If you often feel scatterbrained, fidgety, and overcome by negative feelings about yourself or your circumstances, you may be dealing with a combination of ADHD and depression.
Attention-deficit/hyperactivity disorder (ADHD) is a common mental disorder that affects both children and adults. Major depressive disorder (often, simply called depression) is a separate mental disorder that, like ADHD, can severely affect a person’s quality of life.
People with ADHD are at greater risk of depression than members of the general population. Conversely, people with depression are more likely than other adults to report symptoms of ADHD (Bron, 2016).
When someone has comorbid ADHD and depression, which means they’ve been diagnosed with both disorders, the presence of each condition tends to increase the severity of the other (Bron, 2016).
What is adult ADHD
ADHD is most often diagnosed in childhood, but it continues into adulthood in about 2.5% to 5% of cases. However, some people live with unrecognized ADHD for years and don’t receive a diagnosis until much later in life (Caye, 2018).
Just as our lives are different in adulthood, so too are the signs and symptoms of ADHD. Where hyperactivity is often a central feature of ADHD in some children, adults are less likely to experience hyperactivity and more likely to experience impulsiveness, disorganization, and problems focusing (Caye, 2018).
Adults with ADHD often have more trouble functioning in society than their peers of similar intelligence. This can lead to consistent underachievement and dissatisfaction, feelings that make them vulnerable to depression (McIntosh, 2009).
Common ADHD symptoms in adults include (McIntosh, 2009):
- Difficulty with paying attention, often leading to careless mistakes
- Difficulty managing time and completing tasks
- Losing important things like phones, keys, and wallets
- Difficulty following instructions and completing duties at work
- Getting easily distracted by unrelated thoughts or activities
- Forgetting to complete routine activities like cleaning, paying bills, and keeping appointments
- Trying to do too many things at once
- Acting impulsively
Adults with hyperactivity have additional symptoms like fidgeting, talking excessively, interrupting others, and an inability to sit still. These impairments can negatively affect quality of life and make it difficult to create social bonds (McIntosh, 2009).
What is depression
Depression is a serious psychiatric illness that goes way beyond just feeling sad. People with depression experience a host of debilitating symptoms that negatively impact their quality of life and prevent them from functioning normally.
Depressive episodes can range in severity from mild to severe, but they all share the same basic characteristics. Common symptoms of depression include (Chand, 2020):
- Feelings of sadness, emptiness, or hopelessness
- Loss of interest in many of the activities that used to bring joy
- Irritability, anger, or low frustration tolerance
- Insomnia (difficulty falling or staying asleep) or hypersomnia (sleeping too much)
- Tiredness or complete loss of energy
- Appetite changes
- Rapid weight loss or weight gain
- Feelings of worthlessness or guilt
- Trouble thinking, concentrating, or making decisions
- Fidgeting (wringing hands, bouncing feet, pacing)
- Moving or talking slowly
- Thinking a lot about death or suicide
What is a comorbidity?
A comorbidity is the presence of two or more distinct disorders in a single individual. It is a very broad term used to describe any illnesses that a person may have at any given time, whether the disorders began at the same time or decades apart (Valderas, 2009).
Not all comorbidities are equally significant. For example, if an older adult has had a heart condition for many years and they later develop arthritis, the conditions are technically comorbid, but the connection is of minor importance.
In the world of mental health, though, identifying comorbidities, the sequence in which conditions show up, and the way in which they overlap, is of great importance.
For example, about half of all people who have a mental health disorder will also have a substance abuse disorder at some point in their lives. In such cases, attempts to treat the substance abuse disorder without also addressing the underlying mental illness would probably be unsuccessful (Valderas, 2009).
Overall, a diagnosis of comorbid psychiatric disorders, like depression and anxiety or depression and ADHD, negatively affects the course of both disorders, making them more severe, persistent, and difficult to treat (Valderas, 2009).
What’s the link between ADHD and depression?
Several studies have shown that there is a strong link between ADHD and depression in children, adolescents, and adults. One study found that youths with ADHD were 5.5 times more likely to experience depression than their peers. In a study of adults with depression, about 5% to 12% experienced symptoms of ADHD (Bron, 2015).
ADHD and depression have several overlapping symptoms, which can complicate the diagnostic process. For example, a doctor may see that their patient is having difficulty concentrating and failing to keep a job. If the patient is an adult with no documented history of ADHD, the doctor may assume that their patient is depressed, when they may really have ADHD.
Signs seen in both ADHD and depression include (Chand, 2020; Caye, 2015):
- Trouble concentrating on work or reading
- Difficulty paying attention to others
- Avoiding activities
- Fidgeting and restlessness
- Increased risk of substance use disorders
- Strained personal relationships
- Poor performance at work or school
The primary differences between the two conditions relate to mood and hyperactivity or impulsivity. People with depression have a depressed mood nearly every day, but they do not generally display hyperactivity or impulsivity.
Overall, the presence of ADHD symptoms seems to be more closely connected with people experiencing severe or chronic depressive episodes. According to research, probable ADHD appears to be 7.5 times more common in people with chronic depression than in the general population (Bron, 2015).
Associated risks of ADHD and depression
Substance abuse is often used as a tool to self-medicate. Both depression and ADHD are associated with a higher risk of substance abuse (Iqbal, 2019; Magnus, 2020).
Impulsivity is a symptom of ADHD, and suicidality is a symptom of depression—this puts people with comorbid ADHD and depression at higher risk of suicide (Beauchaine, 2020; Chand, 2020). Friends and family should look out for potential warning signs. Signs that someone is considering suicide include (National Suicide Prevention Lifeline, n.d.):
- Talking about wanting to die or kill themselves
- Researching ways to kill themselves
- Acquiring tools to kill themselves (guns, pills, razor blades)
- Talking about being a burden to others
- Increasing their use of drugs or alcohol
- Behaving recklessly
- Withdrawing from friends and family
- Mood swings
Treatment for ADHD and depression
Treating ADHD and depression often involves a multifaceted strategy that includes both medication and psychotherapy.
- Therapy—Psychotherapy, or talk therapy, is used to treat both ADHD and depression. Cognitive-behavioral therapy (CBT) is commonly used for both depression and ADHD. This type of therapy helps people make changes to patterns of negative thinking and behavior. It is also an effective treatment that helps people focus on both short- and long-term goals (Magnus, 2020; Chand, 2020).
- Medication—Antidepressants are often used to treat both ADHD and depression. However, the primary ADHD medications instead are stimulants. Stimulants are effective in about 70% of people with ADHD (Magnus, 2020).
- Nerve stimulation—Nerve stimulation is a process in which a device generates low-level electrical pulses. Trigeminal nerve stimulation has been shown to reduce hyperactivity, while vagus nerve stimulation has shown promise in treating depression (Magus, 2020; Young, 2020).
Get help in a crisis
Depression and ADHD are difficult conditions to live with. It is not uncommon for people struggling with these conditions to reach moments of crisis, where frustration and despair overtake the rational mind.
If that happens, reach out for crisis support. If you are experiencing suicidal thoughts, call 911 or The National Suicide Prevention Lifeline to get 24/7 crisis support. You do not have to be suicidal to call; crisis centers are available to support you during any difficult time.
- Beauchaine, T. P., Ben-David, I., & Bos, M. (2020). ADHD, financial distress, and suicide in adulthood: A population study. Science advances, 6(40), eaba1551. doi: 10.1126/sciadv.aba155. Retrieved on https://pubmed.ncbi.nlm.nih.gov/32998893/
- Bron, T. I., Bijlenga, D., Verduijn, J., Penninx, B. W., Beekman, A. T., & Kooij, J. J. (2016). Prevalence of ADHD symptoms across clinical stages of major depressive disorder. Journal of affective disorders, 197, 29–35. doi: 10.1016/j.jad.2016.02.053. Retrieved on https://pubmed.ncbi.nlm.nih.gov/26970265/
- Caye, A., Swanson, J., Thapar, A., et al. (2016). Life span studies of ADHD-conceptual challenges and predictors of persistence and outcome. Current psychiatry reports, 18(12),111. doi: 10.1007/s11920-016-0750-x. Retrieved on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919196/
- Chand S.P., Arif H. Depression. (2021) In: StatPearls [Internet]. StatPearls Publishing. Retrieved Apr 15, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK430847/
- Iqbal, M. N., Levin, C. J., & Levin, F. R. (2019). Treatment for substance use disorder with co-occurring mental illness. Focus (American Psychiatric Publishing), 17(2), 88–97. doi: 10.1176/appi.focus.20180042. Retrieved on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526999/
- Magnus W., Nazir S., Anilkumar A.C., et al. (2020) Attention deficit hyperactivity disorder. In: StatPearls [Internet]. StatPearls Publishing. Retrieved Apr 19, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK441838/#article-17985.s7
- McIntosh, D., Kutcher, S., Binder, C., Levitt, A., Fallu, A., & Rosenbluth, M. (2009). Adult ADHD and comorbid depression: A consensus-derived diagnostic algorithm for ADHD. Neuropsychiatric disease and treatment, 5, 137–150. doi: 10.2147/ndt.s4720. Retrieved on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695217/
- National Suicide Prevention Lifeline (NSPL). We can all prevent suicide. Retrieved Apr 19, 2021 from https://suicidepreventionlifeline.org/how-we-can-all-prevent-suicide/
- Valderas, J. M., Starfield, B., Sibbald, B., Salisbury, C., & Roland, M. (2009). Defining comorbidity: implications for understanding health and health services. Annals of family medicine, 7(4), 357–363. doi: 10.1370/afm.983. Retrieved on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2713155/
- Young, A.H., Juruena, M.F., De Zwaef, R. et al. Vagus nerve stimulation as adjunctive therapy in patients with difficult-to-treat depression (RESTORE-LIFE): study protocol design and rationale of a real-world post-market study. BMC Psychiatry, 20(1), 471. doi: 10.1186/s12888-020-02869-6. Retrieved on https://pubmed.ncbi.nlm.nih.gov/32993573/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.