Adult ADD, Comorbid Depression and Anxiety
ByA subscriber sent in this question: “when I was a child I was diagnosed with ADD. Although I was never on medication I didn’t actively seek much help. I’m beginning to realize that perhaps now at age 26 it is related to my depression and anxiety issues as well as motivation. I’m still struggling to get through a degree and not quite sure where to turn. I think I should go see someone about this but I’m not sure who the best person to turn to is”.
This question is a very important one. This is an adult who is describing having been diagnosed with ADD early in life and now has depression and anxiety issues. It sounds as if the depression and anxiety are the main concern – however, let’s remember that this person sent his/her question in to The ADHD Doctor! So, obviously there is some concern there about the impact of the ADD or ADHD as well.
This question is very important along the lines of comorbidity of ADD and ADHD, particularly in adults.
I’m going to assume that the individual who diagnosed the ADD early on was accurate, and that a thorough and complete assessment was done.
Is ADD still a problem for this individual?
I don’t have a lot of information to go on, but it seems that it likely still is. He or she is struggling with motivation, and completion of a degree. That said, this could be completely related to the depression and anxiety that is going on.
It would be important for this person to have a thorough assessment with a psychiatrist with expertise in adult ADD or ADHD. The problem is that they can be hard to find. Also, often it is the child psychiatrist who are better at ADD or ADHD. All child psychiatrists train in adult psychiatry first, and we learn about ADD and ADHD, and how it can change through the course of the lifespan.
Comorbidity in adult ADD is very common. Only 14% of adults with ADD don’t have a second disorder. In other words, comorbidity is the rule, not the exception.
It is very common for an adult with ADD or ADHD to have comorbidity with depression and anxiety.
Sometimes, it is minor depression or anxiety – somewhat of a self esteem issue. This can relate to all of the years of people saying:
“you would do better if you would only live up to your potential, or try harder or keep more organized, I know you can do better etc.”
Eventually a person with ADD can start to feel, “well I must be that kind of loser that everybody’s talking about.”
Then, depression and anxiety can develop.
Coming back to the specific question, the main issue for this person is figuring out if the depression and anxiety are the main problem, or whether the ADD is still active and is the main problem.
If the depression and anxiety are the main problem (or the dominant problem, even if ADD is still there), then they have to be treated first, with therapy plus or minus medication. After these are more stable, it would be important to review if ADD is still there and if it needs treatment.
If the ADD is the main problem, then it will need treatment – with therapy, coaching, plus or minus medication. If the ADD improves, most likely minor depression and anxiety would improve as well.
It can be very complicated for adults with ADD or ADHD, because there aren’t that many doctors who are comfortable and competent in adult ADD.
Start with your primary care doctor (family doctor), ask questions, and seek referrals until you have the answers you need. Also, consider a psychologist who may be able to help with the diagnosis and therapy, though he or she couldn’t prescribe the medication.
Hi
I wonder if someone with ADD feel quite often bored or nervous it migth be due to its ADD or due to anxiety and depression.
Because about me with ADD, depression and anxiety when I start to use Ritalin at begining I became more relaxed and calm and my concentration improved alot.
but now after one year taking medicine my situation some how change it seems that sometimes after the effect of medicine gone I start to feel more nervous.
I have the opposite problem. For 20 years I have been being treated for severe depression. In the last 5 years or so I have been hospitalized 6 times, 1 suicide attempt, ECT treatments, and an endless list of anti-depressants that for some reason I am not responding to at an acceptable level. I have been on “cocktails” of combinations of antidepressants, mood stabilizers, anti-psychotics and tranquilizers. Needless to say my life has been a mess.
I recently for the first time went to see a different psychiatrist for a second opinion after the first one told me he was stumped and didn’t know what to do to help me anymore. The new doctor has suggested that I have a combination of sleep apnea and ADD, and that perhaps once these conditions have been treated I may find I have little or no depression at all, and if I do it would be easily treatable.
This blows my mind and I’d love to hear from anyone who has had the “reverse” experience.
Thanks!
Regarding this person, congratulations on fighting your way through your degree! Good work! Sometimes, you have to be water over stone; going over and over the hard places until they wear down.
It also may be more that you aren’t in love with your major. That happens with younger students. Someone else is paying your bill, so you go in the direction they want.
In my case, after abandoning my bachelor’s, I went back at 37. Because of all the general degree requirements I had soldiered through, I could concentrate on my major.
Water over stone, like in a stream, requires each pass to wear away only a little bit at a time. One class at a time still equals a degree, just not in the usual time frame.
Regarding depression/anxiety, that’s what I was dx’d with for twenty years. The ADD was recent. I’m taking Strattera, brutal on the guts, but it seems to address all three versus Ritalin.
Yes, it’s very painful to have these disorders. I can never fully trust what I feel and think because it may be distorted. Counseling for me, helped when I found a therapist who had a master’s and had been practicing for 25 years. I did poorly when I worked with people with less training.
Either way, your brain is still growing. It really does get better as you get older. Some of this is just waiting out the symptoms as medical professionals can only help so far.
The rest is you choosing to be the leader in your care and accepting any recommended exercises and doing them even if they seem to not work. The discipline is preparing you for the day when your brain becomes better.
I actually have anxiety and attention problems. Surprisingly I have found that adderall can reduce my anxiety. Usually in the morning is when my anxiety is the highest. It seems, though, immediately after I take my adderall, my anxiety levels decrease. I suspect it may have something to do with lower levels of the neurotransmitter dopamine. Increasing dopamine may reduce anxiety levels for some people. Increasing norepinephrine on the other hand seems to increase anxiety.
I think I have a lot of other comorbid disorders as well, so it is interesting that only 14% of people with ADD/ADHD don’t have other problems.
All my family members have any one of (sometimes two) of anxiety, ocd or depression. I haven’t tried whether adderall can reduce my anxiety, any way thanks
When my depression and anxiety were at there worst I was a total scatterbrain. I couldn’t focus on anything for more than a minute or so no matter how hard I tried. I don’t know if that classifies me as ADHD or not but it sure felt like it. As I gained control over my anxiety, the clarity returned to my thinking.
I think your post is fantastic, well thought-through and delivered well.
Sound advice for those who are literally smashing their heads on the wall with a diagnosis that may not even be correct.
I’ve unfortunately seen many patients that have lived for years in pain and agony due to a well-meaning practitioner and a misdiagnosis.
A very good friend of mine recently broke up with her boyfriend after a long term relationship and im sure she’s going through a severe depression phase. However, she seems to be distracting herself on a daily basis, trying to block thoughts of her boyfriend, and instead going out every night, drinking, then going to work the next day. If she was doing this once per week, I’d think that she’s just trying to get over it, but every night….is this ADHD?
Thanks for the great article! I was diagnosed with a hybrid of depression, anxiety and ADHD years back and have been receiving treatment with therapy and medication. It’s assuring to know that comorbidity in adult ADD is very common. I know I’m not the odd one out! Thank you so much!
Regarding Depression’s comments:
Not to pidgeonhole people, because so many things influence us beyond just biological, but it sounds like a basic broken heart.
ive taken a huge variety of psych meds from anti depressants to moodstabilizers to antipsychotics for my long term depression and anxiety and none of them seemed to work. i was recently diagnosed with add, a condition which i feel ive had for awhile due to my utter inability to focus at work or school. this comorbid situation in my head has made my life a living hell for right over a decade. amazingly enough by treating my add with adderrall nearly all of my negative symptoms are gone. ive been told i was bipolar by one Dr. and have been told i was borderline by another . i am glad to finally have the correct diagnosis of comorbid add with depression and anxiety. i also was a substance abuser for years,pouring alcohol and drugs on this problem, now i know what it is and how to treat it
my only hope is that this reaches someone and lets them no they are not alone
if you can relate i love you and pray for you
David,
My case sounds just like yours, I’m sick of trying all different meds., can you tell me what cocktail you are on, I am sick of the whole psychiatric thing. My Dx is
Severe depression, add, anxiety and panic attacks. I would appreciate any input, from anyone with similar diagnosis that is happy with their med combo.
I have add and mild to severe anxiety what wil help one without making rhe other worst??????????
Hi Wendy,
There comes a point where we (and western medicine) have done all we can. If I take Ritalin, Strattera or Wellbutrin, I have higher anxiety and better concentration. If I take anti-anxiety meds (Lexapro, Effexor, Zoloft) with them, I gain 50 lbs.
It’s a grieving process to accept the long term issues of this disorder. There are no magic medications.
The bottom line is to do what you can, but understand your symptoms will never be completely gone. That’s actually a very liveable place.
I have a lot of anxiety at times. I don’t do this perfectly, just have been at it for 21 years. Learning to just ride the waves of icky and let them flow over me has taught me I won’t drown in them. They’re only feelings.
If they’re at a point where I can’t fully control my behavior, I get some short term help. I talk with a counselor as well.
One positive point of having so much anxiety is that I tend to have more courage. Everything scares me so much anyway that I’m more willing to take risks!! How’s that?
It took me years to find a doctor that I was comfortable with that actually helped me. Finding the correct medication was a long term prospect as well…I believe I tried 4 different anti-depressants before I found one suitable in terms of minimal side effects and efficacy.
I hear you there, Bob Marvin!
Great post. Some natural anxiety remedies to look into are St.John’s Wort, SAMe, L-Theanine, and Tryptophan. There’s also cognitive behavioral therapy (CBT) and programs like Panic Away and The Linden Method, to name a few. Hope this helps!
Ritalin works!
Anxiety disorders are a unique group of illnesses that fill people’s lives with persistent, excessive, and unreasonable anxiety, worry, and fear. They include generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (SAD), and specific phobias. Although anxiety disorders are serious medical conditions, they are treatable.
An anxiety disorder and a co-occurring chronic pain disease can make a person’s health more difficult to treat. But a variety of treatments and lifestyle changes can offer relief. Possible health complications are noted below:
• Increased disability or reduced functioning
• Poorer quality of life
• Poorer response to treatment
• Poorer treatment adherence
• Increased perception of disease severity
Source: chronic-anxiety.com
I am so grateful that I just stumbled upon this site after doing a search for the relationship between ADD and anxiety. I was never treated for the ADD as a child, because I was told that my “only problem” was that I was lazy and “should just buckle down”. As an young adult, I first obtained treatment in college after having received a (no longer on the market) migraine headache medicine, Daprisal by SKF, in the 1970s. It contained stimulant medication.
THIS WAS AN EPIPHANY! I couldn’t believe how much better I was able to concentrate, and how much better overall I felt. When it was taken off the market in the late 70s, my medication was switched to Dexamyl, which was soon after taken off the market as well. I then was put on Dexedrine, or Ritalin (made me too jittery) and I have since tried other stimulant medication with success.
As a child, I was anxiety ridden, and now I know that it probably was compounded by the undiagnosed ADD. I wasn’t lazy…I just couldn’t concentrate, and all of this PLUS an abusive home life compounded it all.
These days as a 56 year old man, a few years older, perhaps wiser, but definitely not cured of either the anxiety nor the ADD, I find most doctors hesitant to prescribe stimulant medication because (and “almost” understandably so) they believe that stimulant medication exacerbates the anxiety.
Yes, generally for those who don’t have the co-existing ADD.
I therefore have learned to keep my mouth shut about the anxiety, and just talk about the ADD. The minute one mentions anxiety these days, all these doctors want to do is prescribe those useless antidepressant medications (i.e. Lexapro, Cymbalta, Zoloft, etc.). In my case, they made the anxiety markedly unbearable, and I felt terrible. (Treatment worse than the disease!)
I am currently on Adderall XR 30 mg each day and it works, kind of.
When I moved up here recently from out of state, I told my new doctor here that I had been very successfully treated with the Adderall 10 mg 3x per day. He refused to prescribe that saying there is much more of an addiction potential than with my current 30 mg extended release.
I do NOT find anywhere near as good result with the extended release capsules as I did with the 10 mg dose because I was able to titrate the times I took it.
That’s the medical profession today, and frankly I find it very frustrating and maddening.
I would love to hear anyone’s comments, similar, or dissimilar.
Thank you.
Jon,
Thanks for sharing your story.
As a doctor (albeit in Canada) – I know that what you’re saying is true.
This is one of the reasons that I have this blog and my sites, because of the fact that people often have to manage their own treatment.
It seems absurd that you would have to leave out the anxiety issues to make sure that you actually get the care that you need…
I don’t know that I have anything specific to help you out… sorry…
Thanks Dr. Handelman.
I went to college in upstate NY and have visited Canada not a few times.
I often fantasized about moving to Canada (not sure there is a need for Spanish teachers there) because it seems you folks don’t have all the hang ups that American doctors and out society have.
Rightly so, there is concern. There IS a drug problem in this country – BUT, the rest of us suffer and go under-treated by a medical profession that is more concerned with the state medical boards than with effective patient care.
I appreciate your concern.
@ Ginny you could have food allergies.
I would like too add my two cents into this because it might help someone. First, please over look my spelling for i didn’t do well in school. I am a 52 year old male who for over the past twenty years has had severe depression with severe anxiety. I am also a drug abuser. I have been going to the same Dr for the whole time, have taking all of the anti-depression/anxiety meds that are out there. My Dr said i had OCD, PTSD, depression and so on and so on. I am now on medadone to help control my drug use and it has help with that part. Around three years ago I started to hear about ADD in adults and I started to read about it. I saw a study that said over 70% of the kids with ADD that didn’t get help would likely have drugs/drink problems with they grew up. It also said people who had ADD and didn’t get treatment would also likely have problems with depression and anxiety. When I was a kid they didn’t know about ADD, so I was veiw as a trouble maker and a slow learder. I started thinking about my life, that maybe the problems i was having as a adult was because i had ADD as a kid. I talked this over with my DR who said that it may well be the case, but because i was a drug abuser he coundn’t treat me with the meds that worked the best for ADD. During my reseach into ADD i came across a Dr in ATL GA who worked with adults with ADD DR Darvin Hege and I made a appointment to see him. This has turn out to be the BEST phone call i have ever made. He looked at my whole life and felt like I had had ADD as a kid and was still having the same problems. He gave me a new drug vyvanse and trusted me enought not to take more than what he said. Vyvanse is a form of speed, but the way it is made it has low abuse problems. I was very afaid of taking it because i didn’t want to add to the problems that i aready had, but felt very good with this Dr that he knew what he was doing. I have been on vyanse for about four months now, and yes at first it was a little like speed but after time that went away but the drug is still doing its job. In my whole life I have begun to feel nomal, I can sit still and read a book or paper and not get my mind going off in left field. You can not began to know how great it is to be able to read and study stuff. I had aways felt like i was dumb. To be able to set and wait for a red light has made my and your life safer. My depression is going away, and i don’t understand how taking a drug that is call a upper/speed (can’t spell the name or class of drug but you know what i am taking about) could have such a calming affect on me. It has had a MAJOR affect on helping my life. I will soon start to college and have began a life long dream of playing the guitar. In the past i could never set still long enough to lean how to play, now i am setting down and playing for two or more hours. This has been a complet 360 for my life. I pray each day that the vyvanse will keep working, i feel like i have 50 years of learing to catch up on. They say 70 is the new 50, i hope so. If things keep going like they are now, by the age of 70 i will have a college education and playing in a band. I think I will name the band Vyvanse.
i am a 37 year old woman i have had problems with my mental health since i was a child and have always felt different. at school i couldnt concentrate and found all the lessons boring i found it hard to relte to others and im socially clumsy and awkward i would start acting silly and doodling when i found it boring my homework suffered as i never understood properly what had been said because i found it boring and at home it would take so long i would be too distracted and go and play instead i was asked to leave eventually the thought of exams and how far behind i was scared me as i had too many deadlines etc.. after a troublesome time at home with a depressed father and a mother with anxiety i tried for the first time to take my life since then my life has been a big muddle and i am in dept because i constantly forget to do things, normally because i get distracted. i had been sleeping rough doing drugs etc,when one day i read a book about add it was like reading about me.. so i then asked my doctor for a referal to a psychiatrist to test me, i was diagnosed with anxiety i didnt have any tests done tho it was just one meeting where the doctor took notes. since then ive had a psychological evealuation to test both my memory and my iq my working memory was found to be borderline of 78 whilst my iq was found to be above average of 110 i do not stress over the small things others do as to me most things are a struggle as my brain is so disorganised and hardly worry about anything and i still find social situations uncomfortable as it takes me a while to adjust to new people coming in or out.. i have so many different hobbies and i am far braver than most i tend to speak my mind and am honest my timekeeping is lousy i cannot hold down a job i find it hard to finish things ive started and if i get distracted i get really irritated as it means i have to start again or ive lost track of everything wheras most women can multitask i find it hard as i seem to only be able to focus on the one thing and when i do i kind of get enveloped into that one thing and everything around me seems to blur out… i am wondering if anyone thinks i may have been mis-diagnosed or am i being anxious and mis-diagnosing myself. my life has been a mess to be truthfull homeless forgetting rent payments or because im jobless being kicked out because im late for work everyday as it takes me so long to wake up in the morning or if i find it too boring i just leave… i would really appreciate some advice from someone. my daughter jasmin was diagnosed with borderline traits of adhd, she is always in trouble at school for forgetting answering back talking too much, joking around, not paying attention not putting her hand up being late for school etc and our relationship is voletile she answers back is cheeky she never stopps talking fidgeting and she can be very noisy and disruptive…we both have extremely vivid imaginations though my friends say i think differently to other people.. if anyone has any thoughts on this please help?( sorry about the essay i know it went on abit lol)
Look very seriously at working memory training and the dopamine modulating effects it is producing. Several recent studies show significant effects on reducing depressive symptoms. Here is one of many studies, it is easy to read.
Cognitive training lowers the risk of worsening depressive symptoms
http://insciences.org/article.php?article_id=3396