Adult ADD, Comorbid Depression and Anxiety
A 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.
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Written by Dr. Kenny Handelman - The ADHD Doctor
To find get a FREE special report on ADD/ADHD Medication, visit: Medication Mastery
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June 3rd, 2007 at 12:21 am
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.
May 28th, 2008 at 8:11 pm
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!
August 26th, 2008 at 2:00 pm
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.
September 9th, 2008 at 1:10 pm
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.
September 21st, 2008 at 4:17 am
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
October 15th, 2008 at 11:58 pm
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.
November 19th, 2008 at 1:33 pm
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.