Link, Comorbidity, and Risks between ADHD and Depression

Depression and attention deficit hyperactivity disorder (ADHD) are two distinct mental health issues. While depression is a mood condition, ADHD is a neurodevelopmental disorder. Nonetheless, there is a strong correlation between the two: about one in three ⁽¹⁾  people with ADHD also suffer from depression.

As a result, screening for the co-occurrence of depressive disorders is crucial for all ADHD patients. In order to properly treat the main and secondary illnesses, a comprehensive evaluation of the symptoms and a precise diagnosis are also required.

Continue reading to gain a thorough grasp of both conditions, their linkages, and the hazards of co-occurrence.

Comprehending Depression and ADHD

Understanding the characteristics and prevalence of ADHD and depression separately is crucial before delving into the specifics of how these two conditions might be related. A synopsis of these disorders and their signs may be found below.

What Are the Signs of ADHD and What Is It?

Hyperactivity, impulsivity, inattention, or a combination of these can be symptoms of ADHD. Focus, communication, and impulse control are all impacted, which has an impact on everything from relationships to academic performance.

Traditionally, ADHD was thought to be a childhood disorder. Even though its symptoms often first appear in childhood, recent research indicates that they can last until maturity. Adults with ADHD may struggle with goal-setting, organization, and time management, which can lead to problems at work.

The symptoms of ADHD differ from person to person, as is the case with many illnesses. Nonetheless, the condition is categorized into three kinds based on conventional criteria and characteristic symptoms.

ADHD that is primarily inattentive:

• Inability to pay attention
• Having trouble putting ideas into order
• Getting easily sidetracked
• Ignorance

ADHD that is mostly hyperactive-impulsive:

• Anxiety
• Interrupting other people
• Unable to remain still
• Talking too much

         A mix of inattentive and hyperactive-impulsive symptoms is what defines combined ADHD.

         Males are more likely to have hyperactive-impulsive ADHD, while girls with ADHD typically show signs of inattention.

Normal Conduct versus ADHD

Adults with ADHD are often impulsive, hyperactive, forgetful, or inattentive. Due to their inability to control their emotions, they may regularly have emotional outbursts and mood swings ⁽²⁾, as well as differing attention spans and levels of activity. However, an adult does not definitely have ADHD just because they are different from their peers or siblings. Adults may not have ADHD if they are hyperactive or inattentive in one situation but not in another. A healthcare professional evaluates the patient’s whole medical ⁽³⁾ history as well as several facets of everyday life, in addition to personal characteristics, routines, and behaviors, in order to make a diagnosis.

Why Does ADHD Occur?

There is no one accepted explanation for the causes of ADHD, despite a great deal of study and work on the subject. Rather, there are other hypotheses on the cause of ADHD, such as:

• Genetics: Researchers concur that genes are a major factor in the development of ADHD, and that a family history of the disorder increases the likelihood of getting the disorder.
  
• Environmental variables: Brain damage, diet, maternal smoking or alcohol use, and social situations are some of the possible environmental factors that may increase the chance of having ADHD.

The Signs and Signs of Depression

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, classifies depression ⁽⁴⁾, often known as major depressive disorder (MDD), as a mood illness. Depression is more than just a bad mood or transient melancholy, even if feeling down is a natural part of life. It is a serious illness that frequently leads to social isolation, issues at work and in relationships, and even suicidal thoughts. ⁽⁵⁾

Typical signs of depression include:

• For at least 14 days, a persistently down mood for the most of the day
• A decline in enthusiasm for fun activities
• Experiencing sadness, despair, and emptiness
• Constantly experiencing restlessness, irritation, annoyance, or anxiety
• A shift in weight and appetite
• Having trouble focusing
• A negative view of oneself
• Issues with sleep
• Weariness and fatigue
• Suicidal thoughts on a regular basis when suffering from severe depression

        The two forms of depression are main and secondary ⁽⁶⁾:

• When there is no past history of other mental health ⁽⁷⁾ conditions to account for recurring bouts of depression, primary depression usually develops.
• Secondary depression occurs when depressive episodes are linked to another underlying mental illness, such as obsessive-compulsive disorder (OCD), bipolar disorder, PTSD, or attention deficit hyperactivity disorder ⁽⁸⁾.

What Leads to Depression?

The following are some of the common causes of depression that have been uncovered by research ⁽⁹⁾:

• A biological component. genetic susceptibility, mood regulation problems, and chemical abnormalities in the brain (particularly affecting serotonin, dopamine, and norepinephrine).
• Environmental elements. socioeconomic challenges, stressful life events, and a lack of support.
• The medical aspect. adverse drug reactions or long-term conditions (such as diabetes, cancer, or chronic pain).

Can Depression Be Caused by ADHD?

Some individuals with ADHD experience lifetime difficulties that might result in depression, particularly if they are unable to control their symptoms. For instance, one may experience frustration and pessimism as a result of work-related problems.

Although depression is more likely to strike people with ADHD, not all of them suffer from it. This is especially common in adults who had inadequate treatment as adolescents, resulting in problems with self-esteem that are linked to social and professional challenges.

Can Emotions Be Affected by ADHD?

It might be more difficult for people with ADHD to control their emotions in general since they frequently feel emotions more strongly than other people. Typical emotional difficulties include the following:

• Rapid annoyance over little matters
• Overwhelming concern
• Having trouble relaxing while agitated
• Being sensitive to critique
• Having an overwhelming sense of eagerness to have what they desire right away

  Keep in mind that not everyone has these consequences, and many individuals can manage them with individualized expert care.

Can Depression Result From Untreated ADHD?

Numerous studies  ⁽¹⁰⁾ emphasize the link between untreated ADHD and the emergence of depression and other mental health conditions. Different age groups are affected differently:

• Children: If left untreated, ADHD causes issues at home and in school, especially with social skills and mood regulation. They could have trouble collaborating, sharing, and forming friendships, which can lower their self-esteem and cause early-onset melancholy.
• Teens: If ADHD is left untreated, it can worsen scholastic difficulties, which can result in subpar grades and dangerous behaviors (drugs, alcohol, smoking, and inappropriate sexual choices).
• Adults: Although symptoms of ADHD in adults may lessen with age, they can still be a lifetime worry. If ADHD is not addressed, it usually results in problems at work and in relationships.

Is It Possible to Misdiagnose ADHD as Depression?

Because of their unique brain processes, people with ADHD are more likely to experience anxiety and sadness. Even the symptoms of ADHD, though, can occasionally be confused with those of depression. This may occur due to parallels between these two diseases, including anhedonia, restlessness, irritability, trouble concentrating, and sleep issues. For this reason, proper diagnosis and treatment planning depend on precise assessment. To gain more information about your mental health ⁽¹¹⁾ and to have a more thorough conversation with your healthcare practitioner, you might begin by completing an ADHD screening test.

Patients are more likely to experience long-term issues when significant depression and ADHD co-occur. In addition to thoroughly evaluating patients with ADHD for comorbid depression, clinicians should take into account whether depressed symptoms are brought on by the emotional toll of ADHD or by other factors.

Why Could ADHD Be Misdiagnosed as Depression?

Although comorbid depression and ADHD are prevalent, not all people have both disorders. Sometimes, sadness is mistaken as ADHD, and vice versa. This is due to the fact that they might first seem similar, with symptoms of ADHD occasionally resembling those of depression. A person with either problem may exhibit the following symptoms, albeit they may do so for different reasons and in various ways.

Depression Symptoms Co-occurring ADHD

Like other individuals with depression, patients with ADHD also suffer from depressed symptoms. Among these symptoms might be:

• A consistently depressed mood
• A decline of interest in one’s preferred activities
• Withdrawal from society
• A shift in appetite and sleep patterns
• Unfinished assignments
• A sense of powerlessness and despair
• Sensations of self-harm

ADHD-related behaviors, particularly inattentive symptoms, might be exacerbated by depression. Adults who have both melancholy and ADHD may feel overwhelmed and disorganized, helpless, and totally out of control. Some people may even think about quitting their ADHD medication because they wrongly believe it is the cause of their poor mood. For this reason, it is crucial to communicate with a healthcare practitioner during the whole course of therapy and to address any troubling symptoms.

Depression and ADHD Risk Factors

Compared to people with hyperactive-impulsive ADHD, individuals with primarily inattentive and mixed forms of the disorder are more likely to experience related depression. Because they are more likely to experience internalized reactions to their ADHD symptoms, women with ADHD are also more likely to receive a diagnosis of depression. For instance, depressed symptoms may be brought on by or made worse by emotions such as loneliness, frustration, and guilt.

The following are additional risk factors that may raise the likelihood of depression coexisting with ADHD:

• Genetics: Individuals with ADHD who have a family history of depression are at a higher risk of developing it themselves. About 40 % ⁽¹²⁾  of the risk may be caused by this factor.
• Recent loss and grieving: The symptoms of depression might be similar to those of grief, which is a reaction to stress or loss. Even while grieving normally subsides with time, it can lead to depression, especially in those with ADHD who find it difficult to control their emotional pain.
• Conflicts: Depression can be brought on by personal upheaval. It may occur due to chronically elevated levels of everyday stress brought on by disputes as well as acute ⁽¹³⁾ traumatic situations.
• Abuse: Depression can be triggered by past abuse, such as physical, sexual, or emotional trauma, particularly in people with ADHD.
• Important life transitions: These might involve both good and bad things. Job changes, job loss, marital changes, retirement, or having a child can all trigger sadness in people with ADHD.
• Gender: According to a review ⁽¹⁴⁾, females with ADHD had higher rates of depression, which may be because they are underdiagnosed, especially if they had the inattentive form of ADHD. If left untreated, this might result in depression.
• Drugs: Some drugs used to treat other conditions, such as ADHD, can cause depression as a side effect ⁽¹⁵⁾. Consult your physician about changing your course of therapy if this occurs to you.
• Prenatal factors: According to research ⁽¹⁶⁾, a mother’s depression or serotonin problems during pregnancy may increase the likelihood that her unborn child will be diagnosed with depression, ADHD, or both.
• Early-onset ADHD: According to research  ⁽¹⁷⁾ social and intellectual challenges throughout infancy may account for the link between an early ADHD diagnosis and teenage depression.
• Other issues: Depression can result from social isolation, which includes being cut off from family or another social group.

How Can ADHD Raise the Chance of Anxiety and Depression?

When left untreated, ADHD frequently coexists with other mental health conditions, including comorbid anxiety and depression. Impulsivity linked to ADHD may cause people to take risky actions that have unforeseen repercussions in a variety of spheres of life. People may get overwhelmed by these issues and experience anxiety and sadness.

Additionally, drug usage, especially alcohol, is linked to ADHD and increases the risk of anxiety and despair.

Treatment for Depression and ADHD

ADHD and depression risk can be decreased with early diagnosis and treatment. Suicidal thoughts and other related issues can also be reduced with early therapeutic measures.

Psychotherapy, medication, or a mix of the two can be used to treat depression and ADHD. The intensity of the symptoms, their effect on the patient’s life and personality, and the provider’s advice all influence the kind of treatment that is recommended.

We’ve provided therapy alternatives and lifestyle modification advice below that may help people overcome depression and ADHD.

Psychotherapy

A common treatment for depression with ADHD is therapy. A number of evidence-based strategies have been found to be successful:

• The goal of cognitive-behavioral therapy (CBT) is to assist a patient in recognizing and altering harmful thought patterns. Additionally, it can aid in the acquisition of new abilities that enhance concentration, planning, time management, self-control, and stress reduction.
• The primary goal of interpersonal therapy (ITP), a brief treatment method, is to address serious depression. It focuses on enhancing relationships and understanding how they affect ADHD and depression.

      To receive thorough therapy, look for a therapist that specializes in both depression and ADHD (or suspect comorbidity).

Drugs

Medication can be used alone or in conjunction with psychotherapy to treat both depression and ADHD. Low levels of the neurotransmitter dopamine in the brain, which impact motivation, pleasure, and focus, are linked to several disorders. As a result, dopamine levels are raised by several drugs used to treat depression and ADHD.

• Because they raise dopamine levels in the brain, stimulants such as amphetamine (Adderall and Vyvanse) and methylphenidate (Concerta and Ritalin) are frequently given for ADHD. Both short-acting (few hours) and long-acting (up to 12 hours) versions of these drugs are available. The use of ADHD stimulants may also lower the chance of future depression.
• Atomoxetine (Strattera) is the only non-stimulant ADHD drug that has FDA approval. It helps people with depression and ADHD by influencing norepinephrine levels. It is occasionally used with stimulants.
• Depression and anxiety are treated ⁽¹⁸⁾ with antidepressant drugs. They can be used in conjunction with ADHD drugs to help reduce both conditions’ symptoms. Among them are:
• fluoxetine (Prozac) and sertraline (Zoloft), two examples of selective serotonin reuptake inhibitors (SSRIs);
• duloxetine (Cymbalta) and venlafaxine (Effexor) are examples of serotonin-norepinephrine reuptake inhibitors (SNRIs);
• tricyclic drugs such as imipramine (Tofranil) and desipramine (Norpramin);
• atypical antidepressants like Wellbutrin’s bupropion. ⁽¹⁹⁾

Lifestyle Advice

The following lifestyle adjustments may help reduce symptoms; however, your healthcare professional may advise you to combine these suggestions with medication and/or psychotherapy sessions:

• Regular exercise may help people with ADHD focus better because it may support brain growth and function, according to research ⁽²⁰⁾. The same is true for depression: physical activity can assist you in letting go of your negative energy in a more constructive manner.
• Maintain your friendships: Even though it might be difficult, going out and spending time with loved ones can improve your mood and lessen sadness.
• Combat negative thoughts: It’s critical to alter negative thought patterns in order to combat depression. The next time you’re feeling bad about yourself, use reason to refute such notions.
• Nutritional deficiencies, such as low levels of vitamin D, zinc, ferritin, and magnesium, can affect people with ADHD. Talk to your healthcare practitioner about undergoing testing to determine whether you have these deficits and whether you need to take any supplements to resupply these vital nutrients.
• Getting adequate sleep: Since sleeping helps regulate mood, settle emotions, and enhance concentration and impulse control, it is essential for controlling depression and ADHD.

Conclusion

Having attention deficit hyperactivity disorder may make living difficult and impact many areas of your life. Additionally, comorbid depression or another illness may make things more difficult. For treatment to be effective, it is essential to comprehend the complex link between depression and ADHD. To deal with this dual diagnosis with optimism, fortitude, and a better future, acknowledge the signs and dangers and adopt a comprehensive strategy. If you think your mental health ⁽²¹⁾ has gotten worse, you should think about visiting a healthcare professional right away since prompt assistance is crucial.