ADHD, anxiety, and depression — what’s the connection?

Estimates put the percentage of adults with attention-deficit/hyperactivity disorder (ADHD) at 4.4%. Just 20% seek treatment for ADHD symptoms though. And a majority — 80% — don’t seek treatment for ADHD but for anxiety and/or depression. Hence the link between ADHD, anxiety, and depression where depression and anxiety are caused by untreated ADHD in adults. 

In this article, we dig into how and why and treatments, so you can work with a provider to feel better.

 Klarity Health makes it easy to connect with board-certified mental health providers in your state who can diagnose and prescribe treatment for depression, anxiety, and ADHD. Find a provider today.

How ADHD, anxiety, and depression are connected

Anxiety and depression can’t cause ADHD. But, there are 3 main ways undiagnosed or untreated ADHD in adults leads to secondary — or coexisting — depression and/or anxiety.

Self-esteem and ADHD, anxiety, and depression

Untreated ADHD can cause a person with ADHD to struggle to succeed in school, at work, and in relationships. They might make impulsive decisions like gambling, overspending, or misusing drugs and alcohol. 

A person who doesn’t realize they have ADHD might blame themselves for the circumstances they’re in. They might develop depression or anxiety because it seems so difficult for them to accomplish tasks that they see other people easily completing.

Because their ADHD is untreated, they may have poor self-esteem and are at greater risk of developing anxiety or depression.

Emotional dysregulation and ADHD, anxiety, and depression

A key symptom of ADHD, anxiety, and depression is emotional dysregulation. People with difficulty controlling or regulating their emotional responses to stimuli can get angry, irritated, and frustrated at seemingly small or insignificant things.

When any mental illness is untreated, symptoms like emotional dysregulation can make maintaining relationships difficult, because the person appears disproportionately angry, irritable, or frustrated. When people in that person’s support group feel pushed away, it causes more isolation for the person with the mental illness, further worsening depressive or anxiety symptoms.

If the underlying cause of emotional dysregulation comes from secondary depression or anxiety, treating the depression or anxiety through standard means (antidepressants and psychotherapy) may help reduce symptoms.

But, if the underlying cause of emotional dysregulation is untreated ADHD, antidepressants may only address the secondary depression and not the root problem.

ADHD, anxiety, and depression and motivation and concentration

Low motivation and poor concentration are ADHD symptoms also common with anxiety and depression. 

Shared symptoms of ADHD, anxiety, and depression

ADHD is an inheritable genetic condition. There’s also evidence that primary depression and anxiety are inheritable. A person with ADHD is 3 times more likely to develop secondary (from another disorder) depression than the general population. And ADHD symptoms overlap with symptoms of anxiety and depression. 

The most common symptoms of ADHD, depression, and anxiety are included below. Symptoms common to all 3 conditions are bolded.

Symptoms of ADHD

Symptoms of ADHD fall into 2 categories:

• Inattentive symptoms
• Hyperactive and impulsive symptoms

A person with ADHD might have inattentive symptoms and not hyperactive or impulsive symptoms or vice versa. Sometimes, they have both. Both types of symptoms are common in children, but hyperactive and impulsive symptoms don’t always carry into adulthood.

Inattentive symptoms

• Having a short attention span
• Being easily distracted
• Making careless mistakes
• Forgetting things easily — misplacing items or misremembering directions
• Missing appointments, bills, or other items with a due date
• Difficulty with complex tasks that require focus, time, and attention
• Difficulty listening to spoken directions
• Needing to change activities frequently, trouble staying on task for long periods
• Difficulty organizing tasks

Hyperactive and impulsive symptoms

• Unable to sit still for long periods
• Feeling restless or excited when inappropriate
• Fidgeting or moving constantly 
• Poor concentration
• Excessive or improper physical movements
• Excessive or inappropriate talking
• Emotional dysregulation: getting disproportionately angry, irritated, or frustrated over small inconveniences
• Unable to wait their turn or  interrupting frequently
• Making frequent, rash decisions without considering consequences or dangers — including excessive gambling, shopping sprees, unprotected sex, or alcohol and drug use

Symptoms of anxiety

Several disorders fall under the umbrella category of anxiety disorders. General anxiety disorder (GAD), panic disorder (PD), social anxiety disorder, and various phobias are included.

The symptoms of generalized anxiety disorder include: 

• Feeling restless, agitated, or on edge
• Feeling fatigued or tired all the time
• Difficulty concentrating, focusing, or paying attention
• Emotional dysregulation: getting disproportionately angry, irritated, or frustrated over small inconveniences
• Having unexplained pains with no apparent source or cause — headaches, muscle aches, stomachaches
• Insomnia and difficulty staying asleep
• Ruminating or catastrophizing over fears and thoughts 
• Difficulty regulating feelings of worry and panic

Learn more about ADHD vs anxiety in adults.

Symptoms of depression

There’s a difference between primary and secondary depression. Secondary depression occurs as a result of another disorder. With primary depression, the symptoms are most likely inherited and don’t have clear causes. Secondary depression has a clear cause — another mental or physical illness (chronic or terminal illness), life circumstances, or past trauma.

Whether depression is primary or secondary, the symptoms are often the same.

• Feeling hopeless, sad, empty, or tearful
• Emotional dysregulation: getting disproportionately angry, irritated, or frustrated over small inconveniences
• Loss of interest in activities that once brought joy—sex, hobbies, sports, etc.
• Sleep disturbances, sleeping too little, or sleeping too much
• Becoming easily distracted
• Lack of energy, feeling fatigued all the time
• Feeling anxious, restless, or agitated
• Slowed thinking and cognition; slowed speaking or body movements
• Eating too much or too little
• Feelings of worthlessness or guilt
• Rumination about past failures or self-blame
• Difficulty concentrating, thinking, making decisions, remembering events and appointments
• Frequent thoughts of death, suicide, or self-harm 
• Physical aches and pains that have no apparent source 

Learn more about the link between ADHD and depression.

Symptoms common to ADHD, anxiety, and depression

People with all 3 conditions (or some combination of all 3) can experience difficulty focusing, concentrating, and paying attention. They may appear restless or otherwise agitated and get distracted easily. 

Comorbid mental illnesses: how ADHD, depression, and anxiety are treated

You may not know you have ADHD, but develop anxiety or depression. In this case, you have what’s called comorbid anxiety and/or depression and ADHD, meaning you have 2 or more at the same time.  

You’re more likely to seek treatment for your anxiety or depression. A skilled provider can connect your symptoms to underlying, untreated ADHD and treat you accordingly.  

When treating multiple disorders at once, healthcare providers usually treat the disorder that causes the greatest impairment first. For example, if a person’s secondary depression has gotten so bad that they’re suicidal, medical professionals prioritize treating the depression over other conditions.

But if depression and anxiety symptoms are less severe, a medical professional might recommend treating ADHD with medication and seeing how that affects anxiety and/or depression symptoms. Additionally, it’s possible to treat all 3 simultaneously potentially with a combination of stimulants and antidepressants.  

Dopamine — the link in treating ADHD, anxiety, and depression

Research has shown that imbalanced dopamine levels in certain brain areas cause some of the symptoms of anxiety, depression, and ADHD. And addressing dopamine imbalances can be a key part of medication treatment for all 3 conditions.

Dopamine is a neurotransmitter (or chemical messenger) in the brain. It helps regulate (or is in part responsible for):

• Physical movement
• Working memory
• The reward center of the brain (pleasure and motivation)
• Concentration and attention
• Sleep and arousal
• Learning

Dopamine is also critical for creating norepinephrine and epinephrine, which are vital to memory, alertness, learning, and attention in the brain and central nervous system. 

Low levels of dopamine in certain areas of the brain can lead to problems with motivation, attention, and a lack of desire to do pleasurable or joyful activities (due to dopamine’s role in regulating the brain’s reward center). But when dopamine levels are too high, it can lead to aggressiveness and impulsiveness. 

Stimulants and antidepressants to treat ADHD, anxiety, and/or depression

Most antidepressants and central nervous system (CNS) stimulants used for ADHD treatment have a measurable effect on the levels of dopamine or dopamine-dependent chemicals in the brain. And antidepressants that primarily affect norepinephrine and dopamine can help alleviate ADHD and anxiety symptoms. 

CNS stimulants include Adderall (amphetamine/dextroamphetamine), Vyvanse (lisdexamfetamine), Concerta (methylphenidate ER), Focalin (dexmethylphenidate) etc. They increase or block the reuptake of neurotransmitters, including dopamine, norepinephrine, or serotonin. 

Learn more about stimulant vs non-stimulant ADHD meds. 

Antidepressants include Paxil (paroxetine), Prozac (fluoxetine), Zoloft (sertraline), Pristiq (desvenlafaxine), Cymbalta (duloxetine) Effexor XR (venlafaxine), etc. They’re used to treat ADHD, anxiety, and depression and are considered non-stimulant ADHD medications. Key classes of include:

• Selective serotonin reuptake inhibitors (SSRIs) that affect serotonin and dopamine
• Norepinephrine/dopamine-reuptake inhibitors (NDRIs) (like Wellbutrin) that affect norepinephrine and dopamine
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) that affect serotonin and norepinephrine (which requires dopamine to be synthesized)

Learn more about the differences between SSRIs vs SNRIs.

Healthcare providers though have to be careful when prescribing medication. Many conditions result from imbalances where there is too much or too little of a certain neurotransmitter in different parts of the brain.

Because of all the variables — including a person’s unique body chemistry — finding the right mix of medications can require trial and error. 

The good news is that finding the best treatment doesn’t have to be done alone. Caring, qualified healthcare providers experienced in treating ADHD can help you manage your ADHD symptoms and determine if your untreated ADHD is causing anxiety and/or depression. If they are, they can help treat those as well and recommend a tailored treatment plan that may include medication and therapy.

Find care for your untreated ADHD, anxiety, and/or depression

On Klarity Health, appointments with licensed, caring providers are available often in as little as 24 hours.* There’s no insurance needed and no hidden fees. Find a provider today and put the symptoms of ADHD, anxiety, and/or depression behind you.