The Relationship Between Depression and ADHD

Depression and ADHD are not the same thing. However, there is often overlap between the two. They can also occur at the same time.

If you've been diagnosed with attention deficit hyperactivity disorder (ADHD) and depression, you might wonder what this means for you in terms of prognosis, treatment, and lifestyle changes you can make to improve your situation.

What Is ADHD?

Before we start to disentangle the complex relationship between depression and ADHD, it's important to understand individually what is involved with each diagnosis.

ADHD is a neurodevelopmental disorder, which means that it is present from childhood and persists throughout your lifetime. It is important to note that it is considered a disability because we live in a neurotypical-oriented society.

People with ADHD may exhibit what is called an executive function deficit: they struggle to follow tasks through to completion and easily become disorganized, missing appointments and losing their things.

Inattentive

People with inattentive ADHD have difficulty sustaining attention for tasks that they find boring, have trouble organizing their thoughts and following conversations, and may be easily distracted by what's going on around them or their own internal dialogue.

Hyperactive-Impulsive

People with hyperactive-impulsive ADHD have a constant feeling of being restless, may say things spontaneously without thinking first, and find it hard to stay still (such as sitting in a classroom for lessons).

Combination of Inattentive and Hyperactive-Impulsive

People with the combined presentation will experience both inattentive and hyperactive-impulsive characteristics.

What Is Depression?

Depression is more than just sadness or a case of the blues. Many people experience recurrent episodes that can last anywhere from weeks to months or longer.

Some of the most common symptoms of depression include:

• Feeling sad, hopeless, or empty
• Being irritable, frustrated, or restless
• Loss of interest in things you used to like doing
• Having trouble concentrating
• Eating too little or too much
• Having trouble falling asleep or waking up through the night
• Feeling overly tired or fatigued

Depression can make it hard to do everyday tasks like going to work or school, taking care of your personal hygiene, and eating healthy meals. It is also a life-threatening illness when it is severe and leads to suicidal ideation.

Overlap of Depression and ADHD

How do depression and ADHD overlap? We know that these are comorbid conditions, which means that when you are diagnosed with one, the odds of you also being diagnosed with the other are higher.

Below are some facts on the overlap of ADHD and depression:

• Teens with ADHD are more likely than their peers without ADHD to develop depression.
• Depression is three times more prevalent in adults with ADHD compared to adults without ADHD.
• There is an estimated 6.5-fold increase in the risk for depression within the first year after an ADHD diagnosis.

Furthermore, in a study that examined data from the Netherlands Study of Depression and Anxiety, it was found that rates of ADHD were higher among those who had severe depression, chronic depression, early-onset depression, or comorbid anxiety. This suggests a strong relationship between ADHD and depression.

With respect to suicidal ideation, a study of 627 undergraduates showed that a diagnosis of ADHD was related to increased suicidal ideation. This relationship was affected by various factors, such as managing negative emotions, emotional awareness, and goal-oriented behavior.

Is It ADHD or Depression?

Sometimes it can be hard to tell ADHD and depression apart. This is because there are overlapping symptoms, but also because some ADHD medications can cause side effects that mimic depression such as loss of appetite or sleeping difficulties.

While both ADHD and depression involve issues related to mood, concentration, and motivation, they do differ.

Mood

With ADHD, you may experience temporary mood lability (which means rapid and sometimes dramatic changes in mood) all the way back to childhood. In depression, on the other hand, these mood episodes usually first appear in the teens or later.

Motivation

If you have ADHD, you probably know that you often feel motivated when something grabs your interest. When you are depressed, however, doing anything at all can be incredibly hard. Even if it's something that used to hold your interest, you just can't find the energy or motivation to care.

Sleep

ADHD can make it feel like your mind is always "on." This means you often feel like you have tons of energy, but it can also make it more difficult to settle down at night and sleep. Feeling depressed also makes it hard to sleep, but that's often due to negative thoughts and insomnia. Depression may also cause you to wake up through the night or may sleep too long.

Course

ADHD is lifelong. The traits and characteristics may change somewhat over time, but it doesn't just "go away." Major depression symptoms, on the other hand, tend to last for a certain period before often improving to a normal level of functioning.

Risk Factors for Comorbid ADHD and Depression

There are certain factors that might increase your risk of having comorbid ADHD and depression? Some of these include:

• Being female: Although ADHD is more common in males, females are more likely to have comorbid ADHD and depression.
• Inattentive type: Those diagnosed as inattentive type are more likely also to have a diagnosis of depression.
• Mother's mental health: When a mother has depression during pregnancy, this is linked to a higher likelihood of giving birth to a child who is later diagnosed with ADHD, depression, or both.
• Early-onset: Being diagnosed with ADHD during childhood is related to an increased risk of depression and suicidal thoughts later in life.
• Not receiving treatment: People who have untreated ADHD are at higher risk for depression due to secondary issues such as low self esteem.

Treatment for Overlapping ADHD and Depression

What types of treatment are offered if you have overlapping ADHD and depression? It really depends on your particular situation.

Medications

What medications might you be prescribed? Below is a list of some options you might be given:

Stimulants

Stimulants such as Adderall (amphetamine/dextroamphetamine) may be prescribed for ADHD. Stimulants help to increase brain chemicals that improve focus. However, they can have side effects such as loss of appetite or trouble sleeping.

Nonstimulants

Nonstimulants such as Strattera (atomoxetine) may also be prescribed for ADHD.

Antidepressants

Antidepressants may be prescribed for depression including Wellbutrin (bupropion), which can also help relieve symptoms of ADHD. Antidepressants can take several weeks before you will know if they are working.

Therapy

Psychotherapy for ADHD aims at improving focus and building self-esteem, while therapy for depression may target identifying and replacing negative thoughts and behaviors (which may also be helpful for ADHD).

One study found that adult ADHDers who received extensive psychotherapy were less likely to have ruminative thinking. They were also more resilient to episodes of depression.

Lifestyle Changes

What can you do on your own to improve your ADHD and depression? The basics are most important: eat healthy meals, exercise regularly (aerobic exercise is also important if you have ADHD), and practice good sleep hygiene.

One way to accomplish this is to keep an "interest closet" or another spot in your home where you store activities you can do when you are bored. Add things like books you want to read, crafts you want to do, and podcasts you want to listen to. This way you can also find something to grab your interest and alleviate boredom.

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