The Link Between ADHD & Depression
ADHD and depression are separate disorders that commonly occur together. Studies have shown that anywhere from 19-53% of people with ADHD also have a depressive disorder. However, the actual rates of depression and ADHD are often underreported in adulthood. One 2018 study on depressed adults found that 34% of patients presenting to a clinic for symptoms like suicidal ideation and chronic dysphoria had undetected ADHD.
People living with ADHD and depression may experience symptoms of their disorders more intensely than if they had only one condition — making diagnosis and treatment essential for wellbeing. Why do so many people with ADHD have depression? How can you tell if you have depression? Let’s take a deeper look at the symptoms, potential causes, and strategies for coping with these commonly co-occurring disorders.
Table of contents
What is ADHD?
ADHD (attention deficit hyperactivity disorder) is a disorder that impacts areas of the brain that are involved in planning, attention, shifting focus, and executing tasks.
There are different subtypes of ADHD — inattentive, hyperactive, or combined — that are associated with unique sets of symptoms. People with inattentive subtypes are more likely to be easily distracted, forgetful and tend to zone out. Those with hyperactive subtypes are often constantly physically active, fidgety and may be overly talkative. When a person has combined type ADHD, they have several symptoms from inattentive and hyperactive types of ADHD.
For many people, especially females, ADHD often goes undiagnosed into adulthood.
Signs you may be depressed
Everyone has experienced what it’s like to have a depressed or down mood. Depressive disorders differ from a sad mood in a few key ways.
First of all, depressive disorders tend to last weeks, months or even years. Depression is also characterized by causing significant impairments to a person’s life in key areas of functioning such as work, family or social life. Finally, depression is more than just a down mood. It is associated with other symptoms such as difficulties sleeping, eating, focusing, and experiencing a loss of interest in activities you previously enjoyed.
Let’s take a closer look at mood, physical symptoms and behavioural changes associated with depressive disorders.
Mood changes
Changes in mood are one of the most recognizable symptoms of a depressive disorder. Most people experience shifts such as feeling down or sad more often than not for most days of the week. In some instances, a person who is depressed may experience irritability or agitation instead of sadness. People experiencing a depressive episode are also more likely to engage in negative self-talk, interpret their world more negatively, and struggle with self-esteem.
In order to get diagnosed with a depressive disorder, these negative emotions need to persist uninterrupted for at least two weeks. Although emotional ups and downs are common in ADHD, when a depressive disorder is present, it can feel like you are stuck in the “down” section of your emotions.
Physical symptoms
Depression is also commonly associated with physical symptoms that tend to accompany the onset of a down or irritable mood. Some common physical symptoms can include:
Feeling tense and on edge, or feeling slowed down;
Fatigue or low energy;
Changes to sleeping patterns; and
Changes to appetite (eating more or less)
In a day-to-day sense, some of these changes may feel extreme or subtle. For instance, some people may notice a gradual increase in nervous fidgeting and pacing. On the other hand, another person may experience a feeling that their limbs are heavier, and even getting out of bed suddenly takes extreme effort.
It is also prevalent to experience changes in sleeping. Sleeping issues also occur in around 70% of people with ADHD. A person with depression may sleep excessively (hypersomnia) or have difficulty sleeping (insomnia). When it’s due to a depressive disorder, there will be a significant change in sleeping patterns that co-occur with other symptoms of depression, such as low or irritable mood.
Behavioural changes
A core symptom of depression is loss of enjoyment from things or activities that previously brought you pleasure. This symptom can impact everything from hobbies to how you interact with people in your daily life.
One of the most common behavioural changes that occur as a result of depression symptoms is withdrawal. Withdrawal can look slightly different for everyone, depending on the individual and their environment. For instance, withdrawal for one person may look like hiding their true feelings from everyone, whereas for another person, it might mean staying inside all day to avoid interacting with the world. If you already use these coping mechanisms with ADHD, you may notice they worsen significantly with a depressive episode.
Symptoms like low mood, fatigue, sleeping issues, and negative self-talk can also make it extremely challenging and exhausting to accomplish daily tasks. It is normal for people living with depression to struggle with completing household chores, and it can feel nearly impossible to maintain healthy habits. In severe cases, even getting dressed in the morning can be a massive undertaking. Similar symptoms can occur with ADHD, but the root cause is generally feeling overwhelmed or frozen by the hovering to-do list. With depressive disorders, you are more likely to feel too down or low even to begin a task.
People with depressive disorders are also impacted cognitively. Issues with paying attention, remembering conversations, and juggling tasks can feel overwhelming. It’s common to miss appointments, make errors and forget important details when living with a depressed brain. These issues with focus, attention and motivation can feel extremely debilitating when there is pre-existing ADHD.
Testing for depression
Only a clinical professional can diagnose you with a depressive disorder. However, if you feel like you might have depression, there are several quick assessments you can find online to help you determine if you have symptoms common in depressive disorders.
Patient Health Questionnaire (PHQ-9): This 9-item self-report questionnaire can help you determine whether you have core symptoms of depression and if those symptoms might significantly impact your functioning at work, home or socially.
Quick Inventory of Depressive Symptomatology (QIDS-16): This 16-item questionnaire helps identify and rank the severity of depressive symptoms you are experiencing and can also be used to monitor whether you are improving over time.
Beck Depression Inventory (BDI): This 21-item questionnaire is one of the most widely used tools to screen for a variety of symptoms that commonly occur in depressive disorders.
Does ADHD cause depression?
ADHD, especially when undiagnosed, can lead to significant emotional struggles such as low self-esteem, chronic dysphoria, and even suicidal ideation. Without being given a proper label and options for treatment, many people with ADHD spend their lives feeling inadequate, rejected, and incapable of living up to certain standards. Although depressive disorders and ADHD can develop independently, ADHD quite often contributes to the development of depressive disorders.
In addition to emotional struggles, ADHD contributes to the chances of developing depressive disorders through comorbidities, neurobiological pathways, genetic risks, and environmental risks.
ADHD comorbidities
As many as 80% of adults with ADHD have at least one comorbid psychiatric condition. Some common comorbid conditions with ADHD include mood and anxiety disorders, substance use disorders, eating disorders, Post-Traumatic Stress Disorder (PTSD) and personality disorders.
Multiple disorders can sometimes interact, making symptoms worsen. For instance, a person with ADHD and an eating disorder would experience disproportionate amounts of negative self-talk, which can increase the risk of developing a depressive disorder. Getting a proper ADHD diagnosis is vital in accessing appropriate resources for your unique needs.
What are comorbidities?
Comorbidity is a medical term used to describe the presence of more than one medical condition at the same time. It is common for people to have comorbid mental health disorders due to overlapping risk factors. Getting clarity on your diagnosis is important because the best path forward for treatment often varies depending on which conditions are present.
Neurobiological risks of Depression in ADHD
Neurobiology, also known as the bits and pieces of your brain and nervous system, offers some insight into why people with ADHD often have other mental health disorders, such as mood and anxiety disorders. A recent study published by BMC Psychiatry on adult ADHD and comorbid disorders found that altered activity in specific brain regions and abnormalities in neurotransmitters such as dopamine and norepinephrine (NE) signalling may contribute to developing comorbid disorders with ADHD.
Essentially, the way your brain processes your world is altered in ADHD, which increases your risk of developing other conditions like anxiety, depression or substance use disorders. These differences impact things such as emotional regulation, motivation, and how your brain interprets rewards.
One of the key brain areas identified that may increase your risk of mental health conditions is known as your default mode network (DMN). Your DMN is the area of your brain active when you are at rest and is associated with your internal mental state, planning for the future, and engaging in goal-oriented tasks. DMN dysfunction occurs in both depression and ADHD. In ADHD, DMN dysfunction can look like daydreaming, difficulty switching tasks, or having obsessive thoughts. With depression, dysfunction in these brain areas is often associated with rumination and replaying sad or negative moments. Some experts believe that the pre-existing differences in this brain region may increase the risk of depressive disorders in people with ADHD.
Genetic risks for ADHD and depression
Depressive disorders have a fairly high heritability of around 50%. A 2019 study on genetics and ADHD found that ADHD is also highly heritable at 74%. These numbers indicate that genetics are significantly involved in the development of these disorders. Some genes that contribute to ADHD have also been found to be involved in depressive disorders, which may partially explain some of the overlaps in the disorders. Having a parent with ADHD or depression doesn’t mean you’ll definitely get it; it just means you have an increased risk compared to the general population.
Environment and life experiences
Some life experiences, such as a history of abuse, traumatic events and bullying, can all contribute to the development or worsening of a mental health disorder. Depressive disorders and ADHD can be exacerbated by stressful life conditions such as job instability, break-ups, grief and other types of losses.
The time of year may also impact the onset of depression in ADHD. According to a 2006 study on mood disorders in adults with ADHD, those living with ADHD are at a higher risk of experiencing seasonal affective disorder, a form of depression contained in a specific season, usually winter.
Depression affects LGBTQ2S+ folks at higher rates than cisgender and straight people. Factors such as social rejection, family conflict, assault, bullying, harassment, and gender identity struggles can all increase the likelihood of depressive disorders. Members of the LGBTQ2S+ who also live with ADHD may find that they are especially prone to challenges in their school, work and social lives that make them more susceptible to developing depressive disorders. A strong social support system can help offset some of these risk factors and help improve outcomes for people seeking treatment for depression and ADHD.
Treating your ADHD & depression
Although ADHD and depressive disorders have a lot in common, they are separate conditions with some differences in treatment approaches. When getting a diagnosis, your healthcare provider will discuss your treatment options and may suggest treating one disorder first. For instance, many people find that their depressive symptoms reduce substantially when their ADHD is effectively treated. Treatment options for both conditions generally include any combination of medications, therapy and lifestyle changes.
Therapy
Several types of therapy can help with symptoms of both depression and ADHD. Sometimes, your therapist may use various techniques specifically tailored to help you with your symptoms. Some common forms of therapy for ADHD and depression include Cognitive Behavioral Therapy, Mindfulness, and Acceptance and Commitment Therapy.
Most talk therapy will focus on helping you find effective strategies for dealing with your symptoms and may also help you address and work through previous trauma and challenges you’ve faced. If therapy feels new or intimidating for you, picture it as hiring a personal trainer for your mind. Just as building muscles in the gym takes time, repetition and expert advice — therapy requires commitment, flexibility and dedication to making gradual positive changes. Similar to a fitness plan, your therapy adventure entails many ups and downs.
Medication
Once you have been diagnosed with a depressive disorder, your doctor may prescribe medication to help reduce your symptoms. Medication is often the first line of treatment for depression and can be used in combination with talk therapy and lifestyle changes. Commonly prescribed medications include antidepressants, anti-anxiety or sedative medications, or mood stabilizers. Your physician may also try exploring antidepressant medications such as Bupropion (Wellbutrin), which can help with symptoms of ADHD and depression.
Researchers are currently exploring the benefits of certain psychedelics, such as psilocybin, which has potential benefits for alleviating depression due to its action on the default mode network. More research is needed to determine whether these compounds can help treat ADHD and depression.
Lifestyle
Positive lifestyle changes can be implemented as part of a treatment plan to reduce symptoms and help to improve the quality of life in people living with ADHD and depression. Learning effective and practical techniques to help reduce stress, boost confidence, and navigate your challenges can make symptoms more tolerable and even bring relief.
For some people, it may be as basic as scheduling a daily shower, whereas others may be able to take a daily walk, eat a cooked meal, meditate, or even engage in a scheduled social activity. One effective technique for people who feel stuck is to sign up for a class or event that brings enjoyment. For instance, if you’ve always put off photography or pottery, it might be time to urge yourself to engage in a new adventure. If a scheduled event feels too overwhelming, start by taking a short walk somewhere in nature. Even the tiniest positive act, like putting on a fresh pair of pants, can be enough to help you feel like you’re moving forward.
Leaning into your support system is also key in lifestyle changes. Enrolling people you trust to be accountability buddies, go on friend dates and just be there when you need someone to sit with is extremely helpful when you’re going through a tough time. It often feels much easier to help those we love when they are down than it is to help ourselves. It may help to picture your inner child. Do your best to allow that inner child to come out when you feel down and give them what they need. Nurturing that part of you is an excellent form of self-soothing that can even help bring some healing.
When dealing with depressive disorders, efforts should be made to avoid substance use, such as alcohol, as they can make the symptoms of depression worsen.
Get help for depression & ADHD
Navigating mental health resources as an adult with ADHD can feel overwhelming. It is extremely common to have your ADHD symptoms dismissed, overlooked and disregarded when experiencing significant life challenges that put your health and wellbeing at risk. Here at Frida, we understand what it’s like to feel unheard and misunderstood as you seek to find your best path forward through the challenges you face. We also understand that mental health issues are unique to you, and every person is different.
Getting a proper ADHD diagnosis based on approved diagnostic criteria is a vital step in finding the right treatment and lifestyle changes for you. If you think you may have ADHD and depression, try taking Frida’s self-assessment tool today and get connected with a clinical expert who can provide you with a full evaluation and treatment plan. You’ll also receive ongoing care because your needs are dynamic, and change takes time.
Living with ADHD and depression can feel incredibly isolating. Just know that you are not alone. You deserve to feel heard and access to care that can help you get unstuck. Your path forward begins today.
