ADHD and Depression

Depression is one of the most common co-occurring conditions in adults with ADHD. Research suggests that between 18% and 53% of people with ADHD will experience a depressive disorder at some point in their lives.

Not only do they co-occur frequently, but the symptoms of ADHD and depression often overlap. Symptoms such as low motivation, poor concentration, and mood changes can be present in both, which sometimes means depression is misdiagnosed as ADHD. This is particularly common among women. When ADHD is mistaken for depression, or when one condition is overlooked, it can delay access to the right treatment, reducing its effectiveness and negatively impacting long-term outcomes.

What does depression look like in people with ADHD?

Depression is characterised by persistent low mood, anhedonia (loss of interest or pleasure), cognitive distortions (e.g., feelings of worthlessness or guilt), fatigue, and disturbances in appetite and sleep. These symptoms must persist for at least two weeks and result in clinically significant impairment to meet diagnostic criteria.

In people with ADHD, depressive symptoms may emerge in adolescence or adulthood, often influenced by chronic experiences of failure, social rejection, or perceived underachievement. Importantly, depressive symptoms can look different in people with ADHD, where they often present as agitation, irritability, or emotional dysregulation rather than sadness or withdrawal alone. 

Additionally, the presence of depression can worsen ADHD symptoms. It also increases the risk of substance use and suicide. Studies have shown that people with ADHD are 5 times more likely to attempt suicide. Impulsivity, a core feature of ADHD, may increase the risk of acting on suicidal thoughts.

If you are experiencing suicidal thoughts, it is important to remember these thoughts will pass and to seek help from others or call a suicide prevention helpline. 

Why Do ADHD and Depression Co-Occur?

Depression and ADHD can manifest independently; however, in some people, depression develops as a result of ADHD symptoms. This is known as secondary depression.

Several mechanisms may explain why ADHD and depression frequently present together:

1. Functional Impairment: ADHD symptoms often interfere with academic, occupational, and social functioning. Persistent difficulties in these areas can erode self-esteem and foster feelings of hopelessness, leading to depression over time.

2. Emotional Dysregulation: Emotional impulsivity, a common but often under-recognised feature of ADHD, may predispose individuals to mood instability. Difficulty regulating frustration, rejection sensitivity, and chronic emotional overarousal may serve as risk factors for depressive episodes.

3. Neurobiological Factors: ADHD and depression share overlapping neurobiological substrates. Both disorders are associated with dysregulation of the dopaminergic and noradrenergic systems, as well as abnormalities in the prefrontal cortex and limbic structures. Genetic studies suggest shared heritability.

4. Environmental Stressors: Adverse life events such as academic failure, unemployment, or relationship breakdown are common experiences among people with undiagnosed or untreated ADHD and can act as stressors that precipitate depressive episodes.

When ADHD is mistaken for depression 

Although there is a high co-occurrence of both ADHD and depression, there is an overlap in symptoms of each condition, which can result in ADHD symptoms being mistaken for depression, rather than both being present. 

Poor concentration, fatigue, and low motivation are common ADHD symptoms that can be mistaken for depression. However, there are differences in how these symptoms present in each condition:

• Mood changes in ADHD last for shorter periods of time and are often caused by a setback, whereas depressive moods are chronic.

• Motivation deficits in ADHD are often due to feeling overwhelmed by decision-making, leading to difficulty initiating action. In contrast, people with depression typically experience a lack of energy and an inability to initiate activity due to pervasive lethargy

• Sleep patterns in ADHD typically result in difficulty falling asleep, whereas in depression, they can typically result in falling asleep right away but waking up many times during the night

• Anhedonia (a lack of interest in previously enjoyed activities) is a hallmark of depression, but is less common in ADHD when adequately stimulated or supported.

Treatment consideration

When treating co-occurring ADHD and depression, the approach may differ for different people, often starting with the condition that has a greater impact on the person's daily functioning. 

Pharmacological treatments

This includes stimulant medications such as methylphenidate or amphetamine based medications, which are first-line treatments for ADHD. In some cases, improving ADHD symptoms such as concentration, motivation, and emotional regulation can reduce depression symptoms, especially if it is secondary depression. Another option is non-stimulant medication, which is usually prescribed if stimulant medications are unsuitable. Antidepressants are sometimes prescribed if depressive symptoms are severe or do not improve with ADHD treatment. 

Psychological Therapies

Additionally, therapies are frequently prescribed, such as Cognitive Behavioural Therapy (CBT), which is often the first-line treatment for depression. This helps patients challenge negative thoughts and adopt healthier behaviours. Acceptance and Commitment Therapy (ACT) focuses on accepting rather than changing negative thoughts, while encouraging action based on personal values. Interpersonal Therapy (IPT) addresses the impact of disrupted relationships on mood, and Dialectical Behaviour Therapy (DBT) teaches concrete skills like mindfulness and emotional regulation. While some therapies may be difficult to initiate during severe depression, many can be adapted or combined with medication to meet the patient’s needs.

Summary

ADHD and depression can look very similar. And not only that, but it's very common to have both. Trouble with concentration, irritability, mood swings, and physical restlessness can be symptoms of either condition. 

Depression can worsen ADHD symptoms, and dealing with both conditions can greatly affect daily life. This is why getting the right diagnosis and treatment plans is important. The good news is that many types of treatments can help manage the symptoms of both conditions effectively. 

At Mentalwell, we understand how overlapping symptoms can complicate diagnosis, which is why our ADHD assessments are tailored to each individual. All assessments and treatment plans are conducted online by qualified clinicians, making it easier and more accessible to get the support you need.