Research closely links attention deficit hyperactivity disorder (ADHD) and depression.1 While ADHD is overwhelmingly diagnosed in childhood, depression is thought to have a later onset and is typically identified in adolescence or adulthood. However, no matter when either condition is diagnosed, the right therapy and medication options can make a huge difference in how someone feels.
The Connection Between ADHD & Depression
ADHD and depression can be connected for a variety of reasons ranging from problematic early-learning environments to genetics.2 Someone’s environment, genetics, and biological links influence whether they will experience both depression and ADHD.
Environmental Links
Researchers have suggested that an ADHD diagnosis in childhood is linked to higher rates of environmental stressors that can have lasting impacts on the way people interpret events.1 These early experiences may lead to negative thought patterns making someone more susceptible to becoming depressed. Specifically, the lack of self-control attributed to people displaying symptoms of hyperactivity and impulsivity can lead to the idea that other negative experiences are out of their control, as well as demoralization and low self-esteem.
Additional early environmental factors that may serve as a link between ADHD and depression include family interactions and parenting practices.1 Due to the behavioral challenges that are common to children with ADHD, it is not uncommon for adults and caregivers to respond with negative, inconsistent, and at times coercive strategies. The unpredictable nature of these practices can lead to stressful interactions with adults and peers.2
Genetic Links
Studies of identical twins show that genetic factors are largely responsible for the co-occurrence of ADHD and depression.2 One study found that approximately 70% of the variance between the two disorders can be explained by genetic factors.3 This could mean that the same type of genetic predisposition could manifest as ADHD in childhood and then depression later on in life.2
Biological Disposition
Magnetic resonance imaging (MRI) studies that have investigated the connection between brain biology and major depressive disorder have implicated the hippocampus, a specific region of the brain. Interestingly, the hippocampus is most directly linked to learning and memory. Other functions of the hippocampus include emotion regulation and social cognition.4 Researchers investigating this region of the brain in children with ADHD and depression found significantly reduced volume and connectivity.5 The experts concluded that neurobiological deficits associated with ADHD may increase the risk for depression.
Symptoms of ADHD & Depression
While there may be some overlap between the symptoms of depression and ADHD, there are also distinct differences and understanding these are critical for the proper treatment plan for either.
Symptoms of each condition include:6
| ADHD | Depression |
|---|---|
| Inability to plan | Hopelessness |
| Hypervigilant, hyper-focused | Feeling withdrawn |
| Sensory issues | Inability to complete tasks |
| Impulse issues | Changes in weight and eating |
| Sleep issues | Sleep issues |
| Low self-esteem | Low self-esteem |
| Emotional dysregulation | Poor coping skills |
| Anxiety | Anxiety |
| Inability to make decisions | Inability to make decisions |
| Overthinking | Self-harm behaviors |
ADHD Signs & Symptoms
ADHD features a pattern of inattention with or without hyperactivity that interferes with functioning or development. Typically identified in childhood, symptoms of ADHD need to be evident across multiple settings and with different caregivers to be diagnosed.6
Signs of ADHD include:7
- Sense of underachievement/low self-esteem
- Difficulty getting organized
- Chronic procrastination
- Trouble with follow-through on tasks
- Tendency to speak one’s mind, with little insight into the timing or appropriateness of the remark
- Frequent search for high stimulation
- Intolerance for boredom
- High distractibility
- Often creative, intuitive, and highly intelligent
- Difficulty following “proper” procedure
- Low tolerance for frustration
- Impulsivity
- Tendency to work endlessly
- Sense of insecurity or worry
- Mood swings
- Restlessness
- Risk for drug misuse and dependent behavior
Symptoms of ADHD are usually first observed in childhood, before age 12. These children often display difficulty focusing in the face of challenging tasks (inattention), excessive motor activity (hyperactivity), and in thinking through the consequences of their actions (impulsivity).
Symptoms of Depression
The core features of depression involve either depressed mood, loss of interest or pleasure in activities, or both for a period of at least 2 weeks.6 These features must be present for most of the day, nearly every day. It is common for either insomnia or fatigue to be the most obvious presenting feature of depression. Children and adolescents may have more obvious irritability than sadness.
Additional co-occurring symptoms of depression can include:
- Changes in appetite (either diminished interest or excessive eating)
- Periods of oversleeping
- Feelings of worthlessness or guilt
- Difficulty thinking/concentrating and trouble making decisions
Importantly, these episodes must cause severe distress or impairment in social, occupational, or adaptive functioning. People experiencing more mild episodes of depression may demonstrate less of an impact on daily functioning, but often report that day-to-day activities take a lot of effort. Depression can occur at any age, but the likelihood of being diagnosed with the disorder increases with entry to puberty.
What Is the Risk of Suicidal Thoughts?
Those with ADHD and depression are at an increased risk of engaging in self-harm behaviors and suicide. Those with ADHD are six times more likely to have thoughts of suicide than those without ADHD, and that number increases to ten times more likely with a co-occuring mental health condition such as depression.8 To add, depression is linked with both increase risk of suicidal thoughts and attempts. About 50% of those with depression as a diagnosis have experienced suicidal thoughts at least once, and 16% have attempted suicide.9
Can ADHD Cause Depression?
Left untreated, ADHD can lead to feelings of depression, anxiety, and even self-harm behaviors. Given the symptoms of ADHD such as inattention and impulsive actions, it can be a huge challenge to become organized and structured. Each day you may wake up with a plan and goal of what you want to accomplish and how, but even one thing on that mental to-do list can trigger the anxiety and low self-esteem to drive you into a depressive episode. Over time, living with this pattern of failing your own expectations can lead to a diagnosis of depression, because the failure to meet your own to-do list is both overwhelming and disempowering.10
Can ADHD Medication Cause depression?
There is evidence that ADHD medication can be both a treatment for and sometimes a cause of depression symptoms, so it’s important to consider the person’s complete list of symptoms with a medical team before beginning or stopping any medications. Adderall is the drug of choice for treatment of ADHD, and as a stimulant, can be beneficial for the treatment of depression. For some, adderall is a cause of depression symptoms, depending on the dosage of the medication. Also, because stimulants have side-effects, the withdrawal from adderall can lead to depression symptoms such as sleep issues, feeling tired all the time, and self-harm thoughts.11
ADHD vs Depression
While there are overlapping symptoms between ADHD and depression, there are distinct differences in how these symptoms manifest.
Here are a few of the key differences between ADHD and depression:
Mood
Emotionally, those with depression have chronic low moods and feelings, and those tend to be equal to or outweigh other emotions. Those with ADHD tend to have fleeting emotions and are triggered frequently by distractions.
Motivation
Those with depression tend to lack motivation and drive and can appear lazy. Depression makes it hard for people to engage in activities and initiate anything. Those with ADHD tend to have no problem with acting on a plan, but rather deciding what to do first. They often have a hard time with the initial decision and become overwhelmed by having to make that choice.
Sleep
Those with depression tend to have issues with staying asleep through the night but can fall asleep quickly. Those with ADHD often have difficulties with sleep, such as getting to sleep. However, once they do fall asleep, they stay asleep.
Time With the Diagnosis
ADHD is a lifelong condition and depression can be life long, but with proper management, depression can go into remission. Depression can be exacerbated by ADHD and when those flare ups do occur, it can come back to the surface. Living with ADHD and depression can take a toll, but long-term management of both conditions is attainable.
Treatment of ADHD & Depression
Researchers suggest that the type of effective treatments for those with ADHD that help to prevent and/or address depression vary by the age of the patient.1 With the right therapy, and often medication, those with ADHD who are also experiencing depression can start to feel better.
Therapy
For younger children, behavioral parent training (BPT) may be the most useful way to improve long-term outcomes. BPT works primarily with caregivers to create consistent structure, supervision, and rewards for appropriate behavior. For older children with ADHD and depression, behavioral parenting interventions should be coupled with cognitive therapies to address both the environment and negative thinking styles that include perceived lack of control.
For adults with ADHD, depression in the context of ADHD may be more treatment-resistant, as people dealing with both diagnoses are often more impaired.12 Specifically, the symptoms of ADHD (i.e., impulsivity, distractibility, and inability to focus) can interfere with treatment adherence, which may make it harder to stick with a treatment plan.
However, key components of cognitive behavioral therapy treatments are likely to benefit adults with both depression and ADHD. These components include coaching on adaptive thinking, cognitive restructuring, and behavioral activation.12
ADHD and Depression Medication
While there have been effective medications for either ADHD or depression, it is not fully clear how depressive disorders may impact how people respond to ADHD medications.13 The results of one well-controlled study suggested that the best antidepressant for ADHD and depression may be the combination of atomoxetine (Strattera) and fluoxetine (Prozac). It was well tolerated by 173 patients, who showed improvement in both their ADHD and depressive symptoms.14
How to Get Help for ADHD & Depression
People diagnosed with ADHD, depression, or both often require the assistance of trained professionals to see meaningful improvement in their symptoms. It is common for friends or loved ones to be the first ones to identify the need for additional services; they can often spot ways that symptoms may be impacting daily functioning better than the affected individual themselves.
Primary care physicians (e.g., pediatricians, internists) can be extremely helpful in making referrals to specialists with expertise in presenting problems. Ultimately, licensed mental health providers such as psychiatrists or psychologists have the training to use evidence-based approaches to properly assess and provide treatment to improve symptoms.
If you’re looking for a therapist, one simple way to find someone with the right specialties, insurance, and cost is through an online therapist directory.
Final Thoughts on ADHD & Depression
Both ADHD and depression can be chronic conditions that require substantial support. Small productive steps, taken one step at a time, are essential to ensure that struggles do not become overwhelming. Practicing self-care, including short-term goal setting and finding opportunities to laugh or interact with another person, can be extremely helpful during periods of high stress. Reaching out to healthcare providers can be an important and appropriate way to get started.
