Recognize and Treat Depression & Anxiety Disorder with ADHD

Michael Banov

Life with ADHD can be stressful. When there is stress, depression and anxiety may not be far behind. In fact:

• Rates of depression in children with ADHD have been estimated from 13%-27%, with some clinical reports showing rates as high as 60%.

• Rates of anxiety disorders in children with ADHD can run as high as 30-40% with slightly higher rates in girls. Into adulthood, rates of anxiety may increase to 40% of men and 50% of women. (Anxiety disorders include generalized anxiety, phobias, social anxiety, panic disorder, and obsessive-compulsive disorder.)

Recognizing and accurately diagnosing mood and anxiety disorders in someone with ADHD can be challenging, mostly because these conditions share many of the same symptoms. Depression often features concentration difficulties, motivational problems, restlessness, memory disturbances, and distractibility. Anxiety often appears as fidgety, unable to sit still, trouble with focus, and impaired concentration.

Sometimes people experience ADHD symptoms for years but do not reach out for help until a severe mood or anxiety disorder dramatically worsens their day-to-day functioning. A health care professional then faces a diagnostic dilemma: are the ADHD-like symptoms a result of ongoing or worsening ADHD, or because of a newly developed mood and/or anxiety problem? If the depression and anxiety are treated, will the ADHD symptoms improve as a result?

You may find differing opinions, depending on which health care professional you see, as to which approach is best for you or someone you are trying to help. These considerations, and others, affect the treatment approach a patient, family, and clinician may choose:

  • If ADHD symptoms in these areas lead to depression and anxiety, then it makes sense to focus on getting the ADHD under optimal control before treating anything else. Other psychiatric symptoms could resolve as life feels more in control. 

  • If depression and anxiety are mimicking ADHD, or simply exacerbating a more manageable underlying ADHD, then the best approach would to be to treat the other psychiatric conditions first.

 Accurately diagnosing depression and anxiety in children and adolescents is more difficult than in adults.

Symptoms in Adults

    • Common adult depressive symptoms include feelings of sadness, guilt, loss of motivation, and decrease in energy.
    • Anxiety symptoms include elevated heart rate, shortness of breath, and gastrointestinal complaints.
    • Emotional symptoms of anxiety include expecting the worst to occur, fearing something bad happening, or developing specific fears or phobias.

Symptoms in Children

    • Irritability, excessive physical complaints (headaches or stomach pains), and behavioral problems. May be less likely to ask for help because they do not recognize that feelings of sadness are abnormal.
    • Anxiety includes elevated heart rate, shortness of breath, gastrointestinal complaints, expecting the worst to occur, fearing something bad, or specific fears or phobias.
    • Children may show signs of being afraid to go to school or be separated from a family member or other familiar person.

A diagnosis of depression and anxiety can be unsettling to someone with ADHD and their loved ones. Some may see it as “more serious” than “just ADHD.” They may imagine having to take “powerful and dangerous” antidepressants and antianxiety medications.

But that is not necessarily the case. Most depression and anxiety problems are mild to moderate in severity and can be easily treated, often without medications. If mood and anxiety problems are identified early, there are effective non-medication treatments that involve some lifestyle modifications such as making changes in diet, exercise, avoiding illicit drugs and alcohol use, and reducing work and school load. There are many proven types of psychotherapy that can help such as cognitive-behavioral therapy, interpersonal psychotherapy, and play/art therapy. 

Some complementary medicine treatments such as omega-3, B12 and folate supplements, SAMe, valerian root, and others have been shown to help depression and anxiety, as well. You should consult with your physician if you choose to take any natural therapies, since these products are not as carefully regulated as prescription medicines. “Natural” doesn’t always mean these products are safe, and some of the long-term effects, especially in children, may not be fully known. One common natural antidepressant, for example, St John’s Wort, can have some potential serious side effects and dangerous interactions if taken with other prescription medicines such as antidepressants.

When depression and anxiety is more serious, always make sure that a health care professional is involved and conducts a safety assessment. If medications are recommended, be reassured that antidepressants and antianxiety medicines have a long track record of being safe and effective when prescribed by someone well trained in their use. As with any medication, there are always risks of bad effects. Searching unreliable Internet sites will uncover plenty of descriptions of bad outcomes that people may or may not have experienced because of the medicine.

That said, these medications do not agree with everyone and may cause some disagreeable, but usually not serious, side effects. In some cases, they simply do not work.

The goal should always be to use medication only as long as needed. Engaging in lifestyle changes (described above), along with medication, can help make medicines a short-term intervention rather than a long-term solution.

If you suspect yourself or someone you care about as having ADHD and depression and/or anxiety, make sure you see a health care professional who is experienced and knowledgeable in treating all conditions. Many doctors or counselors may know a great deal about ADHD, but not be as comfortable in identifying and managing mood and anxiety problems. Educate yourself about which therapeutic options are available and become an active participate in your treatment. Use reliable sources of healthcare information such as the National Institute of Mental health site www.nimh.nih.gov or www.healthyplace.com.

The road to recovery from depression, anxiety, and ADHD can have many twists and turns, but, fortunately for most, has a rewarding destination.

Please Note:There is no one antidepressant that has been shown to be more effective than another. Many, but not all antidepressants, are effective for a number of anxiety disorders as well. Often these medicines are preferable to the class of antianxiety medicines called the benzodiazepines (BNZs) which include such medicines as Xanax (generic- alprazolam), Ativan (generic-lorazapam), and klonopin (generic-clonazepam). BNZs are helpful for short-term management of anxiety or for occasional, episodic use. They often cause sleepiness, worsen concentration, lose effectiveness over time with regular use, run the risk of being habit forming, and can be dangerous when mixed with other medicine such as sleeping pills or alcohol. Antidepressants are not addictive but can be associated with uncomfortable (but not dangerous) discontinuation symptoms when abruptly stopped.

In rare cases, especially in children, antidepressant may cause someone feel more depressed or anxious. If that should happen, let your doctor know immediately.

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