ADHD and: Depression

Many women with ADHD face the constant struggle of ADHD combined with depression. It’s a battle that affects every part of their lives. And the weight of these challenges often leaves them feeling drained and discouraged.

In this episode, Dr. Monica Johnson breaks down the connection between ADHD and depression. Listen as she explains how ADHD symptoms might be misinterpreted as depression. And learn ways to manage struggles with depression.

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Related resources

• ADHD and depression

• Did my ADHD make me more likely to have postpartum depression?

• Signs and symptoms of ADHD in adults

Timestamps

(01:33) Common symptoms of ADHD and depression

(06:36) How ADHD and depression affect each other

(09:03) Ways to manage ADHD and depression 

Episode transcript

Dr. J: Many women with ADHD find themselves grappling with the dual challenges of ADHD and depression, feeling like they're constantly swimming against the current. The blend of ADHD and depression can feel like a relentless storm, but understanding and addressing these challenges can lead to powerful breakthroughs.

This is "ADHD and," where we talk about everyday life and ADHD. I'm your host, Dr. J. I'm a licensed psychologist who works with people with ADHD. Today we're talking about ADHD and depression.

The co-morbidity of depression and ADHD is well documented in psychological research. Studies consistently show a significant overlap between these two conditions. However, it's important to note that ADHD doesn't cause depression, nor does depression cause ADHD. Yes, the two are correlated. However, don't panic. While in some situations, those with ADHD may have a higher co-morbidity than the general population, that's really not saying much.

Approximately 32.7% of those with childhood ADHD had recurrent depression, compared to 26.5% of those without ADHD. Conversely, of those with recurrent depression in young adulthood, approximately 7.8% had childhood ADHD, compared to 5.9% in those without.

(01:33) Common symptoms of ADHD and depression

Depression and ADHD can sometimes look similar because they share certain symptoms that overlap, which can make it challenging to differentiate between the two. Here are some of the ways that they can resemble each other.

The first thing I want to mention is difficulty concentrating. People with ADHD often have trouble focusing, paying attention, or following through on tasks because of distractibility or impulsivity. In depression, trouble concentrating can result from feeling overwhelmed, fatigued, or uninterested in tasks. In both conditions, this can manifest as forgetfulness, difficulty completing tasks, or zoning out during conversations, which can make it easy to mistake one condition for another.

The second category that I want to mention is restlessness or fidgeting. Physical restlessness is a hallmark symptom of ADHD, particularly in the hyperactive forms of the disorder. Depression can also cause psychomotor agitation where a person feels physically restless or can't sit still. This restlessness can look the same from the outside, but the underlying causes differ.

The third category that I want to mention is fatigue and lack of energy. People with ADHD may feel mentally drained after trying to focus for long periods. They may also feel unmotivated because they struggle with task initiation and follow-through. Fatigue and depression is often more pervasive and linked to emotional exhaustion, lack of interest, and low motivation.

Depression often causes a deep, lingering tiredness, even when activities aren't mentally demanding. In both cases, the person may feel unable to get things done or be productive.

The fourth category is emotional dysregulation. Emotional outbursts, mood swings, and irritability are common due to difficulties and emotional regulation in those with ADHD. The same is true for depression.

The fifth category is low motivation. A person with ADHD may struggle to get started on tasks or follow through due to executive function, deficits. In depression, low motivation is driven more by emotional factors like feeling that nothing is worthwhile, which can lead to apathy and disengagement from activities. In both cases, the person may seem unmotivated, but the root cause is different.

Number six is social withdrawal. Social challenges and ADHD may arise from impulsive behaviors interrupting others or having difficulty following conversations, which can lead to social rejection or avoidance. In depression, withdrawal is typically due to low energy, feelings of worthlessness, or a loss of interest in social interactions. Both conditions can lead to isolation, but again, for different reasons.

And lastly, I want to talk about the category of poor performance in school or work. In ADHD, poor performance may stem from distractibility, disorganization, and difficulty managing time or staying on task. In depression, a decline in performance may happen because of lack of energy, poor concentration, and a lack of interest in activities that were once fulfilling.

In both cases, a person might struggle with meeting deadlines or staying on top of responsibilities, but the underlying reasons are different. The relationship between ADHD and depression is often bidirectional. The chronic challenges of ADHD, such as problems with attention, impulse control, and organization, can lead to negative outcomes like academic failure, social rejection, and poor job performance, which in turn can increase the risk of developing depression, which makes sense if you think about it.

If untreated ADHD is creating the circumstances for your life to go poorly, then it's a natural reaction to be or get depressed about it. Depression, on the other hand, can exacerbate ADHD symptoms, particularly those related to motivation, attention, and concentration. Accurately diagnosing ADHD versus depression involves a comprehensive assessment that may include clinical interviews, rating scales or diagnostic testing, family history, and symptom onset.

Both conditions can co-exist, so it's important for the clinician to carefully evaluate the full picture. I've definitely had people come into my office thinking that they had one issue, and upon thorough investigation, we discovered that it was something entirely different. Please do not rely on internet information to self-diagnose. If both conditions are present, treating them together often leads to better outcomes.

The impact of ADHD and depression on women can be particularly significant due to a combination of biological, psychological, and societal factors. ADHD often manifests differently in women than in men, which can lead to delayed diagnosis and added stress. While depression in women can also be influenced by gender-specific pressures.

(06:36) How ADHD and depression affect each other

When ADHD and depression co-occur, the impact can be compounded affecting multiple areas of a woman's life. Here are a few examples of what that can look like for women.

Women are more likely to mask ADHD symptoms by overcompensating or working harder to maintain appearances, especially in high-demand environments like work, school, or family life. This can lead to burnout and exhaustion, and it can also lead to ADHD symptoms being missed. Depression is more commonly recognized in women, but when ADHD is present, the focus may remain on the mood disorder, leaving the ADHD untreated.

The combination of the two conditions can lead to more severe emotional distress. The next category that I want to talk about is emotional burden and low self-esteem. The challenges of living with undiagnosed ADHD can lead to self-criticism, guilt, and feelings of inadequacy. Many women internalize societal pressures to be organized, efficient, and put together, so ADHD symptoms that impact daily living can create significant shame.

Depression amplifies these feelings, as women may experience hopelessness, worthlessness, or emotional exhaustion. When compounded by ADHD, a woman may feel incapable of managing even simple daily tasks, further reinforcing feelings of failure.

The last category that I'm going to mention is parenting and family life. Women with ADHD who are also mothers often find the demands of parenting overwhelming. Keeping track of schedules, organizing their child's needs, and balancing their own responsibilities can feel like an impossible task. ADHD makes staying on top of these demands difficult, while depression saps the energy needed to stay engaged.

ADHD and depression can lead to irritability, mood swings, and emotional withdrawal, which can affect family dynamics. Children and partners may feel confused by these changes, leading to increased tension and conflict at home. The great thing about having co-morbid diagnoses is that there is also overlap in the strategies that are effective for treatment as well.

(09:03) Ways to manage ADHD and depression

Similar to ADHD, you should focus on health behaviors. So, this means eating a balanced diet, engaging in exercise, ensuring that you get enough sleep, and also avoiding mood-altering substances. This will greatly impact both ADHD and depression. Additionally, you hear me talk about routines all the time, and that works for depression as well.

In fact, a well-documented treatment for depression is behavioral activation. It's based on the idea that one of the core aspects of depression is a tendency to withdraw from meaningful and rewarding activities, leading to a cycle of inactivity, isolation, and worsening mood. The goal of behavioral activation is to break the cycle by encouraging people to engage in activities that are more likely to improve mood and increase overall well-being.

Now, I know that these basic strategies may be the very thing that you're struggling to implement. This is where I remind you that you're allowed to take care of yourself and seek the help you need to thrive. This includes the process of trial and error that it takes to be consistent with these foundational strategies. These strategies will have the biggest impact across time.

That's it for today. Thank you so much for listening. What's a foundational strategy that you're working on? Let me know. If you enjoyed this episode, I'd highly recommend our ADHD and the Anxiety Spiral episode where I talk about how anxiety can show up for women and also give you tips on how to manage it. Don't forget to subscribe to our channel and I'll catch you on the next episode of "ADHD and."

This show is brought to you by understood.org, a nonprofit organization dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. Learn more at Understood.org.

"ADHD and" is produced by Tara Drinks and edited by Alyssa Shea. Our video producer is Calvin Knie. Ash Beecher is our supervising producer. Briana Berry is our production director. Neil Drumming is our editorial director. Our audio engineer and music composer is Justin D. Wright. Our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick. And I'm your host, Dr. J.