Exploring the link between ADHD and Depression

Attention-Deficit Hyperactivity Disorder (ADHD) and Depression are both mental health conditions with symptoms that often overlap. These conditions can affect numerous facets of a person’s life, such as productivity, self-esteem, social relationships and academic or career performance. Psychological, neurological, environmental and genetic factors impact both these disorders and that’s why they are often linked with each other. Before unravelling the intricate connection between depression and ADHD, let’s understand them individually.

What is ADHD? 

Do you have a persistent struggle with paying attention when someone is talking? Do you find yourself repeatedly interrupting them because you can already guess their next words or sentences? Have you wondered why you could never sit still during important events or discussions?  These behaviours can be attributed to someone who probably struggles with ADHD.

ADHD (Attention-Deficit Hyperactivity Disorder) is a developmental disorder characterized by symptoms that cause inattentiveness, struggles with impulse control, and hyperactivity. 

The symptoms have an early onset during childhood but can affect adolescents and adults too. This condition is debilitating and can interfere with a person’s social interactions, development and work or academic responsibilities. 

People with ADHD may have an executive function deficit which disrupts a person’s ability to manage their own emotions, thoughts and behavior. They struggle to complete tasks, make decisions, keep appointments and arrive on time. Moreover, they tend to be constantly restless and disorganized. An individual with ADHD is likely to have a tough time following conversations or instructions.

Did you know? 

Professionals such as occupational therapists, speech-language pathologists, school counsellors, neuropsychologists and physicians are trained to identify executive function deficits and give effective treatment strategies.

How is ADHD diagnosed?

Based on their recurring symptoms, a person can be diagnosed with one of the following three types of ADHD:

• Hyperactive-impulsive: Exhibits hyperactivity and/or impulsivity symptoms but doesn’t have attention issues.
• Inattentive: Struggles with inattention but does not have symptoms of either impulsivity or hyperactivity.
• Combined: Displays symptoms of both.

To be identified with ADHD, symptoms will have to:

• Be present for at least 6 months persistently.
• Interfere with their daily functions or executive functioning.
• Emerge in more than 2 settings (Home, work, relationships, school)

What is Depression?

One of the most common indicators of depression is diminished interest or pleasure in daily functions or activities that used to be interesting before. Depression is a mood disorder that exhibits insistent feelings of sadness and hopelessness. It affects an individual’s mood, behaviour, thoughts, emotions and functioning. Have you ever come across someone who used to have a lot of zest for life but seems to be extremely down in the dumps and struggles to do basic tasks? That is one of the most common signs of someone going through major depression.

Did you know?

Celebrities who have spoken about their battle with depression include Deepika Padukone, Andrea Jeremiah, Michael Phelps and Jim Carrey. Some famous artists like Robin Williams, Chester Bennington and Matthew Perry lost their lives to this deadly condition.

Read More – Depression: Symptoms, Causes, Types and Treatment

What are the main features of depression?

• Decreased interest: Low/no motivation interest or pleasure in everyday activities.

• Hygiene:  Personal hygiene is often neglected.
• Mood: Persistent feelings of hopelessness, sadness, worthlessness and emptiness.
• Disruption of Cognitive Processes: Difficulties in focus, decision-making, changes in sleep patterns, fluctuations in appetite/weight, brain fog, social withdrawal, etc.
• Fatigue: Constantly feeling tired or not having the energy to move.

Now that we have a fair idea about these individual disorders, let’s dive into how ADHD and depression can occur simultaneously, the reasons behind their comorbidity and the link between their symptoms. 

Overlapping factors 

There are some overlapping factors for people with ADHD and Depression, but the causes may not be the same:

1. Daily Functioning: Both can disturb a person’s functioning abilities whether it is at school, work, or in their relationships. ADHD can make an individual struggle to do their tasks due to inattention or distractibility. Depression can impair a person’s functioning in daily life due to fatigue or lack of motivation.
2. Concentration: Attention issues caused by depression are due to a lack of motivation, low energy, trauma or emotional distress. On the other hand, symptoms of ADHD occur because of the inability to focus on tasks and becoming easily distracted.
3. Stress: When a person with ADHD is not promptly treated, they will have prolonged stress, which makes them more vulnerable to depression.
4. Emotions: Both disorders can cause emotional dysregulation in a person, although the causes can be different. Someone with ADHD is likely to have impulsive or emotional responses. A person who has depression tends to deal with feelings of worthlessness, sadness and hopelessness that persist for a long duration.
5. Genetics: Due to the presence of genetic components, the presence of one disorder can increase the possibility of developing the other one.
6. Sleep: Sleep disruptions are observed in both ADHD and depression. Individuals having depression tend to have sleeping patterns that are either very high or quite low. Due to hyperactivity or continuous thoughts, people having ADHD will struggle to fall asleep or might wake up often.
7. Conjunction: Research suggests that people with ADHD are at a greater risk of developing depression, mainly if their symptoms make them struggle in work, academic and social settings. Without proper treatment, people with ADHD go through tremendous anguish that can often contribute to feelings that signify depression and can exacerbate over time. 
8. Neurobiology: Research studies claim that the prefrontal cortex and the brain areas linked with dopamine pathways are affected by both ADHD and Depression. Both these conditions can cause problems in the functioning of brain areas that are involved in the regulation of emotions, motivation and attention.

When Depression or ADHD occur, it can be a draining cycle of mental exhaustion. Distinguishing between the symptoms of Depression and ADHD can be challenging:

• Someone with depression may seem like they aren’t able to focus or handle their responsibilities (due to low motivation or fatigue), and their behaviour can be wrongly attributed to symptoms of ADHD.
• Someone may appear to be highly inattentive or dispassionate, which can be falsely diagnosed as depression, while they may be someone who has been struggling with it.

Will ADHD and Depression look different across people?

• Age: Children may display hyperactive or impulsive behaviours, while adults may experience symptoms that are more internalized. Teenagers would make trouble at school, make impulsive decisions, sulk, feel fidgety and have self-esteem issues. 
• Gender: Men with depression may display anger or irritation, while women are more likely to have sadness or social withdrawal. ADHD in women often manifests with internalized factors like inattention, social challenges and emotional struggles. Men may display behaviors that are visible outwardly such as hyperactivity, impulsivity and unruly conduct. 
• Culture: Across cultures, the symptoms can be perceived in different contexts. The way a person exhibits the symptoms of their mental conditions can vary based on the surroundings or culture they grew up in.

Treatment Approaches for ADHD and Depression

Medical and Mental Health Professionals are typically trained to differentiate between ADHD and depression by observing specific sets of behaviour or nature, the inception of the conditions, severity and duration of the symptoms. Sometimes, people may struggle with a combination of both disorders making it challenging to detect and treat.

Knowing the interplay between ADHD and depression can promote a better awareness of these disorders and highlight the importance of early detection and effective treatment.

Cognitive Behavioral Therapy (CBT):

• When individuals with ADHD undergo CBT, they can improve their impulse control, time management and decision-making skills. For example: A CBT specialist can help them make a specialized schedule for medical appointments to curb procrastination.
• CBT is used to treat depression by focusing on negative thought patterns or cognitive distortions. Improving coping mechanisms like goal setting, identifying negative beliefs and mood regulation constitute major parts of this therapy method.

Prescriptions:

• Stimulants (methylphenidate, amphetamines) are the medicines prescribed for ADHD, but they could sometimes aggravate the symptoms of depression or anxiety. 
• Antidepressants are recommended for depression. SSRIs (selective serotonin reuptake inhibitors) increase the levels of serotonin by blocking the reuptake of serotonin. SNRIs (serotonin and norepinephrine reuptake inhibitors) are used to raise the levels of norepinephrine and serotonin. For ADHD, these medications can enhance attention and other cognitive processes.
• Sometimes these medications can be combined but close monitoring is advised to avoid complications.

Lifestyle Changes and Therapy:

• When efforts are made to maintain regular sleep and good hygiene, problems like sleep disturbances, insomnia and hypersomnia can be reduced.

• Exercising regularly can improve temperament, concentration, and motivation and reduce distress or adverse emotions.
• To avoid overwhelming themselves, people with ADHD can work with their therapist to come up with a well-structured routine and strategies to help with time management, goal setting, etc. This will help them to be more organized and reduce executive function deficits.
• Therapists have specific approaches to help identify the causes of depression and to cope with it. They provide a safe space to express yourself. Detecting or reframing emotions, behaviours and thoughts that damage the psyche and contribute to depression can be explored in counselling and psychotherapy.

Differences between Depression and ADHD