You’ve spent all the money, all the time, and all the energy planning for this – your son’s 11 year old birthday party. The gathering went off surprisingly well, everyone seemed to have a good time, and the day was filled with many special moments. So why are you feeling bad? After allowing yourself to accept accolades from friends and families, you start wandering around the dark corners in your mind of insecurity and self-doubt. Wasn’t the lasagna a bit soggy? Were the games too babyish? Did people really have fun or just say so to be polite? Despite the outward success of the day, you’ve circled right back to feeling like a failure with a bit of shame and self loathing thrown in for good measure. Your underlying depression and its symptoms have officially re-entered the arena. 

ADHD rarely travels alone

I frequently say that “ADHD doesn’t travel alone”, and it is very true – an estimated 18% of adults with ADHD also have major depressive disorder, and about half of adults with ADHD have anxiety.  This is often referred to as “co-occurring conditions”- when two or more diagnoses (or symptoms of diagnoses) exist at the same time. Depression is estimated to be 2.7 times more prevalent in adults with ADHD than those without.  So how do you know which one came first, and more importantly, how do you know which should be treated first?

Explaining Depression

Depression is a complex mental health condition with a variety of symptoms that can affect somebody’s physicial, cognitive and emotional functioning. Typical signs of depression include: feelings of sadness, hopelessness or worthless; irritability; changes in sleep patterns (too much, interrupted sleep or too little); lethargy including; physical problems (including headaches or digestive issues) with no clear cause; suicidal thoughts or attempts; increased use of drugs or alcohol; isolation and withdrawal from social contact.

While depression can affect concentration and focus, these issues vary and mostly occur under stress. Depression is first and foremost a mood disorder so troubles with paying attention are secondary to emotional and physical distress. If you (or someone around you) are having several of these symptoms persistently (for most of the day, nearly every day, for at least two weeks), then please seek professional help by contacting your primary care provider. 

Key Traits of ADHD

ADHD is a neurologically-based condition that typically presents with a range of symptoms seen to inattention, hyperactivity, and impulsivity. In ADHD,  unlike depression, problems with concentration are primary and stem from the executive functioning challenges that come naturally. Inconsistency with attention is one of the hallmarks of having ADHD and one of its most frustrating aspects. Common issues for people living with ADHD include: disorganization, procrastination, emotional dysregulation, forgetfulness, distractibility, excessive talking or interrupting and chronic lateness.

People with depression and ADHD may experience chronic brain fog due to feeling emotionally overloaded in conjunction with their biological attentional challenges. They may also experience low motivation, a lack of joy from activities they previously enjoyed, persistent low energy and profound sadness.

Get Help!

If you are experiencing any of these symptoms typically associated with ADHD and depression, it is important to start with a professional evaluation to help rule in (or out) each of these diagnoses, and understand the impact they might have on each other (and yourself!).  This information will help you and your provider develop a plan with targeted priorities and measurable goals.  In terms of treatment priorities, typically the symptoms that most impact your day to day life will be of initial focus.  

Tips for Reducing Depression with ADHD

Whether you are diagnosed with co-occurring ADHD and depression or struggling with some of the issues outlined above, here are some important tips to keep in mind to help you along the way: 

1. MOVEMENT: I can’t emphasize enough how beneficial moving your body can be to your overall physical, mental, and emotional well-being. Having endorphins surge through your brain elevates your mood and helps with focus. Whatever you choose to do, start small that you can actually accomplish each day. Keep it simple – gentle stretching, a short walk in the neighborhood, riding a bike around the park–these are great activities to start with. Exercise in any form can help create new routines that brains wired for ADHD and/or depression really benefit from. 
2. BE EASY ON YOURSELF. Be kind to yourself in the ways that you would treat a friend or loved one. When brains wired for ADHD experience depression, it can make even the most simple of tasks feel doubly insurmountable. There are days when getting a shower or putting away groceries require all of our mental, physical, and emotional reserves. When struggling with ADHD and depression, these reserves are already in even shorter supply, and so completing even the smallest of tasks is worth celebrating.  Be kind to yourself, and celebrate the smallest of successes each day along your journey.
3. A WORD FOR WOMEN: Women tend to be referred for anxiety or depression instead of even considering ADHD. As familial, work and social pressures increase in intensity with age, women are more than twice as likely to develop depression compared to those without ADHD . ADHD and depression often “look” different in women than men, as these symptoms and feelings are more often internalized (kept inside, invisible to others) than externalized (able to be seen or observed by others typically in anger).  
4. START SMALL. For brains that get bored easily (yet also struggle with organization and motivation), it may be tempting to feel as though you need to make ALL the changes, RIGHT NOW.  And while change can be good, it’s important to think long term – what is sustainable, and easy to do again and again? What will fit your lifestyle? What is a good “environmental  fit” – ie, what small changes can you make that will meet you where you’re at, in this moment, that you can do consistently each day? Imagine beginning to feel better like training for a marathon – start small, do it each day, and slowly increase the difficulty as you feel better each day.  
5. ARM YOURSELF WITH KNOWLEDGE. Simply reading this newsletter helps to make protective, positive deposits in your knowledge “bank”!  When our brains struggle with symptoms of ADHD and/or depression, education can be an incredible tool to help tame negative self-talk, and counter spirals of shame and self-doubt that repeat in our head.  Use trusted resources and information from professionals available online, and consider time spent online working towards feeling better time well spent!