Why ADHD Makes You More Prone to Depression—And What to Do About It

By its very name, attention deficit hyperactivity disorder (ADHD) might make you think of someone bouncing from one place to another, full of energy and unable to sit still. Depressed? That’s not something most people associate with ADHD—but they should. In fact, it’s quite common for adults diagnosed with ADHD to experience feelings of sadness, hopelessness, and/or worthlessness—all symptoms of depression—for days or weeks.

“Depression is one of the most common co-occurring disorders with ADHD,” says Marcy M. Caldwell, Psy.D., a licensed clinical psychologist specializing in the treatment and assessment of ADHD and learning disabilities, and founder of Rittenhouse Psychological Services in Philadelphia, PA, which helps adults with ADHD to thrive.

“Large population-based research shows that 16% to 30% of adults with ADHD experience depression,” Dr. Caldwell says. “Clinically, we see it even more frequently than that, with a majority of clients with ADHD struggling with depression symptoms as well.”

Some research estimates that one in three people who have been diagnosed with ADHD have depression or have experienced a depressive episode, according to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). Also of note: The suicide rates for adults who have ADHD are higher than those of adults with no mental illness. If an adult has both depression and ADHD, that suicide risk is even higher, CHADD reports. So it’s critical to recognize depression in loved ones with ADHD, as well as make sure they have access to proper treatment for both.

To do that, it’s crucial that you get familiar with the symptoms of ADHD and depression—their commonalities and their differences. We should also all know how to get a diagnosis, what the treatment options are, and where to find them. These insights into adult ADHD and depression, straight from the experts, are an excellent start.

ADHD and Depression Symptoms

First off, how do you know if you have depression when you have ADHD? Are the symptoms similar in any way? According to Dr. Caldwell, the answer is yes and no. Some symptoms can overlap and are common in both ADHD and depression patients, including:

• Inattention

• Difficulty focusing

• Difficulty with motivation

• Feeling sluggish

• Intense negative emotions

• Low self-esteem

The symptoms of ADHD present in three different ways: Hyperactive-impulsive type, inattentive type (called ADD in the past), and combined type. Depending on how ADHD symptoms manifest, they may or may not overlap with common depression symptoms. For example, adults with hyperactive-impulsive ADHD can tend to feel restless, which can also be a symptom of depression. But other symptoms of this ADHD subtype can include difficulty waiting in line or a poor driving history—two symptoms that aren’t associated with depression.

On the flip side, depression can have symptoms that aren’t associated with ADHD, including changes in appetite or unplanned weight loss or gain. There are also several types of depression, which can have different symptoms. The type of depression that people with ADHD are most prone to is major depressive disorder (MDD), also called major depression.

Diagnosing Depression and ADHD Together

It can be challenging to know which you’re dealing with—ADHD or depression—or whether you have both. “Overlapping symptoms of comorbid ADHD and depression often complicates getting an accurate diagnosis,” points out Peter Theodoropoulos, M.D., (who goes by Dr. Peter Theo, for short), a psychiatrist who practices in Fort Pierce, FL.

Disentangling the two can be a complex task for a few reasons. First, it’s so common for adults with ADHD to have comorbid depression that it might be missed or mistaken for ADHD itself, as the ADHD symptoms can overlap or mask the depression symptoms. Also, some people with ADHD can become animated and feel “momentarily buoyed up” by being around others, Dr. Caldwell points out, which makes an accurate diagnosis of depression challenging.

“They may appear much more upbeat and happy in a therapy session, but then when they are alone, those depression symptoms may appear more strongly,” she says.

According to Caldwell, the emotional and mood impact of ADHD is just starting to become more well understood. It’s very common for people with ADHD to experience short periods of intense emotion, including sadness, particularly in reaction to failure or rejection. These moments may look like depression, but the trigger and their brevity distinguish them from major depression.

MDD, or major depression, is diagnosed only after symptoms are present for two weeks or more and typically interfere with a person’s ability to work, sleep, study, and eat, according to the National Institute of Mental Health. So, if you want to determine whether it’s depression or ADHD (or both) that you or someone you care about are experiencing when you recognize common symptoms for both, seek out a professional. Discuss your concerns with a therapist or have an evaluation by a psychologist or psychiatrist experienced in adult ADHD diagnosis, Dr. Caldwell recommends. They can untangle the differences.

Causes of Depression in People With ADHD

One out of three people with ADHD also have MDD—why is that? There’s a lot of research about the tendency for ADHD and major depression to co-occur, says Misty Smith, a mental health therapist in Elmira, MI. “What we don’t know is why they coincide so frequently,” she says. “It could be because ADHD is physically, emotionally, and mentally exhausting.”

In Smith’s opinion, other factors that could possibly explain the higher risk of depression in adults with ADHD, include:

• Feeling overwhelmed, alone, and misunderstood as a neurodiverse person in a neurotypical world

• Managing the exhausting symptoms of ADHD on a daily basis

• Experiencing the highly stigmatizing nature of this neurological condition

• Family history and genetics

Smith herself has ADHD (but not depression), so she can relate to some of these struggles. “It’s hard to constantly manage yourself, putting 100 barriers in place to make sure you don’t ‘mess up,’ and trying to hold it all together,” she says of ADHD.

Factors that might also make you more likely to develop depression if you have ADHD, Dr. Caldwell points out, include:

• Being female

• Having an early childhood diagnosis of ADHD

• Having inattentive type ADHD

• Having untreated ADHD

• If your mother was depressed while pregnant with you

According to Dr. Caldwell, current theories about the overlap in ADHD and depression are focused on the firstly, the correlation between the neurological aspects of both conditions and secondly, the psychological impact and stress of living in a world that’s not made for your brain.

“The friction that’s caused by having a brain that is motivated differently and operates differently than most people, combined with the fact that oftentimes this difference is not well understood or attributed to other factors—you are lazy, bad, stupid, etc.—creates intense shame, low self-esteem, and difficulties in relationships, which can then lead to depression as well,” Dr. Caldwell says.

Treating ADHD and Depression

If you do have ADHD and depression together, you have treatment options, and it’s vital to pursue them. Treating both ADHD and depression is very important, Dr. Theo explains, as untreated ADHD can lead to mood swings, impulsivity, and even aggression, and untreated depression can worsen if not treated. Finding a mental health professional well-trained in ADHD is also key for treating depression and ADHD, Dr. Caldwell adds. Mental health pros versed in ADHD can help determine if newer therapies like transcranial magnetic stimulation (TMS) along with counseling for ADHD could be useful. Possible treatments include:

• Medication, including stimulants for ADHD and medication for depression such as Tricyclic Antidepressants, Selective Serotonin Reuptake Inhibitors (SSRIs) and Monoamine Oxidase Inhibitors (MAOIs).

• Counseling

• Transcranial magnetic stimulation (TMS), using magnetic fields to stimulate nerve cells in the brain—this is used when other treatments are unsuccessful

As for medication, “there is one medication that may treat both depression and ADHD, called bupropion [Wellbutrin XL],” says Dr. Theo. “However, most people prefer a more robust response by using both a stimulant and an SSRI, if tolerable.” But Dr. Theo notes that caution should be taken when using stimulants—especially in people with ADHD and depression—because there may be a high risk of abuse or other drug related comorbidities.

In her practice, Smith assists her clients with “proactive coping skills.” So if a client tells her they’re never on time and struggle to meet deadlines, she helps them identify things that can help, such as setting alarms, using lists, or programming appointment reminders.

“And my clients benefit from discussing how to process and manage emotions,” Smith says. “Emotional regulation is a real thing with both ADHD and depression, and clients need to have the tools to effectively navigate through their struggles. Creating systems, structure, and prioritizing tasks top the list, but it’s also crucial to work through procrastination, lack of motivation, and any kind of fear or worry.” Developing coping and life-management skills can help buoy your mental health.

If you are in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.