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Depression, anxiety, and attention-deficit hyperactivity disorder are mental health conditions that impact a person’s emotions, behaviors, and actions.

All of these are very different disorders with distinct symptomatology; however, they may often exist together in an individual. Comorbidity of these disorders may also worsen the patient’s prognosis.

Depression is characterized by feelings of worthlessness, hopelessness, and despair, leaving a person uninterested in daily life’s activities and pleasures. Depression also takes a toll on the patient’s physical health, causing muscle tiredness, lethargy, and fatigue.

Anxiety disorders encompass a range of different disorders like social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, specific phobias, and panic disorder, all of them sharing the common symptoms of chronic worrying, fear, assuming the worst, and overthinking.

ADHD, on the other hand, is characterized by hyperactivity and the inability to sustain attention for longer periods of time. It mostly occurs in children but many adults also possess ADHD symptoms.

Comorbid ADHD and Anxiety

Around 50% of people with ADHD also have a comorbid anxiety disorder according to the Anxiety and Depression Association of America. Many symptoms of the two conditions overlap, even though they are very different disorders.

In many cases, ADHD may actually cause anxiety. People with ADHD have trouble focusing on tasks and staying attentive, which makes it difficult to cope with different situations, and this may increase their stress and anxiety.

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Image Credit: klarityadhd.com

Comorbid ADHD and Depression

According to research, 18-19% of adults with ADHD also get diagnosed with major depressive disorder (MDD), and 12-13% of adults with ADHD also experience the dysthymic disorder, also known as persistent depressive disorder.

Teens with ADHD are also 10 times more likely to develop depression than their peers without ADHD. When depression co-exists with ADHD, it often makes its symptoms worse.

It is often difficult to diagnose a depressive disorder in a person with ADHD because some of their symptoms overlap. These symptoms may include difficulty concentrating and focusing on tasks, restlessness, and sleep problems.

However, people with depression may experience restlessness and sleep disturbances due to anxiety, while people with ADHD may experience these symptoms because they feel agitated or over-energetic.

What makes the relationship between ADHD and depression even more complex is that in some cases, the challenges and problems that come with ADHD can lead to depression. ADHD symptoms can cause problems in a person’s interpersonal relationships.

These problems may produce anxiety or depressive feelings as a result. In such cases, it becomes even more complicated for the psychiatrist to prescribe the most suitable medication for the management of both conditions.

Treatment Options for Depression and Anxiety

Treatment of either one of these disorders is usually simple, straightforward, and manageable. However, when these conditions co-exist, the treatment may get a bit tricky and complicated. This is due to the fact that different medications are usually prescribed for anxiety, depression, and ADHD.

If more than one medication is taken for the treatment of two or more conditions, then they may react with each other and worsen the patient’s symptoms.  

It is important for a healthcare professional to take into account all the risks and benefits of combining two or more medications. Every person reacts differently to different combinations of medicines, so you may find the most suitable treatment plan after some trial and error.

Fortunately, there are a few medications that can effectively treat these conditions. The following are the best pharmacological treatment options that people with ADHD can take for the treatment of depression and anxiety.

Before we go further, it is important to discuss the two types of ADHD medications that are commonly used for their treatment; stimulants and non-stimulants.

1.   Stimulants

Stimulants are usually the first choice of doctors and psychiatrists for the treatment of ADHD. They are fast-action medicines and work by regulating the levels of two neurotransmitters in the brain: dopamine and norepinephrine, which can also help with symptoms of depression.

Stimulants are not prescribed on their own for the treatment of depression, however, they are often suggested in addition to other medications for optimal results.

Stimulants can help with symptoms of depression like fatigue, lack of concentration, restlessness, etc. If you take these medicines for your ADHD, research shows that they will prevent your risk of developing depression in the future by keeping your emotions regulated.

Some stimulants may help with anxiety if taken with other medications, but mostly they appear to aggravate the symptoms. Due to their mechanism, they have a high potential to cause more anxiety as a side effect or worsen the existing symptoms.

Non-stimulants, described later in this article, are actually a better choice for people with comorbid anxiety and ADHD as they help reduce symptoms of both.

The most popular classes of stimulants are Amphetamines, like Adderall and Vyvanse, and Methylphenidates, like Ritalin, Focalin, and Conceta.

·         Adderall

All of these are very quick-action medications but Adderall has been shown to be the most effective. Although it is not approved by the FDA for the treatment of mood disorders, it is often used as an off-label medicine for treating depression, especially in adults with ADHD.

A recent study also showed that Adderall can help with mood regulation, energy stimulation, and improving concentration, however, the effect may last only for a short period of time.  

Side effects of stimulants

Stimulants are not without their side effects. The most common side effects of stimulants include

·         High blood pressure

·         Changes in appetite

·         Trouble sleeping

·         Increased heart rate

This is the reason why people with heart-related issues must consult with their doctor before starting any stimulant medication course. Stimulants also have the potential to be abused as they can cause drug dependency. Therefore, stimulants should be prescribed with care.

2.   Non-Stimulants

Stimulants do not suit everyone; some individuals with ADHD and comorbid anxiety cannot tolerate such medications. They have prescribed the following FDA-approved non-stimulant medications: bupropion, SNRIs (selective norepinephrine receptor inhibitors) like Atomoxetine and Effexor, viloxazine, and guanfacine.

Non-stimulants are easier to prescribe, are readily available, and have a decreased risk of patients’ dependence on them.

Non-stimulants are especially helpful for people who have a history of tic disorders, substance abuse, bipolar disorder, and psychosis.

The most beneficial ADHD non-stimulants that are effective for the treatment of depression and anxiety include the following.

·         Strattera (Atomoxetine)

Atomoxetine comes in the brand name of Strattera. It is an FDA-approved medication that is widely used for the treatment of anxiety and depression in people who also have ADHD.

It is a type of SNRI that regulates the level of norepinephrine in the brain, which is a neurotransmitter associated with both depression and ADHD. Hence, people who suffer from both these disorders may benefit significantly from this medicine.

Strattera is also very beneficial for people who suffer from ADHD as well as anxiety. Since stimulants have the potential of worsening a person’s anxiety, this may be a safe choice for them. Strattera can be prescribed to both adolescents and adults, and can also be paired with a stimulant if deemed necessary.

Recent research advocated for the effectiveness of atomoxetine to combat ADHD while decreasing symptoms of anxiety, and suggested that patients can safely switch to Strattera from a stimulant.  

·         Qelbree (Viloxazine)

Qelbree is an SNRI that is used for the treatment of anxiety and depression, as well as ADHD. It has been approved by the FDA for the management of ADHD in adolescents and teenagers and also helps significantly in the treatment of comorbid mood disorders.

Side effects of non-stimulants

Some common side effects of non-stimulants include

·         Nausea

·         Vomiting

·         dry mouth

·         stomach problems

·         In extreme cases, suicide ideation in adolescents.

3.   Antidepressants

When a person with ADHD does not respond to stimulants, they have prescribed antidepressants. Antidepressants have been shown to be very effective in the treatment of adult ADHD that is comorbid with anxiety or depression.

Antidepressants are also prescribed by the doctor when the depression or anxiety of a person is aggravating their ADHD symptoms and contributing to inattention.

Antidepressants also function by increasing the level of neurotransmitters like serotonin, dopamine, and norepinephrine in the brain, regulating a person’s mood, which is why they have a similar effect to ADHD medications.

They can help a person with ADHD in sustaining their focus, increase their attention span, reducing hyperactivity, aggression, and impulsiveness.

·         Wellbutrin (Bupropion)

Wellbutrin is an antidepressant that is also used as an off-label treatment for adult ADHD. It is not approved by the FDA for the treatment of ADHD but doctors still prescribe it because they believe it can significantly help with attentiveness, calmness, and emotional stability.

·         Effexor (venlafaxine)

Effexor is an SNRI that functions by blocking the reuptake of serotonin and norepinephrine in the brain, increasing their levels. Effexor helps with symptoms of anxiety and depression, as well as ADHD by improving the mood and concentration of a person.

Antidepressants like Prozac and Zoloft also work wonders for a person’s anxiety symptoms. Other effective antidepressants that can be used to manage these disorders include Pamelor (nortriptyline), Norpramin (desipramine), and Tofranil (imipramine).

Side Effects of antidepressants

Most people do not experience any side effects if they stick to their recommended doses of antidepressants. Mild side effects usually subside within a week as the body gets used to the medication. Following are some of the side effects that you should look out for:

·         Headache

·         Nausea

·         Insomnia

·         Increased heart rate

·         tremors

·         Decreased libido or the inability to orgasm

·         Drowsiness, sleepiness, or dizziness

·         Mild chest tightness or pain

·         Upset stomach

·         Dry mouth

Lifestyle changes

Along with taking medications, you can also incorporate some changes in your lifestyle and daily routine that may go a long way in helping you manage your anxiety or depression as an adult with ADHD.

1. Sleep routine

The most important change that you can bring into your routine is establishing a proper sleep routine. Adults with ADHD often struggle with restlessness, which may cause trouble falling asleep.

Staying awake for hours in bed also provides intrusive thoughts to occur, which may worsen your anxiety and depression.

2. Spending time in nature

Research has shown that children show improvement in their ADHD symptoms when they spend time outdoors in the natural environment.

Getting sunlight in a space surrounded by greenery has a calming effect on the mind and body and helps boost a person’s mood significantly. Spending time in sunlight can also help with seasonal affective disorder, and make people feel happier.

3. Managing Diet

Adults often indulge in over-eating and consume foods that are high in carbohydrates and sugar when they are feeling depressed or anxious. This not only does nothing to relieve the symptoms of anxiety and depression but also worsens your symptoms of ADHD.

Sugar makes the already existing symptoms of hyperactivity and impulsivity in ADHD even worse. Try eating fruits and low-carb food items instead of sugary snacks.

FAQs

What are some factors that increase the risk of developing depression if you already have ADHD?

There are certain risk factors for developing depression if you are an adult with ADHD, some of which are:
·         Obesity
·         Female gender
·         Having a comorbid anxiety disorder
·         Substance abuse

What other treatment options are there for adults with ADHD for the management of anxiety and depression?

Cognitive behavior therapy, also known as CBT, is a great therapeutic tool for the treatment of these disorders. CBT works by challenging the negative thoughts and beliefs of a person that are at the root of most if not all disorders.

Changing those negative thoughts into positive ones significantly improves the patient’s life. Research has also shown that therapy combined with medications works wonders for the patient.

There are many online platforms where you can receive therapy if you can’t go for in-person sessions. BetterHelp is one such platform that is convenient, easy to use, and affordable, with prices starting from $60 per week.

Head over to their website to book a session with the therapist of your choice, today.

How to choose the best medication?

It is very important to consult your doctor before you decide on medication for yourself. Anxiety, depression, and ADHD are very different conditions and only a professional can prescribe medications that may be able to target symptoms of two or more disorders simultaneously.

Generally, doctors try to treat the primary disorder of the patient first, i.e., the disorder that is causing the most discomfort to the patient. Your mental healthcare provider will also assess whether your symptoms of anxiety and depression are independent of your ADHD or due to it.

Before recommending your medications, your healthcare provider will also take into account your past medical and psychiatric history, age, and overall health.

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