Having ADHD increases the likelihood of having anxiety or depression. Often, these conditions develop as a result of living with ADHD. This is especially true for people with undiagnosed or untreated ADHD.

This article explores the challenges of living with untreated ADHD, how they're connected to depression and anxiety, and how to cope with them.

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• ADHD comes with a higher risk for mood and anxiety disorders.
• ADHD, depression, and anxiety are common comorbidities, meaning they often occur together in the same person.
• Untreated ADHD can cause depression and anxiety and increases the risk of addiction, unemployment, accidental death, and suicide.
• Different treatment options can be effective, including CBT and medication. Finding community among neurodivergent peers can also be a great source of support.

Can ADHD cause anxiety and depression?

Living with the negative effects of ADHD on a person's life can lead to developing secondary anxiety and depression. ADHD rarely "travels alone" but tends to present with other comorbidities.

ADHD, anxiety, and depression: a mental health trifecta

Comorbidity refers to having more than one condition at the same time. While comorbid psychiatric disorders are common in adults and children with ADHD, the prevalence is much higher in adults.¹ One study on children and adolescents found that 52% had at least one psychiatric disorder comorbid with ADHD², while a study in ADHD adults found a 77% comorbidity rate.³ The most frequent comorbidities in people with ADHD are substance use disorder (SUD), followed by mood disorders, anxiety disorders, and personality disorders.⁴

Due to some overlap in symptoms, it can be hard to untangle which symptoms one experiences due to ADHD and which are caused by anxiety or depression.

ADHD symptoms

• Difficulty sitting still without fidgeting
• Getting excited in situations where it is seen as inappropriate
• Talking a lot and very fast, including when it is deemed inappropriate
• Getting frustrated at seemingly small difficulties
• Being easily irritated or angry
• Making quick, impulsive decisions without considering the consequences
• Being easily distracted and having a short attention span
• Making 'careless mistakes' and forgetting things or directions
• Difficulties with organization — this includes everyday tasks like paying bills on time, remembering appointments, or staying on top of household chores
• A strong desire for frequent changes and novelty since sticking to one thing for long periods is challenging

Depression symptoms

• Having a hopeless outlook on life
• Losing interest and pleasure in things you usually enjoy
• Feeling very tired all the time
• Sleeping too much or too little
• Becoming easily distracted, restless, agitated, and anxious
• Difficulty concentrating and making decisions — this includes a decrease in organizational ability
• Eating excessively or not enough
• Frequent thoughts about death, dying, or suicide
• A change in mood, including irritability, an increase in self-blame, and rumination

Anxiety symptoms

• Feeling both physically and mentally restless — being unable to "switch off" or turn away from troubling thoughts.
• Difficulty focusing, even on things that are important to you
• Sleep issues, coupled with feeling fatigued
• Becoming easily irritated, frustrated, or angry at seemingly minor inconveniences
• Troubles with regulating feelings of panic
• Catastrophizing

How untreated ADHD can cause depression and anxiety

Unlike ADHD, depression and anxiety can be developed at any point in life. Both conditions are influenced by several risk factors, such as genes, trauma, and environmental stressors.⁵ By contrast, ADHD is a neurodevelopmental disorder that begins in childhood. Many people fly under the radar and don't receive a diagnosis until adulthood due to a number of reasons, including different symptom presentations, lack of understanding, or medical bias.

Untreated ADHD can significantly impair quality of life and take a huge toll on somebody's mental health. In many, depression and anxiety develop as a direct result of living with ADHD.⁶ The many challenges that come with untreated ADHD also increase the risk of addiction, unemployment, premature death from accidents, and suicide.⁷

Emotional challenges

ADHD can cause a range of issues with emotions, including experiencing mood swings and frequently feeling rejected.

Emotional dysregulation

Emotional dysregulation is the inability to regulate one's emotional state to respond appropriately to a situation. This can involve many emotions (such as anger, sadness, frustration, and irritability) and lead to rapid shifts between emotional states and frequent mood swings.⁸ Difficulties with emotional regulation can also lead to anxiety and depression.⁹

Rejection sensitive dysphoria

Rejection-sensitive dysphoria (RSD) is a heightened emotional sensitivity to real or perceived rejection —which can even lead to physical pain or discomfort for some.

It's important to note that RSD is a conditioned emotional response that anyone can experience, but it is more common in ADHDers and autistic people.¹⁰ People with RSD are hypervigilant to judgment and criticism and likely to experience bouts of depression and anxiety.¹¹

Low self-esteem

ADHD can also negatively impact self-esteem. When ADHDers go undiagnosed for a long time, they may struggle to understand the challenges they are faced with and internalize them as personal failings. Regardless of being diagnosed with ADHD or not, research has shown that ADHD has significant effects on many areas of someone's personal, social, and professional life, which can lead to depression and anxiety.¹²

Social challenges

Many typical ADHD symptoms, like impulsivity and forgetfulness, can lead to difficulties in relationships.

Feeling left out and misunderstood

While all people can have moments where they struggle to fit in, ADHDers consistently report feeling misunderstood and misjudged for how their symptoms manifest.¹³ Particularly when relating to people in the general population (who tend to be neurotypical), people with ADHD will often internalize the criticism they get due to a lack of understanding.

Social anxiety

Social anxiety disorder causes an individual to feel anxious in social situations due to an intense fear of being watched and judged by others. It can make it hard to work, keep up with daily activities, go to school, develop and maintain relationships, and contribute to feelings of isolation and loneliness.

ADHD masking

ADHD masking or "impression management" refers to a person's conscious or unconscious attempts to hide their ADHD symptoms and appear neurotypical.¹⁴ This behavior can take many forms, for example:

• Being overly careful not to interrupt people
• Obsessively checking your belongings to avoid leaving them behind
• Taking hours to check tiny details in assignments to avoid "careless mistakes."
• Bottling up intense emotions
• Suppressing stimming behaviors

Whatever form it takes, masking behavior requires tremendous vigilance, which can contribute to anxiety. It's also incredibly draining, often leading to depression and burnout.

Difficulties at school or work

Since ADHD causes difficulties with organization, planning, and focus, it can lead to underperformance at work and in academic settings.¹⁵ These are often exacerbated for individuals who have to go without appropriate accommodations — particularly those who are undiagnosed or untreated.

High-functioning anxiety

Some ADHDers might overcompensate and adopt perfectionistic tendencies to overcome their challenges. While this works in the short term, sometimes propelling us to incredible productivity, consistent hypervigilance can lead to chronic stress and anxiety.

Imposter syndrome

People with ADHD can sometimes hide their difficulties or the extra effort they put in to keep up at work or school. Due to this and low self-esteem, they tend to judge their work more harshly. If they receive positive feedback or even a promotion, they often feel the praise is undeserved. Imposter syndrome is a common issue for ADHDers, and the negative self-image associated with it can contribute to depression.

Treatment and management options for anxiety, depression, and ADHD

The good news is all of this can be helped. Several types of treatment have been found to be effective. Here are a few options to consider.

Talk with your doctor

There's nothing wrong with seeking help to improve your quality of life.

Getting a diagnosis

While it may seem like "everyone is getting diagnosed with ADHD," the reality is far more nuanced. In fact, ADHD is underdiagnosed in adults. Unfortunately, many healthcare professionals don't have the experience required to diagnose ADHD in adults, so it's important to find the right doctor for an ADHD assessment.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) works by teaching people how to identify and change negative thinking patterns that influence their emotions and behavior.¹⁶ It is focused on the automatic negative thoughts that contribute to emotional difficulties and has been used to treat depression, anxiety, and ADHD (to name a few).

Medication options

Different medications can also treat all the conditions mentioned here. While this may be scary for some individuals, it is important to note that pharmacological treatments have been found highly effective.¹⁷ For some, ADHD treatment alone has prevented the worsening of their comorbid conditions.

• Antidepressants (e.g., SSRIs) — Zoloft, Prozac, or Celexa
• Stimulant-based medication — Adderall, Concerta, or Ritalin
• Benzodiazepines — Ativan, Valium or Xanax

Find a supportive community

Support groups can benefit individuals with ADHD (diagnosed or not) by finding like-minded people who share and accept their struggles. Online communities of neurodivergent people have been flourishing all over social media, providing a sense of belonging and understanding that can be hard to come by in this neurotypical world.

Inflow has a dedicated community section to connect with other ADHDers, feel validated and supported, and share in each other's wins.

“The negative, irrational voice in your head may talk you out of self-help. However, if you can learn to recognize it, you can learn to replace it.” -- The Inflow app | Depression module, day 1

Feeling stuck? Inflow has in-depth learning modules on anxiety, depression, and many other common ADHD struggles to help you break the cycle. Join our supportive community of ADHDers who get it. Get started with Inflow today!

Final thoughts

Untreated or undiagnosed ADHD can cause many issues, including depression and anxiety. Therefore, it is crucial that individuals who suspect they may have ADHD seek treatment and support. While it may seem scary to navigate, all research has shown that it is the path of least resistance!

Sources

¹ Clinical Psychopharmacology and Neuroscience | Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder Among Adults and Children/Adolescents in Korea (2022)
² Attention deficit and hyperactivity disorders | Comorbid mental disorders in children and adolescents with attention-deficit/hyperactivity disorder in a large nationwide study (2015)
³ European archives of psychiatry and clinical neuroscience | Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD) (2007)
⁴ PLOS ONE | The prevalence of psychiatric comorbidities in adult ADHD compared with non-ADHD populations: A systematic literature review (2022)
⁵ Behav Res Ther. | The Genetic Links to Anxiety and Depression (GLAD) Study: Online recruitment into the largest recontactable study of depression and anxiety (2019)
⁶ Psychiatry | ADHD in Adults: The Invisible Rhinoceros (2007)
⁷ Therapeutic Advances in Psychopharmacology | Treatment of adult ADHD: A clinical perspective (2017)
⁸ Neurosci Biobehav Rev. | Pharmacotherapy of emotional dysregulation in adults with ADHD: A systematic review and meta-analysis (2018)
⁹ Frontiers in Psychiatry | Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review (2021)
¹⁰ Developmental Cognitive Neuroscience | Temporal dynamics reveal atypical brain response to social exclusion in autism (2011)
¹¹ Journal of Child Psychology and Psychiatry | Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder – implications for clinical recognition and intervention (2019)
¹² PLOS ONE | A Population-Based Study of Attention Deficit/Hyperactivity Disorder Symptoms and Associated Impairment in Middle-Aged Adults (2012)
¹³ J Atten Disord. | The Burden of ADHD in Older Adults: A Qualitative Study (2018)
¹⁴ Eur Arch Psychiatry Clin Neurosci | Symptoms in individuals with adult-onset ADHD are masked during childhood (2019)
¹⁵ Journal of Neural Transmission | ADHD at the workplace: ADHD symptoms, diagnostic status, and work-related functioning (2020)
¹⁶ Cogn Ther Res | The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses (2012)
¹⁷ BMC Psychiatry | Adult ADHD and comorbid disorders: Clinical implications of a dimensional approach (2016)