ADHD — attention deficit hyperactivity disorder — is plenty misunderstood in children, with society still catching up with the fact that it's not simply "naughty-child syndrome". ADHD in adults is a different matter still. Around 36 percent of people who met the diagnostic criteria for ADHD as kids will continue to do so in adulthood, and they can encounter many struggles. Various studies have tried to figure out how common it is for adults with ADHD to be depressed, and came up with figures ranging from 18.something percent to fully half — pretty shocking, if you ask us, because even the lowest estimates suggest that adults with ADHD are more likely to become depressed than the general population.
Major depressive disorder: Understanding the diagnostic criteria
If you think you are depressed, you'll probably have seen the diagnostic criteria for major depressive disorder, as laid out in the DSM-5, countless times before in various forms. Let's take another look, this time with an emphasis on the aspects of the diagnostic criteria that often seem to be skipped. Many websites I've looked at over the years simply list (some of) the nine possible symptoms of depression that the DSM-5 encompasses, but there's more to the diagnosis than them — so this is pretty important.
First off, to be diagnosed with major depressive disorder, a person has to meet at least five of the listed symptoms — including at least one of the first two. This minimum of five symptoms should have been present for at least two weeks, and, very importantly, must "represent a change from previous functioning". Additionally, symptoms clearly caused by another medical condition — which includes ADHD — should be disregarded for diagnostic purposes.
The possible symptoms of depression are:
- A "depressed mood", which manifests differently in different people but can be felt internally or seen by other people, on most days for the majority of the day.
- A loss of interest (motivation) in "all" or "almost all" activities. So, this would include things you would previously have been thrilled about, as well as routine tasks that most people find kind of boring but are nonetheless motivated to do, like brushing their teeth or tidying up.
- Appetite changes and resulting weight gain or loss.
- Insomnia, or its counterpart hypersomnia, which is sleeping a lot.
- "Psychomotor agitation or retardation", terms somewhat puzzling to most laypeople that refer to a physical speeding up or slowing down. Yup, this can mean fidgeting, rapidly moving your legs up and down while you're sitting and talking, and all those kinds of things that are pretty common in ADHD.
- "Fatigue or loss of energy".
- Feeling worthless and/or experiencing disproportionate or unwarranted guilt.
- Trouble concentrating and/or making decisions.
- Thoughts about death or suicide plague you, which go beyond simply fearing death.
This concludes section "A" of the diagnostic criteria for major depressive disorder, but there's a whole lot more. Section "B", for instance, lays out that the symptoms in question must also cause social or functional impairment, while section "C" makes it clear that the symptoms shouldn't be attributable to another medical condition or to the use of any kind of substance.
ADHD and depression can both be diagnosed in the same person for the simple reason that it's possible to have both, but the diagnosis may be a bit trickier than usual.
So, what's next?
This includes assessing whether the symptoms you are experiencing are (at least partially) caused by ADHD itself, rather than depression. This is part of the reason that the fact that symptoms have to be new, to "represent a change from your previous functioning", is important.
It should also include exploring whether the way you feel is caused by very legitimate and logical grievances related to the way society relates to you as a person with ADHD. That is, it's perfectly normal to become, for instance, fatigued, sad, irritated, and to experience feelings of worthlessness if you constantly face barriers that block you from participating in society because of your ADHD.
Such feelings may indeed lead to major depressive disorder over time, but in themselves, they are simply expected human reactions. It may help people with ADHD to look into the medical vs social model of disability. The medical model holds that a disability causes impairment. The social model, on the other hand, posits that societal reactions to and ways of coping with disability are what disables disabled people. This may come in the form of refusing to make accommodations or in the form of discriminating attitudes and policies.
Because we're writing an article and not a book, we'll just say — if increased understanding of ADHD in your personal world would make the depression symptoms you are experiencing go away overnight, major depressive disorder may not be the right diagnosis for you.
Treating depression in people with ADHD: How?
Some crucial things you should know if you have ADHD and are also ultimately diagnosed with depression are:
- Evidence-based guidelines suggest that the more acutely impairing problem should take priority when a treatment plan is made. That often means focusing on the treatment of depression over ADHD, in this case.
- If you take medications for your ADHD, they may interaction with any antidepressants your doctor prescribes. It is important that the prescribing healthcare provider knows what other meds you are on, so these drug interactions can be avoided.
- If you can find a clinician who has (abundant) experience in treating people with comorbid ADHD and depression, you've probably struck gold.
- Especially if your depression is related to very real concerns about your life or present situation, talk therapy can play a very important role in your treatment.
- Finally, though ADHD can mimic some of the symptoms of depression and your life experiences as a person with ADHD may induce depression, do not let a healthcare provider wave you off just because you already have another diagnosis. You can still be depressed. And depression comes with many risks, including the risk of suicide. In fact, research shows that people with both depression and ADHD have a higher risk of suicide and poor outcomes. You deserve a correct diagnosis and effective treatment.