Comorbidity and Depression
Let's start off by talking a bit about co-morbidity ADHD tends to have a lot of friends. I myself have ADHD dyslexia deal with some depression and anxiety, and I'm also looking into getting an evaluation for autism.
Other common co-morbidities for ADHD include:
Disruptive behavior disorders
Learning disabilities (such as dyslexia or auditory processing disorder)
Mood disorders
Tourettes
OCD
Anxiety
Depression
Substance abuse
It's a real fun list we have there, right? And it isn't even exhaustive.
There are a lot of things that can be going on in our brains. Now I do want to be clear here just because we have ADHD, it does not mean that we're going to have a co-occurring condition. There are plenty of people who only have ADHD, which itself is a spectrum disorder, so has its own range of symptoms.
As well, some of the disorders on that list are much more common than others. For example, it's estimated that 70% of adults with ADHD will at some point be treated for depression. When we're talking about comorbid conditions with ADHD, what we're saying is that if you are diagnosed with ADHD, then you just have a higher chance of being diagnosed with one of these other disorders as well. This just means that these issues are something we might want to keep an eye open for.
I also want to emphasize that while self-diagnosis is a valid tool with co-morbidities, it is important to talk with a psychiatrist or psychologist. As I mentioned, ADHD is a spectrum disorder, which means that there is a whole range of symptoms that can occur and at different severities. This is important to think about because many of these possible co-occurring conditions also have their own range of symptoms and the symptoms can easily overlap.
For example, both ADHD and OCD have a huge overlap in how we're able to regulate our executive function. when this happens, it's easy for us to look at a list of symptoms and go, oh, I have that. And again self-diagnosis is a valid tool, but it also has to come with a healthy dose of skepticism because we're not trained in the symptoms to look for and how we treat each of these conditions is going to differ.
I also want to point out that many of these things aren't just one thing. While many mental disorders have a genetic component, we often don't have a good way of detecting them.
Just look at ADHD, we know there's absolutely a genetic component, but there's no specific genes that we look for. Additionally, not all cases of ADHD appear to be genetic. There are some cases of brain injury, premature birth and exposure to toxins that researchers believe have led to ADHD.
There's still a lot. We don't know. and then we can also think about how ADHD is diagnosed. We have a list of symptoms, and if you present six or more of those symptoms in two or more settings, then you can get your diagnosis. but what about the people who only displayed four of the symptoms?
They might still have significant impairment in their life. And yet based on current diagnostic criteria would go undiagnosed
And that's not entirely fair because as we've discussed, ADHD symptoms often overlap with other disorders. This means that if you only have four symptoms, you may in fact not have ADHD, but something else that presents in a similar fashion, this is important because we treat these disorders in different ways.
For example, we often treat ADHD with stimulant medication. If you have anxiety though, stimulant medication might not be the best choice of action for you. This is why it's important for us to work with a psychiatrist or psychologist to confirm our diagnosis.
Okay. But let's get to the heart of the question we have. How would I change my advice for someone who is dealing with depression?
First and foremost, here I'm not a doctor, psychiatrist, or psychologist. I run a podcast on ADHD. I'm not just saying this to be boiler Platy I'm saying this because it's important that if you're dealing with depression, that you're getting professional help.
All right. With that said, let's get into it.
At the 2021 international ADHD conference, I went to a great presentation by Dr. Roberto olive RDA on OCD. One of the key insights I took away when considering dual-diagnosis is to think about who's driving the bus. That is what symptoms are leading the way. this is a way for us to think about these conditions that have overlapping symptoms.
So with depression, we're looking at symptoms that include:
Feelings of sadness or hopelessness
Loss of interest or pleasure in most or all of our normal activities
Tiredness and lack of energy
Trouble thinking, concentrating making decisions and remembering things
Angry, outbursts and irritability,
Anxiety and restlessness
Slowed thinking, speaking, or body movements
Weight loss or weight gain.
While some of these things on the list are clearly not ADHD, there are a lot of things on the list that do have overlap. Additionally, ADHD medication can make some of these symptoms worse through their side effects, for example, some people experienced problems sleeping when they're on stimulant medication. It's also important to understand that depression. Isn't just one thing and that there are six types of depression.
We've got:
Major depressive disorder
Seasonal affective disorder
Atypical depression
Bipolar disorder
Postpartum depression
Premenstrual dysphoric disorder.
How you experience depression is going to affect how it needs to be treated. Now let's go back to this idea of who's driving the bus. When we're looking at our symptoms, we want to be thinking about what's driving what symptom. While ADHD symptoms don't have to be one-to-one overlap with depression, they can have some of the same effects.
Let's say we want to put our laundry away, but we just can't seem to get ourselves to do it. There are a lot of ways depression might lead us here, but there are also a lot of ways that ADHD might have the same effect.
So our job in fixing the problem is to first figure out who's driving the bus, what symptom is leading to this outcome? And this is important because if we employ that strategy, that doesn't actually address the problem, we're probably not going to fix that problem. For example, let's say we're feeling that depression and its lack of energy and pleasure in doing things that are keeping us from acting. Well, using an ADHD solution, like putting on some music might not help. This isn't to say that some strategies won't have overlap in helping out those problems. for example, having someone over as an accountability partner might be helpful regardless of the symptoms.
The point is that we should start in a mindful place about how we're implementing strategies.
Along with this idea of who's driving the bus, it's also important that we're thinking about how our symptoms might be influencing each other. Both conditions have overlapping symptoms, but they can also have symptoms that can exasperate other symptoms.
So if your ADHD is making you late and unable to get to work on time, that can lead to additional feelings of hopelessness or loss of interest in doing things from depression can make task activation, even harder with ADHD. The two conditions can create a negative feedback loop.
And we want to remember these exacerbated symptoms can lead to a chain reaction. For example, ADHD gives us a propensity to lose things. And for a lot of us, that includes our keys. But often losing our keys doesn't affect us that much until we need our keys again.
So it's then when we need our keys to get out the door and we can't find them, we end up leaving late and that can lead to a host of other downstream events.
Maybe we're late and our boss yells at us and that leads us to feel bad about ourselves. And now we feel like some of those feelings we have from depression are justified. Or you could go from the other side of things where depression is keeping us in bed, staring at the ceiling, unable to move until we realize we need to get someplace.
And then we're rushing out the door. And that makes us even more likely to forget things as we're leaving. And all of this is going to depend on which symptoms you have from each condition. This is, why the idea of who's driving the bus is so important because if we're not treating the upstream issues that are causing those downstream symptoms, then those things are going to just happen over and over again,
A helpful exercise, to try and root out where our issues begin is to just start asking the question why - but equally important here is to ask these questions in a nonjudgmental way. It would be very easy for me to ask why do I lose my keys so often? And then just answer with, well, because I'm a piece of crap. In fact, there have been large periods of my life, where I felt like that was the best answer to that question. But that answer isn't very helpful.
It doesn't even matter if it feels like it's true, it's not going to lead us to anything we can take action on. Instead, we can try a nonjudgmental version, go with, I feel like I'm rushed coming in the door, or there isn't a place for me to put my keys. This is better because now those are solvable problems and we can work on figuring out ways to fix those issues.
This is also a place where we can work with a therapist or a coach to help figure out those starting places because it can be really hard to navigate those issues when we're in the middle of them.
And of course, we also want to be talking to our doctors here because we do have options when it comes to treating both of these conditions. There are a number of medications for treating both ADHD and depression, finding the right medication or combination of medications can be incredibly helpful here.
Additionally, there are lifestyle changes that you can make to help with both ADHD and depression. If we're eating healthy exercising regularly and getting good. We're likely to see a reduction in symptoms from both conditions.
And I know those are not the easiest things to fix, especially when you have ADHD, which is one of the reasons that it's so important that we make sure we're treating our ADHD when we're trying to manage the symptoms of these comorbid conditions.
This Episode’s Top Tips
ADHD had a plethora of comorbid conditions and it's important to see know how they interact to properly treat your mental health issues.
Depression has one of the most common comorbidities with ADHD and it's estimated that 70% of adults with ADHD will at some point be treated for depression.
When figuring out how we want to approach treating comorbid conditions it's important to figure out who's driving the bus. Symptoms from each condition can exacerbate other symptoms and by figuring out whose driving the bus you can work treating the root cause of your issue.
