The relationship between Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety, and depression is complex, and these conditions frequently co-occur, impacting a person’s quality of life in unique and challenging ways. Research shows that individuals with ADHD are more likely to experience anxiety and depression, but the connection between these three conditions is far from straightforward. Three patterns are typically seen:

• ADHD, Anxiety and/or Depression as independent conditions.
• Symptoms of anxiety and/or depression make it difficult to focus and remember information, imitating or exacerbating ADHD.
• The stress of trying to function with untreated ADHD leads to symptoms of anxiety and, eventually, depression.

We see the last pattern most often, but it requires a skilled evaluation and strong clinical judgment to deduce what is what. When underlying ADHD is overlooked, treating the other conditions can be frustrating and unsuccessful.

ADHD and Its Impact on Mental Health

ADHD typically affects focus, organizational skills, time management and impulse control.  These difficulties can have a negative impact on multiple areas of life, including academic and work performance, social interactions, money management and daily functioning. The result? Frustration, a lower sense of accomplishment and impaired self-esteem. The challenges posed by untreated ADHD often lead individuals to feel overwhelmed and can trigger anxiety, as they might constantly worry about their performance and social interactions.

The Role of Anxiety

Anxiety creates an ongoing sense of worry and tension, often intensifying the symptoms of ADHD. From a brain perspective, so much neural energy is consumed by anxiety that there is diminished capacity in the prefrontal cortex, where executive functions (ADHD) are controlled. For instance, someone with ADHD may struggle to start and finish tasks, leading to trouble meeting deadlines; if they also have anxiety, the fear of missing those deadlines can become paralyzing. This combination can lead to avoidance behaviours and even more heightened stress, perpetuating a cycle of worry and inefficacy.

Depression and Low Self-Esteem

Depression, a frequent companion to both ADHD and anxiety, often arises from prolonged experiences of self-doubt and feelings of underachievement. The ongoing challenges and setbacks of living with ADHD can lead to a sense of failure or inadequacy. Individuals may start to feel hopeless or fatigued by the effort it takes to manage daily tasks, leading to depression. Moreover, when combined with anxiety, depression can create a heavy emotional toll, as individuals might feel both anxious about the future and hopeless about their ability to change it. Once again, from a brain point of view, the depressed brain leaves little energy available for effective functioning in the prefrontal cortex.

Breaking the Cycle

Managing the intersection of ADHD, anxiety and depression involves a multifaceted approach, including therapy, medication and lifestyle changes. For ADHD symptoms, medication is highly effective, which can then ease anxiety and depression as fewer daily struggles are experienced. Mindfulness practices, regular exercise, and structured routines can also provide support by reducing stress and enhancing emotional regulation. If the anxiety and/or depression are central or persist after the ADHD is treated, then Cognitive Behavioural Therapy (CBT) or even Dialectical Behavioural Therapy (DBT) can help individuals reframe negative thoughts, develop healthy coping strategies and improve self-esteem.

In short, while ADHD, anxiety and depression each bring unique challenges, understanding their interplay and seeking appropriate support can make a significant difference. Recognizing that these conditions influence and exacerbate each other can help those affected—and their loved ones—approach treatment with greater compassion and insight.