How Undiagnosed ADHD Triggers Depression and Anxiety

Depression and anxiety disorders occur with attention deficit hyperactivity disorder (ADHD) at significant rates. While figures vary across studies, it’s estimated that 18% of adults with ADHD also have major depressive disorder, and about half of adults with ADHD have anxiety.¹ What explains these high comorbidity rates?

Many factors may explain the overlap, and one of them I can’t stress enough: ADHD does not happen in a vacuum, and its effects are far more impairing when the condition goes undiagnosed, untreated, or improperly treated.

Untreated ADHD Causes Feelings of Inadequacy

Undiagnosed and/or untreated ADHD makes children, teens, and adults who are otherwise bright and competent feel severely inadequate. It’s not difficult to see how; untreated symptoms of ADHD, from impulsivity and emotional instability to poor planning and execution skills compromise one’s ability to find success in school, work, relationships, and other parts of life. Ongoing challenges and failures, especially when the root cause is neither identified nor treated, makes these individuals feel like failures — like they aren’t trying hard enough. Self-esteem, as a result, plummets.

Other emotions — like anger, resentment, and feelings of worthlessness — often come up as a result of experiencing challenges related to undiagnosed and/or untreated ADHD. Emotional sensitivity and reactivity are not uncommon, especially strong emotional responses to failure. These emotions cause depression and anxiety to develop. Irritability and feelings of worthlessness, after all, are symptoms of depression.

Living with ADHD and depression, of course, creates its own set of challenges. Children with ADHD and depression, for example, experience more impairment in social and academic functioning than do children with just ADHD or children without ADHD.²

[Self-Test: Could You Be Showing Signs of Depression?]

In adolescents with ADHD, feelings of worthlessness are particularly important to recognize, as one study found that these feelings are directly related to suicidal thoughts and planning.³

Women with ADHD Are at Greater Risk for Depression

ADHD does not disappear with age for most people⁴, and the longer ADHD goes undiagnosed, the more problems it potentially creates as life’s demands and responsibilities evolve in complexity. This may explain why females with ADHD — who tend to be diagnosed later than males — are more than twice as likely to develop depression compared to females without ADHD.⁵ Hyperactivity and impulsivity — obvious signs of ADHD — are not so common in girls and women, which may explain why clinicians miss or misdiagnose their ADHD. What we often see now is women getting diagnosed while in college.

Depression also appears to take a greater toll on women with ADHD, as depression has an earlier age of onset, lasts longer, comes with more severe symptoms, a higher rate of suicidality, and a greater likelihood of requiring psychiatric hospitalization in this group compared to women without ADHD.⁵

The Importance of Recognizing ADHD, Depression, and Anxiety

Yes, there is significant comorbidity between ADHD, depression, and anxiety. But even together, these conditions are treatable. Complete, thorough evaluations are a must to identify and properly manage these conditions in patients as early as possible. Measurement-based tools can help clinicians in this respect. Clinicom® is a psychiatric assessment tool I have been developing and refining for many years to help clinicians identify more conditions that may be comorbid with a patient’s presenting complaint. The assessment tool, completed by patients, can identify 80 psychiatric conditions, and it also takes a patient’s environmental stressors into account. (As epigenetics research tells us, we cannot ignore our environment, and adverse life events do appear to be linked to a whole host of conditions, including ADHD.^{6 7})

[Get This Free Download: Signs of Depression That May Surprise You]

As an example, I recently saw an 18-year-old female patient — a college student — with depression as her chief complaint. She completed the Clinicom assessment before her visit, and after a thorough evaluation that accounted for personal and family history and stressors, we realized she exhibited symptoms of ADHD — undiagnosed until then — and generalized anxiety disorder, among other conditions.

I can tell you story after story of seeing patients who did not know they had ADHD, and who had succumbed to the belief that they were failures and would never accomplish anything. I remember another patient I first saw as she was finishing high school. After an extensive evaluation, we diagnosed her with ADHD and started her on treatment. Many years later, she came back to my clinic — when she was finishing her medical school residency — to thank us for treating her. And that meant the world to me.

Untreated ADHD in Adults: Next Steps

• Read: Depression — When It’s More Than a Symptom Of ADHD
• Read: What’s Behind the “Depression Gap” Impacting Women?
• Read: Late Diagnosis — Was ADHD to Blame All Along?

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “New Insights Into and Treatments for Comorbid Depression” [Video Replay & Podcast #456]  with Nelson M. Handal, M.D., DFAPA, which was broadcast on May 24, 2023.

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