Am I Depressed? Symptoms of Depression and ADHD, Untangled

Someone with ADHD may experience depression for various reasons:

• Biological: Sometimes the origin of depression is totally independent of ADHD, and is brain-based. For some people, depression runs in families, much the way ADHD does.
• Environmental: Sometimes the depression is brought on by circumstances, which might be completely unrelated to ADHD symptoms (the death of a loved one, for example) or possibly the result of ADHD symptoms (unemployment due to lateness related to weak executive functioning, for example).

Regardless of whether the depression is related to the ADHD, once it develops, it becomes its own entity and must be treated as an independent condition.

[Self-Test: Depression in Adults]

When someone has both ADHD and depression, the comorbidity exacerbates symptoms of both conditions, often making them worse than what you would see in people who have just one of the conditions. Having ADHD is associated with:

• more frequent hospitalizations due to depression
• more recurrent depressive episodes
• greater suicide risks and more attempts at self-harm

In making a proper diagnosis for depression, it’s important for your doctor to make distinctions between a depressive symptom and an ADHD symptom.

Symptom: Sadness & Irritability

Sadness & Irritability in ADHD:

The sadness or irritability is highly contextual and environment-specific. For example, if a person with ADHD was working in a job that was a terrible fit for them, they’d likely be sad or irritable at work but happy and relieved at home, or out with friends.

Sadness & Irritability in Depression:

The sadness or irritability in depression is chronic and affects every aspect of a person’s life. A person with depression is likely to be sad and irritable at work, and when they come home, and also when they’re with their friends.

[Watch: How ADHD Amplifies Emotions]

Loss of Interest in Activities with ADHD:

People with ADHD may hyperfocus on and become totally immersed in a certain activity — and then grow tired or bored of it quickly and look for something new. So, a person with ADHD might throw themselves into painting, but then once the novelty wears off, they might find painting boring — instead they want to try ice skating.

Loss of Interest in Activities with Depression:

When a person is experiencing depression, they find no enjoyment, even in the things they’ve long felt passionate about. So, a person who has always loved to paint might find the thought of painting does not interest or excite them any longer, and neither does the prospect of any other activity.

Change in Appetite with ADHD:

Changes in appetite or eating tend to be short-term. Sometimes people with ADHD skip meals because they're hyperfocused on work or a hobby, or they might not be paying attention to their bodily cues because they're so stimulated by whatever is happening externally. If that person structures their time for a meal, and there’s food there, however, they’ll eat. People with ADHD who struggle with impulsivity may also be prone to binge-eating.

Change in Appetite with Depression:

With depression, we can see weight gains or losses of 20 pounds or more, and these changes occur over a longer period of time. People report a persistent feeling of just not being hungry. Even when there’s food right in front of them, there's nothing inside their body that makes them want to eat. Sometimes the opposite is true, where people with depression binge eat in order to numb sad or hopeless feelings.

Sleeping Trouble with ADHD:

Individuals with ADHD are very prone to sleep problems and sleep disorders. These issues tend to be chronic, often beginning in childhood. For example, a person with ADHD might tend to struggle with racing thoughts and a hyperactive brain that has a difficult time slowing down at night.

Sleeping Trouble with Depression:

In depression, it’s common to see people who don’t usually have sleep issues experiencing episodic intervals of sleeping too much or too little. Someone in the throes of a depressive episode might sleep just 1 or 2 hours a night or, conversely, might sleep 16 to 17 hours a night and still feel tired afterward.

Concentration Problems with ADHD:

Trouble with focus is a classic symptom of ADHD. People with ADHD are easily distracted, veer off-task, and struggle to attend, particularly to activities that are not inherently interesting to them.

Concentration Problems with Depression:

Difficulty concentrating is also a classic symptom of depression. In trying to discern if the trouble is being caused by ADHD or depression or both, consider your history. If you've always had difficulty concentrating in school or at work, then it may be attributable to ADHD. But if you've always been a good student and had no problem concentrating in math class, and now suddenly you can’t focus on finishing even simple problems, that may be an indication of depression.

Fatigue with ADHD:

Many people with ADHD, especially those with the inattentive subtype, report feeling fatigued all the time. It takes considerable energy and a marshaling of many resources to compensate for weak executive functions and the other challenges ADHD involves. If you worked a 15-hour day, you would feel tired at the end of it; people with ADHD often feel every waking moment is hard work. Or, sometimes, people with ADHD may feel a lack of energy when presented with an uninteresting task or activity that they’re unmotivated to tackle.

Fatigue with Depression:

In depression, there is often a massive sense of fatigue. It pervades everything, even when individuals are doing their favorite activity, and even in those people who’ve never had problems with fatigue. People with depression often describe a cognitive slowing, like their mind is made of molasses. Unlike in ADHD, this slowing can be episodic and can happen in cycles, sometimes every three or four weeks.

Feelings of Worthlessness with ADHD:

Someone with ADHD who has a growth mindset, the right support, and is situated in the right environments, might never experience a feeling of worthlessness. Unfortunately, many individuals lack this support and understanding, and their ADHD symptoms sometimes lead them down paths where they do not feel successful. In these cases, they can feel a sense of ineffectiveness or worthlessness.

Feelings of Worthlessness with Depression:

In depression, there is often a pervasive sense of worthlessness, and also a feeling of inappropriate guilt. This guilt is a classic depressive symptom, and it’s something you don’t tend to see in people with just ADHD. Individuals with depression often feel guilty for things far beyond their control, almost as if they see themselves as a negative force in the world.

Recurrent thoughts of death or suicide are a very serious matter that must be treated. No matter what the cause, whether they are related to ADHD symptoms or not, recurrent thoughts of suicide are very indicative of a depression and must be addressed quickly.

It’s important to note, too, that severe depression can have psychotic features, where people can suffer from hallucinations, paranoia, and delusional thinking. A lot of people feel shame about this, and are afraid to disclose their experiences, but it’s very important to talk to your doctor about this. It can be treated.

Am I Depressed? Next Steps

• Watch: Managing Mood Disorders and Depression
• Read: Depression and ADHD are More Common Than You Might Think
• Read: 10 Commonly Misdiagnosed ADHD Symptoms

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