A subscriber sent in this question: “when I was a child I was diagnosed with ADD. Although I was never on medication I didn’t actively seek much help. I’m beginning to realize that perhaps now at age 26 it is related to my depression and anxiety issues as well as motivation. I’m still struggling to get through a degree and not quite sure where to turn. I think I should go see someone about this but I’m not sure who the best person to turn to is”.
This question is a very important one. This is an adult who is describing having been diagnosed with ADD early in life and now has depression and anxiety issues. It sounds as if the depression and anxiety are the main concern – however, let’s remember that this person sent his/her question in to The ADHD Doctor! So, obviously there is some concern there about the impact of the ADD or ADHD as well.
This question is very important along the lines of comorbidity of ADD and ADHD, particularly in adults.
I’m going to assume that the individual who diagnosed the ADD early on was accurate, and that a thorough and complete assessment was done.
Is ADD still a problem for this individual?
I don’t have a lot of information to go on, but it seems that it likely still is. He or she is struggling with motivation, and completion of a degree. That said, this could be completely related to the depression and anxiety that is going on.
It would be important for this person to have a thorough assessment with a psychiatrist with expertise in adult ADD or ADHD. The problem is that they can be hard to find. Also, often it is the child psychiatrist who are better at ADD or ADHD. All child psychiatrists train in adult psychiatry first, and we learn about ADD and ADHD, and how it can change through the course of the lifespan.
Comorbidity in adult ADD is very common. Only 14% of adults with ADD don’t have a second disorder. In other words, comorbidity is the rule, not the exception.
It is very common for an adult with ADD or ADHD to have comorbidity with depression and anxiety.
Sometimes, it is minor depression or anxiety – somewhat of a self esteem issue. This can relate to all of the years of people saying:
“you would do better if you would only live up to your potential, or try harder or keep more organized, I know you can do better etc.”
Eventually a person with ADD can start to feel, “well I must be that kind of loser that everybody’s talking about.”
Then, depression and anxiety can develop.
Coming back to the specific question, the main issue for this person is figuring out if the depression and anxiety are the main problem, or whether the ADD is still active and is the main problem.
If the depression and anxiety are the main problem (or the dominant problem, even if ADD is still there), then they have to be treated first, with therapy plus or minus medication. After these are more stable, it would be important to review if ADD is still there and if it needs treatment.
If the ADD is the main problem, then it will need treatment – with therapy, coaching, plus or minus medication. If the ADD improves, most likely minor depression and anxiety would improve as well.
It can be very complicated for adults with ADD or ADHD, because there aren’t that many doctors who are comfortable and competent in adult ADD.
Start with your primary care doctor (family doctor), ask questions, and seek referrals until you have the answers you need. Also, consider a psychologist who may be able to help with the diagnosis and therapy, though he or she couldn’t prescribe the medication.