ADHD and depression together: signs, assessment and treatment in the UK

ADHD, attention deficit hyperactivity disorder, affects attention, activity levels and the ability to control impulses. The NHS notes that it is common for people with ADHD to have other conditions as well, including depression, anxiety and addictions. The Royal College of Psychiatrists lists depression among the mental and physical health conditions that research has shown to be more common in people with ADHD.

The relationship goes both ways. Years of disorganisation, missed deadlines, criticism and a sense of falling short can wear down self-esteem, and the Royal College notes that anxiety and depression can make ADHD symptoms worse. Poor sleep, which is common in ADHD, can in turn lower mood. Living with undiagnosed ADHD can therefore be a route into depression.

Concentration difficulties, restlessness, irritability, sleep disturbance and low motivation can occur in both conditions, which makes it easy to attribute everything to one or the other. The Royal College of Psychiatrists says that some people struggle to be referred for an ADHD assessment because their challenges are thought to be caused by something else. For example, they may be diagnosed with anxiety or depression when this only explains part of their difficulties.

The key difference in how clinicians approach it is history. ADHD symptoms start in childhood (the NHS says usually before the age of 12) and are long-standing, whereas depression typically represents a change from a previous baseline. Looking at childhood, schooling and function over time helps separate the two.

The NHS describes ADHD symptoms as inattentiveness, hyperactivity and impulsivity. NHS inform lists the features of depression, including continuous sadness or low mood, feeling hopeless, losing enjoyment, tiredness, sleeping or eating differently and, in some people, thoughts of self-harm or suicide.

• Low mood, hopelessness or loss of interest lasting weeks rather than days.

• Feeling worse about yourself because of ADHD-related difficulties.

• Sleep and appetite changes that are new, rather than long-standing.

• Increased irritability, anxiety or withdrawal.

• Any thoughts of self-harm or suicide, which need urgent help.

If you think you have ADHD, the Royal College of Psychiatrists says to speak to your GP, who can refer you to the most appropriate service, often a Community Mental Health Service or a specialised neurodevelopmental service. An ADHD assessment includes a discussion of symptoms, structured tools and questionnaires, a full review of mental health, childhood and development information, physical health and, where possible, information from people who knew you as a child.

In England, the NHS says Right to Choose lets you ask for an NHS appointment at any clinic that provides ADHD services for the NHS, including a private clinic, which may have a shorter waiting list. The Royal College warns that if you have an assessment elsewhere, specialist NHS services will check the report has all the necessary detail, so make sure it will be accepted locally before paying for one.

Both conditions are treated, and the plan is individual. For ADHD, the Royal College of Psychiatrists describes environmental adjustments, psychological therapies such as psychoeducation, mindfulness and CBT, coaching, and medicine. It says CBT in ADHD tends to be most effective when combined with medication. Medicines fall into stimulants (methylphenidate and dexamfetamine) and non-stimulants (atomoxetine and guanfacine), with the latter generally used if stimulants have not worked or are hard to take.

For depression, the NHS describes watchful waiting, exercise and guided self-help for mild depression, talking therapies such as CBT, and a combination of talking therapy and antidepressants for moderate to severe depression. Which treatment comes first, and whether medicines for both are used together, is a decision for the prescriber, who should check your mental and physical health before starting ADHD medicine.

The Royal College of Psychiatrists suggests telling the people around you what is and is not helpful, getting regular exercise, getting enough good-quality sleep (including avoiding sugar, caffeine or alcohol within a couple of hours of bedtime) and aiming for a regular, balanced diet. The NHS adds that lifestyle changes such as exercise, cutting down on alcohol and giving up smoking help people with depression, as can a self-help book or support group.

The Royal College warns that buying ADHD medicines online or getting them without a prescription can be dangerous, so use a prescriber if you think medicine might help.

If you have thoughts of suicide or self-harm, or have seriously harmed yourself, call 999 or go to A&E. For urgent advice, use NHS 111 and choose the mental health option, as the NHS advises. Tell your GP or specialist if low mood appears or worsens after starting any medicine.