Autism with anxiety and depression: what to know and where to get help in the UK

The NHS describes autism as a difference in how your brain develops that affects how you see and experience the world, and says autistic people are more likely to have some physical and mental health conditions, such as epilepsy, anxiety, eating disorders or depression. The National Autistic Society is explicit that autism is not a mental health problem, but that autistic people can have good and bad mental health like anyone else.

Anxiety and depression are therefore common co-occurring conditions rather than part of autism itself. They are real, treatable and deserve their own assessment. The risk is that distress is dismissed as just being autistic, or that autism itself is missed because the anxiety or depression was the reason a person sought help.

The National Autistic Society says there are reasons specific to autistic people. Difficult social situations and sensory environments can increase stress and anxiety, and a sense of being misunderstood or not accepted by non-autistic people is another significant cause. To fit in, some autistic people mask or camouflage, which can increase anxiety and harm mental health. Unexpected changes to routine and difficulty identifying, understanding and managing emotions (alexithymia) can also contribute.

For depression, the charity lists social isolation, low self-esteem, loneliness and a lack of adequate support, as well as general causes such as stressful events or trauma, family history, other health conditions and drugs or alcohol. High levels of anxiety can lead to exhaustion, meltdowns and autistic fatigue or burnout.

The signs the National Autistic Society gives for anxiety include feeling restless or worried, a churning stomach, a fast or thumping heartbeat, faster breathing, sweating, nausea, problems sleeping and panic attacks. For depression it lists continuous low mood or sadness, hopelessness, thoughts of self-harm, changes in appetite or weight, disturbed sleep, lack of energy and avoiding contact with people.

The charity also says autistic people may be more likely to show social withdrawal, increased repetitive behaviours, a change in interests (perhaps becoming more focused on death or dying), more frequent meltdowns and an increased risk of self-harming or suicidal thoughts. Family, carers and clinicians who know the person well are often best placed to notice a change from their usual pattern.

• Sleeping or eating differently from usual.

• Withdrawing from people or activities that were previously enjoyed.

• More meltdowns, shutdowns or repetitive behaviours.

• Persistent worry, panic or physical anxiety symptoms.

• Hopelessness or any talk of self-harm or suicide.

If anxiety or depression is affecting your life, the National Autistic Society suggests talking to someone you trust and, if you need more support, speaking to your GP. Treatment for depression is the same for autistic and non-autistic people and depends on severity. The NHS says a GP can refer for an autism assessment if you think you might be autistic, that waits can be a few months or longer, and that in England you can choose which NHS service does the assessment under Right to Choose.

The NHS notes it may be difficult to see signs of autism in an adult who also has anxiety, depression, an eating disorder or ADHD, and that a mental health professional may notice signs of autism and recommend a referral.

The National Autistic Society says that talking therapies such as CBT can be effective for some autistic people if adapted appropriately, with options such as mindfulness, exposure therapy, low arousal techniques and sensory integration training for anxiety. It advises that therapists use clear examples and unambiguous language, and know how depression may look different in autistic people.

On medicines, the charity says antidepressants are generally considered useful and safe, but that there is very little research into whether they help depression or anxiety specifically in autistic people, and that autistic people may be more likely to experience side effects such as drowsiness, irritability and reduced activity. It says antidepressants should be carefully considered and closely monitored by a medical professional. In England, statutory guidance for adults says autistic people should have support adapted to their needs if they have a mental health difficulty.

The National Autistic Society collects advice from autistic people. For anxiety it suggests understanding triggers by keeping a diary, monitoring energy levels after social events, making the environment work (for example noise-cancelling headphones), using sensory tools and stimming to self-soothe, relaxation and visual schedules. For depression it suggests structure and routine, time with family and friends, gentle exercise, giving yourself extra time for tasks and keeping things simple when low.

These are tips, not treatment, and are best combined with professional help when symptoms are persistent or severe.

If you or someone you care for has seriously harmed themselves, or you feel you may be about to, call 999 or go to A&E. For urgent advice about mental health, use NHS 111 and choose the mental health option, as the NHS advises. Tell the person assessing you about the autism, as you may need communication adapted.