Is it Weird to Have ADHD and Anxiety at the Same Time?

DSummary: No, it’s not weird to have ADHD and anxiety at the same time – in fact, it’s quite common.

Key Points:

ADHD often co-occurs with other mental or behavioral disorders like anxiety and depression.
In some cases, the symptoms overlap, and distinguishing between them can complicate diagnosis and treatment.
Experienced mental health professionals can identify what needs treatment first and work with patients on a plan that addresses ADHD and anxiety.

ADHD and Co-Occurring Mental Health Disorders

In the article “Adult ADHD and Comorbid Anxiety and Depressive Disorders: A Review of Etiology and Treatment” a group of researchers examine the factors involved when ADHD happens, at the same time, in the same person, as anxiety or depression. We’ll use data from that study throughout this article, which can help us understand how and why these conditions may co-occur. On that note, let’s clarify that terminology:

When an individual receives a diagnosis for two or more mental or behavioral disorders at the same time, it’s/they’re called co-occurring disorders.

Here’s the overall data on ADHD and co-occurring disorders, which shows it’s not weird at all to have ADHD and anxiety at the same time.

Prevalence of ADHD and Co-Occurring Mental Health Disorders

Total: 70% – 80% of adults with ADHD have a co-occurring mental health issue.
Anxiety: Around 50% of adults with ADHD also have anxiety
Depression: Between 20% and 50% of adults with ADHD also have depression
Bipolar disorder: Between 7.0% and 11% of people with ADHD also have bipolar disorder.

That data clarifies what we claim above. It isn’t weird to have ADHD and anxiety at the same time. About half of all adults with ADHD also have anxiety. In fact, it’s the most common co-occurring mental health issue among people with ADHD.

The symptoms that appear in people with ADHD and anxiety include, but are not limited to:

Problems with concentration
Restlessness/feeling fidgety
Irritability/anger
Procrastination/problems following through on tasks
Tension in body/persistent muscular tension

In addition, people with either ADHD or anxiety may have problems meeting deadlines at work, have problems in relationships, and experience issues completing daily tasks. Separately, symptoms of ADHD and anxiety can impair daily function. When a person has ADHD and anxiety at the same time, i.e. co-occurring ADHD and anxiety, the symptoms of ADHD and anxiety may exacerbate one another, meaning each can make the symptoms of the other worse.

That can create challenges in treatment, but people with ADHD and anxiety should understand that it’s possible to receive effective treatment for both, and people with ADHD and anxiety can learn to successfully and effectively manage the symptoms of both disorders.

Treatment for Co-Occurring ADHD and Anxiety

In mental health treatment in general, the most common approach is to treat the disorder that causes the most disruption first. Then, when a patient can manage the most disruptive symptoms, the treatment shifts to the less disruptive symptoms associated with the other disorder. Here’s something that’s important to understand about the treatment of co-occurring disorders:

“Treatment selection must be informed first and foremost by efficacy in terms of functional outcomes. Functional outcomes include symptom reduction, but also extend to improved daily functioning and increased quality of life.”

In the study we cite at the beginning of this article, the researchers confirm what we indicate above: the best approach is to treat the disorder that causes the most disruption first. When we’re talking about ADHD and anxiety, here’s what that might look like:

Worse Anxiety Than ADHD

When a person with severe, disruptive anxiety and also has ADHD, but the symptoms of anxiety are more extreme and overwhelming than the symptoms of ADHD, they may need to receive treatment for anxiety first. When the symptoms of anxiety stabilize, treatment may then shift to address the symptoms of ADHD.

Worse ADHD Than Anxiety

When a person has severe, disruptive ADHD and also anxiety, but the symptoms of ADHD are more disruptive than the symptoms of anxiety – i.e. impulsivity and inattention (ADHD) create more functional problems than worry or fear (anxiety) – then they may need to receive treatment for ADHD first. When the symptoms of ADHD stabilize, treatment may then shift to address the symptoms of anxiety.

A Common Fear and Important New Approach

In the recent past, providers and patients exercised caution about the use of stimulant medication common in ADHD treatment for people with anxiety, out of fear that the stimulant properties of ADHD medication would exacerbate anxiety symptoms. However, evidence shows this is not the case, and long-term, 10-year study on people with ADHD showed the following:

“ADHD patients treated with stimulants had a lower incidence of secondary anxiety/depression versus untreated peers.”

Also, new studies show that when patients meet clinical criteria for ADHD, managing and controlling the ADHD first can improve outcomes for co-occurring mental health conditions like anxiety. Here’s the logic behind that approach, explained in the article “When ADHD and Anxiety Coexist” published by the non-profit organization Children and Adults with Attention Deficit-Hyperactivity Disorder (CHADD):

(Disclaimer: this applies when co-occurring anxiety is not too severe)

In most people, ADHD is a problem caused by differences in brain function.
That means problems with executive function, i.e. memory, focus, organization, and completing tasks, cause most of the functional problems associated with ADHD.
Impulsivity and hyperactivity cause fewer functional problems than executive function problems.
Executive function problems cause more functional disability when a person with ADHD reaches adulthood, compared to problems with impulsivity.
Therefore, managing executive function problems early, or first, can create “a better platform on which to start building the best management program for the anxiety.”

We’ll elaborate on this below.

What This Means for Treating Anxiety and ADHD

The first thing it means is that for people who think have ADHD, anxiety, or both, the best thing to do is seek expert care from experienced mental health professionals. This means finding either a provider or treatment center that can administer a full psychiatric evaluation, arrive at an accurate diagnosis, and recommend an appropriate course of treatment.

As we mention above, when ADHD and anxiety co-occur, it can complicate both diagnosis and treatment. That’s why seeking expert support is essential. People with ADHD and anxiety can learn which symptoms correspond with which disorder, which symptoms cause the most functional disruption, and work with their provider to decide which disorder and set of symptoms to address first.

In some cases, treatment can begin simultaneously, but in most cases, there’s a clear hierarchy of need – meaning both patient and clinician readily agree one needs to be addressed first – and treatment begins by addressing those symptoms. When treating co-occurring ADHD and anxiety with common stimulant medication for ADHD, the clinician’s mantra is “start low, go slow” in order to find the optimal balance between ADHD symptom regulation and any negative impact on symptoms of anxiety.

As we mention above, the most recent research shows that managing ADHD symptoms first can have a positive and protective impact on co-occurring, and subsequent, symptoms of anxiety. Treatment will typically involve a combination of the following:

Medication:

Stimulant and non-stimulant medication can be effective for ADHD
Anxiolytics can be effective for anxiety
SSRIs (i.e. antidepressants) can be effective for anxiety, but have no impact on ADHD

Psychotherapy:

Cognitive behavioral therapy (CBT) is recognized as effective for ADHD and anxiety

Lifestyle changes:

Improving diet, engaging in daily exercise and activity, and improving sleep hygiene all have a positive effect on both ADHD and anxiety

If you have ADHD and anxiety, it’s not weird at all: it’s common. That means experienced mental health professionals know how to help, and there are a wide range of effective therapeutic options currently available.

Finding Help and Information: Online ADHD Resources

If you want to learn more about ADHD, these resources below are reliable, evidence-based, and easy to access.

These downloadable files from Children and Adults with Attention Deficit-Hyperactivity Disorder (CHADD) are excellent:

ADHD Fact Sheets & Infographics

Resources from the Centers for Disease Control and Prevention (CDC):

Resources from the National Institutes of Health (NIH):

Publications About ADHD – National Institute of Mental Health (NIMH)

From the National Alliance on Mental Illness (NAMI):

Attention Deficit Hyperactivity Disorder (ADHD)

Additional evidence-based resources:

Finding Treatment: Online ADHD Resources

If you want to find treatment ADHD, call us here at Crownview Co-Occurring Institute (CCI). In addition, the following resources below are reliable, evidence-based, and easy to access.