comorbidity

ADHD is often comorbid with other disorders, ones present from birth and ones developed later in life. Anxiety and depression are the most prevalent. Studies show that 50%+ of ADHDers have comorbid depression.

There are two roughly ‘types’ of depression seen in ADHDers: primary and secondary. Primary depression is essentially clinical depression presenting alongside ADHD and can be caused by any number of factors, same as in non-ADHDers.

Secondary depression, meanwhile, is an effect of ADHD, with various possible causes ranging from our emotional dysregulation to repeated failure, to chronic under-stimulation.

You may find that your mood darkens when you have nothing to do, and keeps getting worse the longer you go unstimulated. This is quite common in ADHDers — to be happy, our brains need to be kept stimulated.

Depression can further add to our struggles as, like ADHD, it can cause executive dysfunction. In addition to making it harder to cope with the ADHD symptoms, depression can also mask/ muffle them. I found that my ADHD symptoms got “worse” as my depression got better, which seems to be common, especially my emotion and impulsivity symptoms.

We already know what tends to work for primary depression: treatment such as counselling/therapy and medication.

Counselling can also be quite useful for secondary depression as it can help you learn to manage emotions and frustrations, learn to recognize and deal with under-stimulation.

Pursuing some creative, sporty, or hands-on hobby is a good way to ward off under-stimulation and provide an outlet for our emotions.

Counselling really helped me deal with my depression. I also started my ADHD related blogs/ YouTube channel for that very purpose, and I honestly haven’t felt the worst of boredom since then.

Note: I am not a doctor. This post is meant to be a springboard to start your research. All the sources are at the bottom, and I highly recommend reading the ADDitude ones. 

ADHD affects every single aspect of our lives. It affects our ability to focus, our memory, our social skills, our relationships, our emotions, and much more. These issues can all be debilitating by themselves but there is an aspect of having ADHD that’s not as talked about: ADHDers are incredibly likely to have comorbid conditions.

Comorbidity is when two or more condition occurs in the same person. Studies have shown that around 60-80% of adults with ADHD have at least one comorbid condition [1]. The most common comorbid conditions for ADHDers are depression (~50%) and anxiety (~30%) [2]. It has also been noted that the prevalence of comorbidities can differ depending on gender, eg, female ADHDers are likelier to have comorbid anxiety than male ADHDers [2].

Comorbid conditions can mimic and even mask each other. When I was younger, I had very severe depression. As I got my depression under control, I noticed my ADHD symptoms were getting more severe. I was confused so I asked my psychiatrist, who confirmed to me that depression can ‘suppress’ ADHD symptoms [3].

Comorbid conditions are separate from ADHD. Just treating the ADHD will not manage the comorbidities, which have to be treated simultaneously with ADHD [4]. As such, recognizing co-morbid conditions can be vitally important for treatment. For example, stimulants can exacerbate certain anxiety issues, which can make them unsuitable for some ADHDers.

[1] Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017;17(1):302. Published 2017 Aug 22. doi:10.1186/s12888-017-1463-3

[2] Managing ADHD in children, adolescents, and adults with comorbid anxiety in primary care. Prim Care Companion J Clin Psychiatry. 2007;9(2):129-138.

[3] ADHD Comorbidity: An Overview of Dual Diagnoses, ADHD Editorial Board, https://www.additudemag.com/general-questions-about-comorbid-conditions

[4] When It’s Not Just ADHD: Symptoms of Comorbid Conditions, S. Larry, MD, https://www.additudemag.com/when-its-not-just-adhd/

[5] Kooij JJ, Huss M, Asherson P, et al. Distinguishing comorbidity and successful management of adult ADHD. J Atten Disord 2012; 16(5 Suppl): 3S-19S.

[6] Comorbidities, ADHD Institute, https://adhd-institute.com/burden-of-adhd/epidemiology/comorbidities/

Note: I am not a doctor. My aim is for this article to be an informal but informative springboard to start your own research. I have tried to mostly refer to my own experiences but balanced with expert sources (listed at the bottom). 

Addiction is a major issue for ADHDers. Studies have shown that we have an increased risk for addiction to substances (e.g., nicotine) and behaviours (e.g., sex and video games) [1] [2].

I categorize my own experiences with addiction as either self-medicating (stuff that stopped me from feeling bad) or pleasure-seeking (stuff that made me feel better). 

Self-medication involves using “non-prescription” methods to help us manage our symptoms. It is very common with ADHDers, especially when we are undiagnosed. Substances with stimulants can help us focus, so we naturally tend towards smoking and consuming caffeinated beverages from a young age. 

While studying for my university exams (before my diagnosis), I used to drink multiple cans of energy drinks and cups of very sweet tea, while also vaping the highest legal concentration of nicotine. I still remember getting headaches from (what I assume was) acute nicotine poisoning

However, the most problematic self-medication substance for me was alcohol. It was very appealing as it would alleviate my anxiety (which is very common in ADHDers), stop my racing thoughts and help me fall asleep. I am very thankful that alcohol upsets my stomach, or I might have had a severe problem today.

Pleasure seeking activity is using/doing things that make us feel good. I really struggled with an addiction to video games and pornography during my teens and early twenties. Simply put, they made me feel good and I would want to do it more and more, especially when I was bored (which was all the time).

I still strictly manage my consumption of these activities as I know that I can easily fall back into addiction (like I have many times before). 

Cycle of addiction

Addictions can be especially troublesome for ADHDers. An addiction cycle for ADHDers tends to go as follows (with the example of smoking) [3]:

1. ADHDers are likelier to start smoking at a younger age for reasons previously mentioned

2. Due to difficulties with self-control, ADHDers start chain smoking and become increasingly addicted to nicotine

3. ADHDers have a harder time quitting due to difficulties with impulsivity and self-inhibition

4. Due to issues with our dopamine system, ADHDers experience worse withdrawal symptoms and relapse much easier

I want to heavily stress that relapsing is not a sign of weakness or failure. Managing addiction is difficult for everyone but can be especially difficult for us ADHDers. With support and treatment, addiction can be managed, and the possibility of relapse reduced.

Treatment

Truthfully, what helped me the most with my addiction issues was my prescribed ADHD medication. The stimulants completely removed the need for me to self-medicate and helped curb my excessive pleasure-seeking activities.

There are fears that ADHD meds act as a ‘gateway drug’ but these fears are unfounded. It is quite the opposite; studies have found that meds can SIGNIFICANTLY reduce the likeliness of future addiction in youths [1]. For people who have already battled with substance abuse, there is also the option for non-stimulant ADHD medication (such as Strattera). Traditional addiction treatment options such as therapy are also a viable option.

Addiction is a very common issue for ADHDers. I would hazard a guess that most (if not all ADHDers) struggle with some degree of addiction at some point in their lives. However, it has to be stressed that addiction can become quite a serious problem. 

If you are struggling with addiction, I would heavily advice consulting your doctor for options to treat your addiction issues alongside your ADHD, as one can make the other even harder to manage, and as such might need be treated simultaneously [4].

[1] ADDitude. 2020. The Truth About ADHD And Addiction. [online] Available at: <https://www.additudemag.com/the-truth-about-adhd-and-addiction>. 

[2] Davis, C., Cohen, A., Davids, M. and Rabindranath, A., 2015. Attention-Deficit/Hyperactivity Disorder in Relation to Addictive Behaviors: A Moderated-Mediation Analysis of Personality-Risk Factors and Sex. Frontiers in Psychiatry, 6.

[3] McClernon, F. and Kollins, S., 2008. ADHD and Smoking. Annals of the New York Academy of Sciences, 1141(1), pp.131-147.

[4] WebMD. 2020. ADHD And Substance Abuse. [online] Available at: <https://www.webmd.com/add-adhd/adhd-and-substance-abuse-is-there-a-link >.