Ever since I discovered and wrote about the importance of treating ADHD if one also has depression, I have found myself thinking a lot about why this is the case. I’ve floated hypotheses that it has to do with regulating brain chemistry, since both conditions can be caused my imbalances and it is not unreasonable to think that the two might interact in some way.
I was lying in bed, my mind racing and thinking about the dozens of different things that my mind seems to decide must be thought about as I desperately attempt to fall asleep, that I began to think about the many ways that the two mental illnesses present in terms of symptoms. The more I thought about it, the more I realized the myriad of ways that the two reinforce one another.
ADHD isn’t really an inability to focus but rather it is a difficulty in choosing what to focus on. This can manifest in a variety of ways, including hyper focusing on the wrong thing or simply being unable to process the need to do other things in light of said hyper focus, being unable to filter out various stimuli and focusing on everything at once making it difficult to focus sufficiently on any one specific thing, and so forth.
One of the ways that this presents is in difficulty with motivation and self-starting. If you think about it, motivation is the ability to shift your focus towards the task you have decided is to be completed at this time. That ability, to choose to shift ones focus, is exactly what is hindered when one has ADHD. As a result it can be difficult to make yourself close the tab with Facebook and focus on the open word document in front of you. It can be difficult to turn off the show you are watching and go to bed, or make food, etc. If that activity is in some way unpleasant or requires some higher cost of mental or physical energy than your current activity, the ability to shift your focus can be even more difficult.
Depression also imparts difficulty with motivation. The inability to feed yourself, to clean yourself, to get out of bed, do something other than bingeing Netflix,are not unknown to depressed people. Depression creates a physical cost for all of those activities whether through exhaustion, pain, troll-brain thoughts related to the activity in question (like your brain telling you shouldn’t bother eating because you’re fat/you don’t deserve nutrition/slowly starving yourself is a passive form of suicide).
When you have ADHD and are in a current depressive state or flare, the two can work together to make motivation and focus even more difficult. What’s more, it can be harder to recognize when you are entering a depressive state since motivation issues can exist regardless. Not eating regularly or showering as often as you would otherwise like are not unusual, what changes is the severity with which this is the case. As a result the warning signs that you are entering a period of increased depression can be easily missed until you are already comfortably ensconced in crisis mode.
The additional failure to complete tasks can worsen anxiety and self-esteem issues. In turn, anxiety provokes a worsening of ADHD symptoms making the situation yet direr. The hit to your self-esteem of course feeds the trolls in your head. Instead of just being a bad day, it becomes an example of how you can never complete anything and you will die with your goals unfulfilled so you might as well give up.
Untreated, it is not uncommon for ADHD to cause what appear to be sudden mood swings. In the same way that our thoughts can jump from one thing to the next, seemingly unconnected, so too can our emotions and feelings manifest in a similarly seeming random pattern. Like those thoughts however, the connection exists but is not always recognizable to the outside observer.
Our minds make connections that other people don’t. It has to do with how we store information. For most people it is a linear process, where point a leads to point b. It makes it easier to access that information on a moment’s notice. However, the ADHD mind relies a lot on pattern and so creates multiple connections between different things, meaning there are different paths by which to reach that information, and sometimes it can be difficult to find the right one at any given moment, and sometimes the connection you are following suddenly leads somewhere other than what you were expecting.
Imagine it a little like the staircases at Hogwarts. You could be following an information trail that reliably before led to a certain spot, only to have the staircase shift on you suddenly and leave you in the forbidden corridor on the third floor. Our minds are much the same.
Sometimes these sudden staircase changes can lead us to thoughts or memories that provoke a different emotional response than what was felt previously. Imagine following a train of thought, and having it lead to memories of a loved one who died recently, or to a memory of abuse. The change in emotions is a reasonable response to being unable to choose what you focus on and ending up focusing on something that makes you upset or alternately, that makes you laugh at inappropriate moments.
Depression in turn can make you focus on the worst memories over and over again. Moreover, depression can make you irritable which in turn can make the inability to choose your focus that much more overwhelming.
The irritability in turn can make it even harder to control your focus. It can be like sensory overload with a bunch of stimuli flying at you and an inability to shift your focus or ignore the irrelevant.
Insomnia and Hypersomnia
One of the symptoms of ADHD is insomnia. Whether it is caused by the fact that many people with ADHD find that they work better at night, or because we find it difficult to shut down our thoughts sufficiently to sleep.
It is not uncommon for many of us to spend hours unable to stop thinking about what we are going to do tomorrow, replaying conversations in our head and scripting new ones, coming up with all the worst case scenarios for big events, unable to tune out the sound of the clock ticking, the snowplow outside, the sound of the air filter. This hyperactivity of brain, can sometimes manifest itself as physical restlessness like legs that can’t stop jittering.
Since falling asleep is so difficult, once we finally are asleep, it can be difficult to get up. We sleep in later than others, since we fell asleep so much later.
Similarly depression can also cause both insomnia and then later hypersomnia. Since the two can feel very similar, depressive symptoms can be mistaken for worsening ADHD symptoms. This can lead to people missing signs that would otherwise have given them the opportunity to seek help before spiraling to a crises point.
The impact ends up being threefold:
1. The related symptoms make it difficult to recognize when you are entering a depressive spiral. This means that getting help and treatment is delayed which can make the overall symptoms worse.
- The symptoms exacerbate each other so that ADHD gets worse with depression and in turn fuels the depression.
- Treating only one, like the depression might not eliminate symptoms if they are caused by the ADHD rather than the depression, giving the impression that treatment isn’t working and thus adding to despair.
The high comorbidity between depression and ADHD, although likely also caused by systemic ableism that leaves many with ADHD feeling inferior and like failures, means that the drug shaming experienced by those of us with ADHD has potentially lethal consequences.
The tendency to ignore the impact that ADHD can have on depression, makes it easier for therapists and doctors to accept the harmful position of denying treatment to adults or denying the need for treatment in adult’s altogether. Many of us have had our use of ADHD medication suggested as temporary therapies or to be used on special occasions.
It’s time to stop treating ADHD like it is just a learning disability or the result of poor discipline. It is a real condition that benefits from treatment and which requires accessibility in places other than just school.