ADHD is Often Accompanied by Anxiety or is Said to be Co-morbid with Anxiety
I recently read a very interesting article on ADHD and comorbid disorders, specifically adult ADHD and anxiety. When I see patients, almost 75% of the time they have comorbid illnesses which means more than one illness or one being accompanied by another. We often see in adults or ADHD and comorbid disorders such as anxiety. Many people who have ADHD also have depression and/or anxiety. Some believe that the depression or anxiety is secondary to the ADHD. This is very important because we often have to discern which of the illnesses is the primary illness driving the co-morbid illness to implement an effective treatment program. Often a patient with comorbid disorders might complain of anxiety symptoms so the practitioner will treat them for anxiety, hence the ADHD which is actually the primary illness will be interpreted as “mere confusion” caused by the anxiety. What ends up happening is the ADHD is never treated, and being the primary cause of the anxiety, the patient never gets relief from the anxiety. This is why the initial evaluation is so crucial in the treatment planning and implementation. Often when a patient is given a stimulant for the ADHD, Ironically the anxiety subsides. I say this is ironic because conventional wisdom would dictate that stimulants provoke anxiety, hence the anxiety was a secondary condition.
Comorbid Depression and Anxiety are Common Disorders Simultaneously Presenting
This situation often works in reverse as well. The patient may be suffering from bipolar disorder and the practitioner will treat them for depression and anxiety comorbidity. Instead of giving the patient a mood stabilizer, the practitioner prescribes an SSRI to pick them up (which often sends them into mania) and then an anti-anxiety medication to bring them down. Now they are going from one extreme to the other and this condition is usually much more severe than the underlying bipolar disorder. Once again, the initial evaluation is of utmost importance in getting the appropriate diagnosis, which then leads us to the correct treatment course. ADHD and comorbid disorders are quite common and sometimes occur with bipolar disorder as the comorbid disorder.
Establishing The Primary Illness is Crucial with ADHD and Comorbid Disorders
The importance of establishing the primary illness versus the secondary illness is that if the practitioner focuses on the secondary illness such as depression, which might be driven by the primary illness ADHD; then the ADHD will continue to cause the depressive episodes. There are several techniques that trained psychiatrists use to determine the differences between the primary and secondary illnesses. This aspect of medicine is as much an art as it is science and comes with years of experience and study. Again I can’t stress the importance of a practitioner’s ability to discern between the primary and secondary illnesses because the vast majority of those suffering from mental illness will have comorbid conditions. You may wish to read about ADHD and Comorbid Disorders and the genetic link to ADHD.