• fatigue, irritability, lack of enthusiasm and motivation, poor sleep, guilt, poor self esteem, worrying, etc.

Depression and ADHD together is very common and while many do find it improves on treating the ADHD, it may well need separate treatment, either with counselling or medication and fortunately that’s not a big problem to combine with stimulants.

Typical symptoms of depression are:

low energy – how often do you feel tired, or find it’s too much of an effort to get off the sofa. Often, while you are actually doing things you don’t notice the fatigue, but both before and after you do.

poor quality sleep (more often staying asleep than getting which is common in ADHD), or sleeping excessively.

lacking enthusiasm – you may have interests but are you doing them – do you make excuses not to go out to a restaurant or avoid social engagements, or not go for walks like you used to. Do you get excited about anything any more?

motivation – while ADHD makes people avoid the tedious, the involved, the boring, depression makes even routine tasks an effort. In severe cases, even bothering to shower may be more than you can face.

forgetfulness – while ADHD often makes people forget things, depression tends to leave people in a fog, unaware of what’s happening around them Poor memory often feels worse in depression than others report about you where in ADHD, it’s usually others that are noticing the poor memory.

Concentration – in ADHD patients get distracted by other things, often more attractive. In depression poor concentration involves stalling out, staring into space, missing blocks of time.

Irritability – ADHD patients are irritable when things don’t go right, or they are taken to task for not getting something done, or being asked to stop what they are doing. Depressed patients are just cranky – little things irritate them. It might be how your partner chews their food, or the dog, or the piece of machinery you’re trying to use. Depression makes people look for faults before they happen.

Anxiety – in depression it often involves things over which you have no control where in ADHD – it’s about the things you are responsible for, falling behind on, or forgot to do.

Pessimism – most people with ADHD still think things will work out. If anything they are unrealistic in their assessment of their own ability to perform, unless it starts to be depression too.

The depressed patient thinks what’s the point – it won’t work out anyway. You could argue that in the ADHD patient it’s depression that makes them look at their abilities more realistically, but really, it’s about taking it beyond even what previous experience would suggest is a reasonable expectation.

Suicidal Thoughts – Fleeting thoughts might not be depression but ruminating about death and not being here are depression till proven otherwise.

Chronic pain – especially stomach aches and headaches on a daily basis, in the absence of a specific injury to explain them is frequently associated with depression but not ADHD.

Autism Spectrum

Autism is associated with poor social skills but it’s more awkward than impulsive, lacking eye contact or having difficulty relating to people. It’s often associated with a limited number of interests which are often taken to the n’th degree and frequently in a very narrow part of a subject to the total exclusion of the rest of that interest area. It can be associated with repetitive movements – often more complex than the simple tics that are sometimes seen in ADHD. This used to be referred to as Aspergers Syndrome, though that has been dropped as a diagnosis in the latest DSM Manual of psychiatric diagnoses.


Many people with ADHD talk about large mood swings, but the swings aren’t gigantic, are more often triggered by something, even if it is minor or innapropriate to react to, and swings in bipolar tend to happen over several days to many months, rather than flipping thought the day depending on what’s happening and who pisses you off.

In bipolar, patients only look ADHD when they are manic. In fact, being a little bit manic (hypomanic) often means people are especially productive.

Bipolar must be under control before you look at treating ADHD. Not doing so can put the patient in hospital, on the psychiatric ward and locked up. If the patient is on their mood stabilizer(s) and doing well, treating ADHD is not especially risky, though I do like someone to keep an eye on the patient as going manic, the patient is usually unaware that anything is wrong.