Anxiety and ADHD

Roughly a third of those with ADHD also meet criteria for an anxiety disorder. Disrupted attention, hyperactivity, and impulsivity can be present in both conditions, and conventional self-assessment scales do a poor job of differentiating whether symptoms arise from ADHD, anxiety, or both.

ADHD in early childhood contributes to the development of anxiety disorders, whereas most research has failed to show that anxiety disorders cause full-blown ADHD. However, anxiety often worsens symptoms of ADHD. In other instances, anxiety can reduce the expression of ADHD symptoms such as impulsivity.

A careful exploration of the progression of symptoms over time, and examining which situations worsen or improve symptoms yields the most help in differentiating anxiety from ADHD. Medication can also be quite helpful in sorting out the two conditions. Stimulants and other ADHD medications (at appropriate doses) usually reduce anxiety in those with ADHD, but tend to exacerbate anxiety in those without ADHD.

The treatment of anxiety in the setting of ADHD often starts with proper adjustment of any ADHD medications. A number of agents, including SSRI, buspirone, and guanfacine, can be added on to target anxiety reduction in individuals with ADHD. Behavioral approaches, including cyclic sighing, exercise, meditation, and the chanting of mantras, may also help reduce anxiety, as can CBT based cognitive reframing and re-education.

References:

A meta-analytic review of the impact of ADHD medications on anxiety and depression in children and adolescents (2023)

Attachment and comorbid anxiety in ADHD (2024)

Early Development of Comorbidity Between Symptoms of ADHD and Anxiety (2021)

Differential diagnosis and comorbidity of ADHD and anxiety in adults

Is Clinical Anxiety a Risk or a Protective Factor for Executive Functioning in Youth with ADHD? A Meta-regression Analysis (2018)

General:
Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions. Subscribe if you're curious about how neuro-atypical brains can optimize their functioning in our shared, and somewhat strange, world.

Dr. Kruse has posted talks in both the "live" and the "video" sections of this channel. Thumbnails on ADHD topics have a pink background, and those on more general mental health topics have a purple background. A small collection of ADHD-Trump videos have an orange background.

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[jenniferhizzy]

Caffeine is weird with me at first I'm tired but then when it wears off I cannot get to sleep.

[louise]

Thank you so much for this video! In your opinion what would be a great course of activation for female 27 undiagnosed but definitely has had add (cognitive function problems, struggle to concentrate when I need to, getting frustrated easily, over stimulated, interrupting) her whole life and now in adulthood it’s coupled with severe anxiety? Would it be worth it to try a stimulant even with the risk it may increase anxiety?

[notrace]

Positive illusiory bias is a brilliant concept. I learn alot from your videos thanks.

[PhumeleleKunju-udiq]

Hi DR. I currently take fluxotine 20mg for anxiety and recently started Ritalin 20mg 3 times a day. My anxiety is through the roof. But the Ritaline is working really well.

[notrace]

Taking 5 htp with methylphenidate reduced my anxiety. It also helped with sleep.

[blueyepasta]

i have autism together with my adhd, so im very anxious especially socially. Guanfacine has helped a lot unlike the stimulants that make me worse. Had an allergic reaction to Wellbutrin and curios to try Strattera after many stims failed. What is your clinical exp doc? Is having commorbid autism an indication that somoene mihjht have a likely higher chance for a negative exp on stimulants? seems to be common reading stories of people with also autims on reddit...

[Ryan-udfk]

What would be your first go to treatment for someone who is on a stimulant and doing well but still experiences anxiety & overwhelm. I have a Doctors appt in a week and was going to ask about guanfacine, straterra or buspar but I dont know how much my Doctor would know. Do you have a particular one that stands out as the best option to start with?

[georgehales]

Hi Dr, I have tried all the stims but they all make me incredibly anxious, unsociable and restless. I am currently on Ituniv 2mg for 3 weeks but do not notice much. I have CPTSD from a bad childhood and have very bad social anxiety and anxiety in certain settings. Would SSRI be best to help combat this?

[Truerealism]

I have adhd autism which is best to try whst you have found in your practice as can meds maked autism worse

[JatasyaSantim]

I was taking buproprion 75mg (3 yrs) then adderral 15 mg (6months) and had a drug induced mania
and tinnitus. I stopped and was prescribed buspirone and felt happier but low energy and hard time with focus so I tried Stratterra and stopped today because I was having severe dry mouth, cracked lips, scallopped tongue and problems swallowing, sore throat and stomach issues, as well a pain in upper right stomach. I also have BPD and feel that buspirone is helping with anger. I feel like the mix of wellbutrin was messing with sympathetic system and just need the adderral with buspirone but Dr. is afraid i may have mania . what do you suggest... I think possible combo Ritlin and buspar because adderal increasesed anger and impulksivity.

[afser]

What's the difference between anxiety and hyperarousal / hyperactivity? I heard from Dr. William Dodson ADHD patients often confuse the two and that anxiety means to have a 'baseless apprehensive fear' most of the time.

I don't have any fear except normal worry of not reaching my goals. But my mind is always thinking of random things, going 100 miles an hour which Dr Dodson says is the physical experience of hyperarousal. My mind can't go quiet for a single moment.

I think most people confuse the two conditions, even educators in this field label hyperarousal symptoms as anxiety. If you don't have any fear can you say for sure that what you have is not anxiety?

[mediumslime]

well... why'd my treatment get interrupted?

[afser]

Hey doc,

I have tried methylphenidate hydrochloride. 5mg, 10, 15mg did almost nothing for me. 20 mg worsened my daydreaming. I was expecting it to calm the voice in my head. Is this enough to know that methylphenidate is not for me? There aren't other forms of methylphenidate where I live. My other options are armodafinil, atomoxetine, clonidine and bupropion.

Can you use clonidine acutely and quit abruptly without monitoring blood pressure if your bp is on the lower side? I want to try it but fearing it'll make me lethargic and give me rebound hypertension if I quit?

I am not asking for medical advice, just wanted to know your experience with it.

[AhmedAhmed-zeh]

Female, 5 weeks pregnant, 29 years, ADHD, anxiety and depression
Struggling with everything, no motivation mostly, powerless
What is the best ttt for her ?

[foxybyproxy]

i just sleep all the time now. well, i'm up at night, but i don't beat myself up for making up the time anymore. doesn't mean that my life isn't a smaller pile of s&*t cause i'm well rested, but i do get a bit of 'feeling better.' i'm interested in a non-stimulant stimulant to add to my adhd med. adderall was awesome at first but quickly created more panic and anxiety! bummer! so, i'm assuming i need the non-stimulant...can anyone relate? i'd love some feedback from viewers, thanks!

[shanzashai]

Green tea and Green nutrient smoothie and flaxseed with omega 3