Dr. Umesh Jain is now exclusively responsible for TotallyADD.com and its content

So many people who struggle with ADHD also suffer from Anxiety. Myself included. A number of our Patrons have asked, does having ADHD inevitably lead to developing this second challenge? And how do you diagnose two disorders? How do you tell which one is causing a particular issue? And once you’ve figured out what’s going on, how do you treat these two separate problems? Do you deal with one first? Both together?

I asked the experts and they offer some great advice based on decades of experience. (I love these videos. You get to hear from top experts and benefit from the best advice… and you don’t need to wait months for an appointment!)

Transcript


Let’s talk about two things that I know like the back of my hands, ADHD & Anxiety, oh what’s that on the back of my hand?

Rick Green –Welcome to me before I was diagnosed with ADHD:

  • I’m worried about early onset dementia
  • I’m worried that somehow I’m broken
  • I worry there’s something wrong with me
  • I really worry there’s nothing wrong with me and I’m just a loser

Ah yes I worried, I worried that I was going to fail, or be held back, or go broke, or have a car crash, die alone, live in a cave, fart in church.

Worrying

You know what I was not worried about? How much I worried, because to me my worrying seemed like a prudent logical response to a very scary and dangerous world out there. My scattered mile a minute, lost in thought, endless mental meandering seemed normal to me because, well, you know, it was normal for me. I just assumed life was meant to be hard, I had self-diagnosed myself as weak, flaky, lazy, dumb, and with a side order of underachieving. ADHD never occurred to me, or to anyone else for that matter, for decades.

Imagine the shock of finding out that most people are not dealing with this constant cacophony of clamour and turbulence. To be clear, what they call full disclosure, in fact over flowingly full; I was diagnosed with attention deficit hyperactivity disorder, I have not been diagnosed with what’s called general anxiety disorder, but ask people who know me well and yeah you know in my experience among people who have the ADHD mindset elevated anxiety is common. Studies have shown that at some point in their lives 25 to 50 percent of people with ADHD develop a full-blown anxiety disorder compared to six percent of the general population.

Disorder means when it’s reached the point where it’s undermining multiple areas of life, severely, noticeably, it’s a big problem, it’s a disorder because while anxiety is a normal part of everyone’s life no one knows what’s going to happen next, we live in this incredibly complex ever-changing world with turmoil, lockdown, masks, alternate facts, what is Bitcoin, new gadgets, new software, driverless cars, online scams, climate change, massive fires, mom is coming to visit for two weeks!

Sorry I didn’t mean to add to your stress, let’s just agree everyone has reasons to be anxious… sometimes. Just as we all have reasons to be sad sometimes, or cautious sometimes, or inattentive, restless, forgetful, struggling… sometimes, but when the anxiety is persistent, when it’s out of proportion to what you should be worried about, when it’s interfering because it’s abnormally intense, regardless if there’s something to worry about. In fact your brain may actually be actively looking and scanning and seeking out things that it can glom onto and worry about, then it’s a disorder.

Hypersensitive & Agitated

Terry Matlen, LMSW, ACSW: I’m like the queen of hypersensitivities, so everything bothered me and when you’re feeling over stimulated by lights and sound and kids walking down the aisle one way this way, one way that way, you’re overloaded and when you’re overloaded you become anxious inside. So these kids are just tied up in knots, or they’re daydreaming but they’re not causing a problem because they’re embarrassed, no one understands them, they’re not going to go and tell the teacher “I just can’t take it” you know, because they don’t understand what they’re not being able to you know deal with.

Rick Green: Generalized anxiety disorder is what doctors call it when you’re paralyzed with fear, you’re on the edge all the time, terrified of making mistakes, unable to handle uncertainty, stuck on the worst case scenarios all the time, never seeing anything but what you should worry about, then it’s time to deal with it, get it handled, get it treated.

So how do you deal with it? What’s the answer when you have ADHD and an anxiety disorder, or even if it’s not a full-blown disorder, maybe it’s not severe enough to qualify as a full disorder but you’re still overly apprehensive, fretful, wound up, and this is actually a very common problem especially for adults with ADHD.

Now in other videos we’ve seen how tricky it is to diagnose when someone has two or three issues going on at the same time and most adults have at least two at some point in their life, forty percent have three or more so teasing apart what’s what takes time, and of course medicating two different disorders with two different medications presents a real challenge. It depends on whether you have two separate issues that are coexisting or is it that one disorder has led you to developing a second disorder, having ADHD has led you to become very anxious.

Kathleen Nadeau, PhD: In other words is it secondary to, is it caused by the ADHD, and if we just treat the ADHD that will calm down and mitigate in some cases that’s true.

Easily Distracted

Dr. Lawrence Jerome: I’ve seen two different responses to treatment with medication, for example I can think about a teacher, a special ed teacher who had ADHD, she always walked on eggshells because she knew she got easily distracted and she got very anxious about this, she was always sort of second guessing herself.

When the stimulants helped her focus she became much more relaxed and the anxiety just sort of disappeared, so it was clearly a sort of a secondary compensation that she used over the years to help keep her on track and double check things.

Rick Green: That’s an ideal outcome, get the core challenge under control, the ADHD, and the secondary issues will abate, but… there’s always a but.

Kathleen Nadeau, PhD: But in many cases it is a dual diagnosis that stimulants aren’t going to be tolerated very well if there really is indeed an anxiety disorder unless they’re both treated. I would say it’s more commonly coexisting in women than in men.

Dr. Lawrence Jerome: I’ve also seen people who when you treat their ADHD symptoms, if you did start to treat them before the anxiety, you’re still left with a lot of anxiety symptoms, ruminative, worry, sometimes panic, we tend to choose the most disabling, functionally disabling problem first so sometimes we might actually treat the anxiety before the ADHD and see what we’re left with, if that’s evidently more impairing functionally.

Kathleen Nadeau, PhD: It’s never a good idea to start two medications at the same time, if I suspect that someone has anxiety, and I talk to them and do a good family history, if they say oh yes anxiety runs in my family and my grandmother had it, my mother had it, my mother has obsessive-compulsive tendencies you know, if there’s a strong family history then I’m going to say let’s get the anxiety treated first, because if we don’t the stimulant medication isn’t going to have as positive result and maybe make you feel very bad. You may say I can’t stand this take me off of it.

Hyperfocusing on Worries

Rick Green: This is the challenge, you’re worrying, and you’re scattered, you take an ADHD medication and now you can focus, even hyper focus on all those worries, all the things that could go wrong, all the worst case scenarios, instead of focusing on something worthwhile, you’re in the grip of a fever dream of ghastly scenarios, what if this is not good? In fact it’s potentially dangerous.

Brian M (focus group participant – used with permission)

I told my therapist I wanted to start at the lowest dosage possible and he incrementally increased me over the course of my treatment. The most that I ever had was up in the 80-milligram range, when that happened things started to get a little weird for me, I was on 54 milligrams, at that point it put me up to the next incrementation and I started having bad anxiety, sort of free-floating, not for any real reason, and it was just you know a few more milligrams.

I remember sitting on my couch of an apartment building, and I was feeling really low, I was looking out on my balcony and I remember thinking you know what would it be like if I were to leap off that balcony. I wasn’t intending to actually do harm to myself, it was just a thought that just occurred to me, and that scared me, that scared me, so I immediately called my therapist and I said, look at this, this isn’t working, I need to drop back down. When I went back down to 54 those things stopped.

Rick Green: It’s kind of like the chicken and the egg, kind of, which came first the worrying, the anxiousness, or the ADHD? Is your anxiety the result of years of struggling and living with undiagnosed and untreated ADHD, or are your ADHD symptoms, your inability to focus, the memory, all of the different problems, the result of your anxiety, or did the chicken and the egg arrive separately as they would in the grocery store? In other words, two distinct disorders.

Figuring out which is which can take time, author Kate Kelly told me about a friend who tried ADHD medication but hadn’t dealt with this anxiety and it did not go well.

Sensitive to Medication

Kate Kelly: Well there’s a story in the book about the person who came to me saying I can’t take medication, I tried it and I’m extremely sensitive, but I want to do something about this ADD and you know so can we just do the coaching, and we did and what we worked on was for him to do meditation, for him to start putting boundaries and limits on the demands other people were making on him and to calm down and slow down his life, and a year later he was much calmer and slower and more a choice in terms of his life and he went on medication again had a completely different experience.

Kathleen Nadeau, PhD: If we get the anxiety under control, first of all we’ll see how much of this is due to anxiety and then add the stimulant on top and we have a much clearer idea of what’s leading to what.

Kate Kelly: And what we both figured out was that probably his bad experience on the medicine was that for the first time he was tuning in to how anxious and adrenalized he actually was and when he did the work to kind of calm his system down, took the medicine, he’s tuned in, no problem because I’m not all jacked up anymore.

Rick Green: As you’ve heard me say in other videos, yes ADHD medications can help you to focus, but they can’t tell you what to focus on, so for a good part of my life my thoughts were predominantly focused on disaster and I was anxious, I focused on anticipating anything and everything that could go wrong, it was horrible. Now I can nip it in the bud, almost always, hey they haven’t called uh well they’re probably busy there, and guess what they’re always busy, they forgot, or their phone isn’t working, they didn’t get cell phone reception, dog ate their phone.

So having ADHD and anxiety presents problems, problems to think about but hopefully not to worry about. I didn’t want to make this too pessimistic or dark or too complex or boring or too flippant, I mean this is serious I know, and now if I’m too flippant people leave nasty comments and then it’ll get angry. I should have got a haircut better than this one, what is that on my hand, oh my god it’s no way, oh no it might spread to this hand.

I hope you enjoyed this video, I really do because I could understand if you didn’t, I mean I know you got other things to think about, and I’m not young and beautiful …I’m beautiful but I’m not young and ….

 

  • View related videos

  • Leave A Comment