Today, I would like to talk a bit about depression and its relationship to ADHD. But rather than a cold clinical description, I want to talk about the experience of what we typically call depression. Although defined by a list of symptoms in the diagnostic manual (DSM-5), this may not be the lived experience of people who struggle with depression.
For some people, this symptom list touches many elements of their experience. However, for many others, their depression is more elusive and resists the kind of clean categorization reflected in the DSM. I think one of the most helpful ways of thinking about depression is to see it as a form of suffering.
A person has lost the ability to flexibly adapt and is stuck in a pattern of behaviour or a set of expectations for their relationships with others, making them decidedly unhappy. We tend to think about depression as someone who is trapped by their sadness, loneliness, despair, hopelessness, and fearfulness. While these emotional states are common in those we describe as depressed, things may not be quite so clear.
Different faces of Depression
Alternatively, depression may look like an inability or very limited ability to experience positive emotions such as joy, excitement, fulfilment, or positive anticipation. Someone may experience all three of these dimensions in what can only be described as a perfect version of hell.
Sometimes, depression is characterized by an angry irritability. In this case, the experience is coloured by the belief that “if only the world or the people in it would behave differently, my suffering would end”. They may seem angry, rather than depressed; however, it is absolutely clear that being stuck in a state of anger is painful. It feels awful to be angry.
Remarkably, depression may be not be apparent to others and might be all but invisible to the sufferer. Those affected may have difficulty identifying the onset because feeling “blah”, flat or unhappy has become the new normal. Sometimes this happens because there is greater focus on getting through the next week, day or moment. Thus, “feeling” is placed on the backburner. At other times, the onset is so gradual they don’t notice.
Stuck in a Loop
Another characteristic of depression and ADHD is a tendency to get locked in one’s own head. Not only is life experienced through a cloud of grey smoke, there is a tendency to think and rethink about negative experiences. Most of this thought is circular, going over the same material, reinforcing the idea that life is and will continue to be a disappointment. Depression brings isolation. Speaking less with others creates biased counsel. They talk and talk and talk to themselves about their hurt and disappointment.
Unfortunately, while this may be motivated by trying to find a solution to the suffering, it tends to reinforce painful feeling states, leaving them further stuck in their unhappiness.
So, why is it that people with ADHD seem to be so much more prone to depression? One true, but unhelpful answer is that people with ADHD tend to suffer more with many types of human hardship. They are more prone to struggle with anxiety, substance abuse, eating dysregulation, underemployment, marital issues, and so on.
A more substantial answer has to do with a pattern that I think develops very early on for many individuals with ADHD. A well-recognized characteristic of ADHD is emotional dysregulation.
ADHD individuals tend to be more reactive emotionally; reacting more strongly to both positive and negative events. As a result, I believe they get a great deal of feedback when they are quite young that they are simply too sensitive, overly excitable, get upset over nothing, or are simply just too intense.
This type of feedback is pretty much useless since people have next to no capacity to alter this characteristic of themselves. Thus, instead of being able to react in a more restrained fashion, they instead simply learn how to feel wrong about their emotions. They believe that something is wrong with their emotional reactions. As a result, they move into a position of blaming themselves for what they feel rather than learning to cope with what they feel. This initiates the long and often hardened process of self-condemnation, self-criticism, embarrassment, and shame.
The ADD emotionality is inherently a normal emotional process. The emotions are just occurring in a somewhat more intense manner for those with ADHD. This type of self-consciousness decreases a person’s ability to adapt to emotion. They become caught up in their own heads, thinking about how they should feel and react rather than giving them an opportunity to cope with the way they do feel and the do react.
The Critical Difference
Getting unstuck from the tremendous pull of the depressive mind can be extraordinarily difficult. Furthermore, the path is not the same for everyone. For some, antidepressant medication can have a tremendously positive effect. When it works well, it can shift a person’s perspective quite dramatically and allow them to look at themselves and their life through completely different lens.
Psychotherapy can be important as a means of changing the relationship to the thoughts and biases that enable and maintain depressive suffering. From my perspective as a psychologist, this learning can be a critical difference in changing lifelong patterns and understanding the workings of the mind differently. It can be particularly effective when combined with medication which may allow the therapy to become more effective when less oppressed by the effects of a depressive mind.
One of the central aspects of recovering from depression is establishing a more compassionate way of relating to our own personal suffering. It is tied to removing the blame and condemnation for being caught in the patterns of mind that give rise to and sustain depression.
It is hard enough living in depression but made overwhelmingly difficult when a person condemns themselves for their own suffering, seeing their depression as a fundamental character flaw versus an inevitable consequence of certain patterns of thought due to neurochemistry. Kindness toward oneself can be extraordinarily difficult when lost in depression.
Additionally, it is worth noting that for many individuals undiagnosed and untreated for their ADHD, the response to treatment for depression is clearly diminished. If the ADD mind is not simultaneously treated, it is more difficult to break patterns of mind that sustain this suffering we call depression.
We all need others
It is sometimes difficult to find the motivation to get help when painfully upset and disappointed with oneself.
However, the good news is that depression can improve. Even within a bout of depression, it is sometimes worse, sometimes better.
With help, either from medication or therapy or both, one can move away from spending the majority of time in the painful sway of depression.
It typically requires the compassionate assistance and encouragement of a friend, partner or family member to alter the understandings that have developed over years or a lifetime.
Leaning on another can be so helpful. We need others to help us get better. Often, we need others to move us toward seeking the help we need.
About Dr. John Fleming, Ph.D. C.Psych
John is a psychologist in Toronto, Canada and has over 35 years of clinical experience in helping people deal with a variety issues that have prevented them from living a more fulfilling life. This has included a great deal of counselling relating to issues of disordered eating and obesity.
During the last fifteen years he has co-directed a research and clinical program concerning the role of attention deficit hyperactivity disorder (ADHD) in the development and perpetuation of disordered eating. He is also actively involved in the assessment and treatment of ADHD in adults and adolescents. His clinical approach employs cognitive behavioural therapy and mindfulness-based cognitive therapy as well as elements of positive psychology and psychodynamic psychotherapy. For more information: http://drjohnfleming.com/