Untreated ADHD can be a breeding ground for anxiety. It’s a common pairing with frequently overlapping symptoms — things like difficulty concentrating, sleep irregularities, and constant feelings of restlessness. Days riddled with missed deadlines, misplaced keys, and countless social blunders create an ambient hum of chronic worry.
Edward Hallowell, MD and founder of The Hallowell ADHD Centers, says:
“Pretty much everyone with untreated ADHD has anxiety, because ADHD leads you to make a lot of mistakes — you forget or overlook things, misspeak, misplace, fall behind, lose track of time … It’s an anxiety generator.”
Nearly half of us living with ADHD also grapple with the weight of an anxiety disorder. But in a world where every oversight and impulsive decision seems to catalyze symptoms, embracing a diverse approach to treatment can lead you to a place of calm coexistence.
A prescriptive approach: medication for ADHD and anxiety
Stimulants and non-stimulants
Stimulants, like Adderall and Ritalin, are often the initial treatment choice for ADHD, with proven effectiveness for about 70% of patients. While some worry that stimulants will exacerbate the anxious mind, many experts argue that addressing ADHD head-on can in fact alleviate anxiety.
Think about putting on a pair of glasses for the first time; suddenly, the world comes into sharper focus — and with it, a sense of calm.
There are two types of medication that are approved by the U.S. Food and Drug Administration (FDA) to treat ADHD: amphetamines, such as Adderall, Vyvanse, Dexedrine, and Adzenys; and methylphenidate, such as Ritalin, Focalin, and Methylin. Mental health professionals also prescribe modafinil, commonly known as Provigil, which is another stimulant that’s used off-label to treat ADHD symptoms.
“We’ve got over 70 years of experience with both of these stimulants, yet there is so much misinformation about them.” Dr. Hallowell advocates for the efficacy of these medications when used properly, noting that amphetamines were first used to treat ADHD in 1937 and methylphenidate has been in use since around 1950. “Nothing lasts that long unless it’s safe and effective,” he says.
For those who find the effects of stimulants too intense or anxiety-provoking, non-stimulant medications offer an alternative path:
- Selective Norepinephrine Reuptake Inhibitors (SNRIs): Medications like Strattera (atomoxetine) and Qelbree (viloxazine) can improve focus without the “jittery” feeling some experience with stimulants.
- Alpha-2 Agonists: Originally marketed as blood pressure medications, research has shown that medications like Intuniv (guanfacine) and Kapvay (clonidine) have proven benefits for both ADHD and anxiety symptoms.
- Antidepressants: While not specifically approved for ADHD, certain antidepressants like Wellbutrin (bupropion) can help with both attention and mood regulation.
Antidepressants and ADHD
Mental health professionals may prescribe antidepressants, either alone or with a stimulant. But Dr. Hallowell insists that SSRIs — one type of antidepressant — should be a last resort for treating ADHD.
“SSRIs are safe, but there are two side effects that I think make them particularly not worth going on unless you really need them,” he says. “The first is that they’re cognitively dulling. The second is that they reduce libido, a natural, affirming, joy-producing life force.”
While antidepressants aren’t approved by the FDA to treat ADHD, those living with both ADHD and an anxiety disorder may need to take both a stimulant and an anti-anxiety medication.
Stimulants’ effects on anxiety
It is commonly believed that stimulants can lead to increased anxiety. And while this can be true, Dr. Christine Sauer, MD and Certified Brain and Mental Health Coach, explains: “For many of my patients, treating their ADHD with stimulants actually reduces their anxiety. When they can focus better and make fewer mistakes, their anxiety naturally decreases,” a sentiment also acknowledged by Dr. Hallowell.
“A trial of medication is just that … You may continue to use it, or you may not,” Dr. Hallowell says. “It’s just a shame that people are afraid of using a stimulant because whatever it does, good or bad, it only lasts for a matter of hours.” According to Hallowell, a primary reason for stimulant failure is using too low of a dose. He explains, “The beauty of stimulants is they give you an automatic feedback reading — your body will tell you if you’re taking too much,” noting that the five variables to watch are weight, heart rate, blood pressure, sleep, and how you feel.
A delicate balance
In some cases, a combination of ADHD medication and traditional anti-anxiety medication may be the most effective route. However, this approach requires careful monitoring and open communication with your healthcare provider to avoid potential interactions and side effects.
A classic coupling
While medication can be a game changer, it’s only one piece of the puzzle. An effective treatment plan is a comprehensive one, marrying various pharmaceutical and non-pharmaceutical strategies to address both ADHD and anxiety.
Psychotherapy and rewiring the brain
Cognitive Behavioral Therapy (CBT) is particularly effective for both ADHD and anxiety, helping individuals identify and change negative thought patterns and behaviors. For those with trauma-related anxiety, Eye Movement Desensitization and Reprocessing (EMDR) therapy can be transformative.
By way of movement
Regular physical activity is a powerful tool for managing symptoms of ADHD, anxiety, and virtually every other condition. Whether it’s a brisk walk, a swim, or hitting the gym, exercise releases endorphins that can quiet the anxious mind and improve focus.
Mindfulness, meditation & the present moment
Incorporating mindfulness practices into your daily routine can make a world of difference. These techniques help cultivate a sense of presence and awareness, allowing you to observe anxious thoughts without getting swept away by them. Apps like Headspace and Calm offer guided meditations specifically designed for those with ADHD and anxiety.
Fueling the brain and the body
Research shows that what you eat can significantly impact both ADHD and anxiety symptoms. While a balanced diet rich in omega-3 fatty acids, complex carbohydrates, and lean proteins can help stabilize mood and improve focus, some also find that reducing caffeine and sugar intake helps manage anxiety symptoms. Dr. Uma Naidoo, a nutritional psychiatrist at Harvard Medical School, recommends incorporating foods like fatty fish, leafy greens, and fermented products to support brain health and function and reduce anxiety.
Sleep hygiene matters
Both ADHD and anxiety can wreak havoc on sleep patterns. Establishing a consistent sleep routine, creating a relaxing bedtime ritual, and limiting screen time before bed can significantly improve sleep quality and, in turn, reduce symptoms of both conditions.
The road ahead
Navigating ADHD and anxiety is a journey that requires patience and self-compassion. And though the path may seem like an isolating one, it’s important to remember that you are not alone. By seeking support and advocating for your needs, you can reclaim your power and live a fulfilling life. The goal is not about achieving perfection; it’s about finding a balance that allows you to thrive.
Take care of your mental health today with our Smart Assessment, a diagnostic evaluation that offers a diagnosis (when warranted) and insight into a growing range of mental health conditions.
