ADHD and anxiety together

A large share of adults who come in for one of these turn out to have both, and a large share have been treated for the wrong one first. Anxiety can look like ADHD: a mind that will not settle, tasks that cannot be started, sleep that will not come. ADHD can produce anxiety: years of missed deadlines, lost keys and unfinished things teach a person to dread their own follow-through. And the two feed each other — the ADHD makes the anxiety worse, the anxiety makes the ADHD worse. Getting the order of treatment right is most of the work.

A calm, private space set up for a telehealth psychiatric appointment

Who this is for: Adults 18–65 in Connecticut, Massachusetts, New Hampshire, Maine, Rhode Island, Virginia, and Kentucky who have been told they have ADHD, anxiety, or both — or who suspect one and wonder whether it is really the other.

Why they get confused

They share a surface. Restlessness, difficulty concentrating, trouble sleeping, irritability and a sense of being overwhelmed all appear on both lists. What differs is the shape underneath. ADHD inattention is there whether or not anything is worrying you; it is the interesting article you cannot finish, the conversation you drift out of, the bill you meant to pay. Anxiety-driven inattention is worry crowding out attention — the concentration comes back when the worry lifts. ADHD tends to be lifelong and visible in school reports; anxiety often has a start date.

The evaluation is where that distinction is drawn, and it takes a proper history: childhood, school, work, sleep, what makes each symptom better and worse, and what has been tried. Rating scales help; they do not decide.

Why the order of treatment matters

Treat the ADHD first and the anxiety often shrinks on its own, because a life with fewer dropped balls is a less frightening life. Treat the anxiety first with an SSRI and the ADHD is unchanged, and the person concludes they are simply anxious and disorganised. Treat the ADHD with a stimulant in someone whose anxiety is severe and untreated, and the stimulant can sharpen the anxiety into something worse.

So the plan is usually sequenced. Where anxiety is the louder problem, it’s often addressed first, then ADHD is treated on top. Where ADHD is clearly primary, it’s treated first and the anxiety is re-measured a few weeks later. Where both are significant, a non-stimulant ADHD medication — which doesn’t aggravate anxiety the way stimulants can — is often the bridge, sometimes with an antidepressant alongside. None of that’s a formula; it’s the reason the evaluation comes before any prescription.

What treatment can include

A non-stimulant ADHD medication, which is often the first choice when anxiety is part of the picture
An SSRI or SNRI for the anxiety, where it is significant in its own right — with the combination checked for interactions
A stimulant, where the ADHD is primary and the anxiety is manageable, decided at the evaluation within each state's telehealth rules
The things that treat both at once: sleep, exercise, caffeine and alcohol, and the structure that stops the ADHD generating new things to be anxious about
Therapy — ADHD-focused coaching, CBT for anxiety — coordinated with your therapist where you have one

Common questions

Can anxiety be mistaken for ADHD?

Yes, and the reverse. Anxiety crowds out attention, and years of ADHD teach a person to dread their own follow-through. The history usually separates them: ADHD symptoms are there whether or not anything is worrying you and typically reach back to childhood; anxiety-driven inattention lifts when the worry does and often has a start date.

Do stimulants make anxiety worse?

They can, particularly when the anxiety is significant and untreated — the same alertness that helps attention can tip into a wired, on-edge feeling. That’s one of the main reasons a non-stimulant, or treating the anxiety first, is often the plan when both are present. It isn’t universal: some people find their anxiety improves on a stimulant because their days stop going wrong.

Which should be treated first?

Usually the one causing more trouble, with the other re-measured a few weeks later. Where both are significant, a non-stimulant ADHD medication is often the bridge, because it helps attention without aggravating anxiety and can be combined with an antidepressant. The sequence is set at the evaluation.

Can I take ADHD medication and an antidepressant together?

Commonly, yes — the combination is one of the most frequent in adult psychiatry. Some pairs need care because of interactions, and the prescriber makes that call with your full medication list. It isn’t something to assemble yourself from two prescribers who haven’t spoken.

How do I find out whether this is right for me?

At an evaluation. NCNE's first visit is a 60-minute video appointment that covers your symptoms, history, past treatments and what you’re hoping will change; treating ADHD and anxiety together is one of the options weighed there, against the alternatives and against not medicating at all. You leave with a plan you helped write, and nothing is started until you understand what it does and doesn’t do.

Sources

U.S. Food and Drug Administration. Prescribing information for atomoxetine (Strattera) — indications, warnings and adverse reactions. DailyMed
U.S. Food and Drug Administration. Prescribing information for escitalopram (Lexapro) — indications, warnings and adverse reactions. DailyMed
Cortese S, et al. Comparative efficacy and tolerability of medications for ADHD in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018. PubMed

This page is general information, not a prescription or a recommendation for you. Whether any medication is right for you, and how it would be started, adjusted or stopped, is decided at an evaluation with a prescriber who knows your history. Do not start, change or stop a medication on the strength of a webpage.

If you are in immediate danger, call 911. For urgent emotional support at any hour, call or text 988(Suicide & Crisis Lifeline). Telehealth visits and this website are not an emergency service.

Not sure whether it is ADHD, anxiety or both? Book a telehealth evaluation with Laura Gabriel, PMHNP-BC, or send a message and we will respond within two business days.

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