ADHD or anxiety and depression? How to tell the difference

Often you cannot tell from the symptoms alone, and you do not always have to choose: ADHD, anxiety and depression frequently occur together [3][4]. What helps is looking at how they fit together over time, and deciding which one is getting in your way the most.

That is a different question from “is it ADHD or is it just anxiety?”. “Either-or” is an all-or-nothing way to read your own mind, and it hides the most common answer: it can be more than one thing.

Why they look so alike

Trouble concentrating, restlessness, forgetfulness, low energy, poor sleep and irritability can belong to any of the three. Overlapping symptoms are one of the main reasons ADHD is hard to recognise when other conditions are present [3]. NICE asks that an ADHD assessment also consider coexisting mental and physical health conditions [1], and the NHS describes clinicians checking for other explanations such as anxiety before reaching a conclusion [2].

So when your attention is poor, the useful question is not “which label?”, but “when does this happen, and what else is going on?”.

The body belongs in that check too. A physical condition, such as a thyroid problem, can cause mental fog and anxiety, imitating both ADHD and an anxiety disorder, or making them worse. When that is the case, it is treated first, and only then can the rest of the picture be read clearly.

Questions that help sort it out

None of these is decisive alone. Together they tell a story, and that is what an assessment reads.

1. Since when? ADHD symptoms usually start in childhood, before 12 [2]. If your concentration problems began after a period of stress, loss or illness, we look hard at that period. Researchers still debate how strictly the childhood-onset rule should be applied, and the course of ADHD and of the conditions around it can change over a lifetime [5], so this is a clue and not a verdict.

2. What are you like in your best periods? If the difficulty with planning, time and follow-through is still there when your mood is fine and you feel calm, that points one way. If it clears when the low mood or worry lifts, that points another.

3. Does it come in waves or is it always there? A low mood that arrives for weeks and then lifts is a different pattern from a lifelong tendency to lose track of time.

4. Where does it show up? At home, at work or study, in relationships. One setting only means we look at that setting first.

5. What changed in your life? A move, a new language, a job, a loss. Context belongs in the picture.

One more distinction is worth putting into your own words. “I’m low” points towards depression. “I’m not sad, I just can’t get started” points more towards ADHD. Both can leave the same unfinished pile on your desk, but they come from different places, and they are helped in different ways.

When they coexist, which one first?

ADHD in adults is frequently associated with mood and anxiety disorders, substance use and personality disorders [3]. In a large US survey with clinician follow-up, adult ADHD was highly comorbid with other disorders and linked to substantial impairment in daily roles [4]. Guidelines recommend that when ADHD coexists with another condition, the most impairing condition should generally be treated first [3].

Why this order? When a severe depressive episode or intense anxiety is draining you right now, then any plan for organisation, routines or concentration will fail, because you have no energy left to carry it out. “When two problems overlap, I start with the one that gets in your way most right now.”

Thinking traps that blur the picture

Whatever the diagnosis, a few thought patterns make everything feel worse and make it harder to see what is actually going on:

• All-or-nothing: “If I can’t do it perfectly, I can’t do it at all.”

• Overgeneralising: “I always mess up.”

• Catastrophising: “If this goes wrong, everything falls apart.”

• Mind-reading: “They think I’m lazy.”

• Rigid “shoulds”: “I should be able to cope with this by now.”

Try asking yourself a concrete question: if you missed one deadline, does that make you a failure? What would you say to a friend in the same position? Being kind to yourself is not self-pity. It is what lets you look at the problem clearly enough to do something about it.

And if you are exhausted in a demanding or unsupportive environment, struggling is an expected reaction, not a personal failure.

When anxiety turns into panic, the thoughts race: “a thousand thoughts at once, and it turns into panic”. The feeling deserves to be taken seriously; the catastrophic content does not have to be believed. A catastrophic thought is a symptom of anxiety, not a sign that you are going mad.

Women, hormones and mood

In a study of 209 women with ADHD, the authors reported high rates of premenstrual dysphoric symptoms, postpartum depression symptoms after a first birth and more severe symptoms around menopause, compared with the general population [6]. It was a single-clinic study and cannot tell us how common this is for every woman. It is still a good reason to mention mood changes linked to your cycle, childbirth or menopause during an assessment.

Living away from home

If you are living in a country that is not your own, with a new language, new rules and none of your usual support, tell the clinician. Feeling low, anxious or unfocused in those conditions can be an understandable reaction, and the assessment makes room for it rather than rushing to a label. Our guide to psychiatric help for visitors in Greece explains how to get help if you are just passing through.

What helps: small steps first

You do not have to settle the diagnosis before you act. Action comes before mood.

“Action comes before mood: you don’t wait until you feel like it. You start small, and you see what happens.”

If you are low, choose one small, concrete action today: a ten-minute walk, one email, one meal at a normal time. If you are anxious, notice what you avoid. When you avoid something, the relief is immediate, then the worry grows, because you never find out what would really have happened. So try a small experiment: take one step towards the thing you avoid, write down what you predicted, and compare it with what happened.

Psychological approaches are options worth discussing. A 2026 meta-analysis of 13 randomised trials (744 participants) found that cognitive behavioural therapy (CBT) reduced anxiety symptoms in people with ADHD by a small-to-moderate amount, and the effect was still there at follow-up [8]. A 2025 network meta-analysis ranked CBT favourably for adults with ADHD, but its authors rate the certainty as low or very low for most treatments and ask for caution [7]. An umbrella review in the BMJ found at least moderate-certainty evidence for CBT on ADHD symptoms in adults, no high-certainty long-term evidence for any intervention, and offers an online tool to support shared decision-making [9]. My own training in CBT is specialist training, and I use it where it fits.

In practice, options are laid out and decided together. If a treatment is started, we agree what to expect and when, any side effects are discussed with a timeline, and we set a trial period after which we review whether it is helping.

What the assessment looks like with me

If ADHD is part of the question, I use the structured diagnostic interview DIVA-5, usually over two 45-minute sessions at 130 € each, in Trikala or online. We also look at mood, anxiety, sleep and context, because the aim is to understand the whole picture. Whether medication is appropriate, and whether a prescription is issued, is decided by me after the appointment, based on the full assessment. Read how an adult ADHD assessment works in Greece, or learn more about adult ADHD, anxiety and panic and depression, or book an appointment.

If you are thinking of harming yourself or are in immediate danger, call 112 or your local emergency number.

This article is educational and does not replace individual clinical assessment.

Sources

1. NICE. Attention deficit hyperactivity disorder: diagnosis and management (NG87), section 1.3 (assessment, including coexisting conditions). https://www.nice.org.uk/guidance/ng87/chapter/Recommendations (retrieved 29/10/2026)

2. NHS. ADHD in adults: symptoms, getting help. https://www.nhs.uk/conditions/adhd-adults/ (retrieved 29/10/2026)

3. Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017;17(1):302. https://doi.org/10.1186/s12888-017-1463-3 (PMID 28830387)

4. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-723. https://doi.org/10.1176/ajp.2006.163.4.716 (PMID 16585449)

5. Franke B, Michelini G, Asherson P, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol. 2018;28(10):1059-1088. https://doi.org/10.1016/j.euroneuro.2018.08.001 (PMID 30195575)

6. Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res. 2021;133:10-15. https://doi.org/10.1016/j.jpsychires.2020.12.005 (PMID 33302160)

7. Yang X, Zhang L, Yu J, Wang M. Short-term and long-term effect of non-pharmacotherapy for adults with ADHD: a systematic review and network meta-analysis. Front Psychiatry. 2025;16:1516878. https://doi.org/10.3389/fpsyt.2025.1516878 (PMID 39958157)

8. Wang X, He H, Lan J, Guo Y, Zhang Y. Cognitive behavioral therapy for anxiety symptoms in ADHD: a systematic review and meta-analysis with dose-response exploration. Psychother Res. 2026 (online 22/4/2026). https://doi.org/10.1080/10503307.2026.2658745 (PMID 42018981)

9. Gosling CJ, Garcia-Argibay M, De Prisco M, et al. Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making. BMJ. 2025;391:e085875. https://doi.org/10.1136/bmj-2025-085875 (PMID 41297970)