Anxiety and ADHD

Roughly a third of those with ADHD also meet criteria for an anxiety disorder. Disrupted attention, hyperactivity, and impulsivity can be present in both conditions, and conventional self-assessment scales do a poor job of differentiating whether symptoms arise from ADHD, anxiety, or both.
ADHD in early childhood contributes to the development of anxiety disorders, whereas most research has failed to show that anxiety disorders cause full-blown ADHD. However, anxiety often worsens symptoms of ADHD. In other instances, anxiety can reduce the expression of ADHD symptoms such as impulsivity.
A careful exploration of the progression of symptoms over time, and examining which situations worsen or improve symptoms yields the most help in differentiating anxiety from ADHD. Medication can also be quite helpful in sorting out the two conditions. Stimulants and other ADHD medications (at appropriate doses) usually reduce anxiety in those with ADHD, but tend to exacerbate anxiety in those without ADHD.
The treatment of anxiety in the setting of ADHD often starts with proper adjustment of any ADHD medications. A number of agents, including SSRI, buspirone, and guanfacine, can be added on to target anxiety reduction in individuals with ADHD. Behavioral approaches, including cyclic sighing, exercise, meditation, and the chanting of mantras, may also help reduce anxiety, as can CBT based cognitive reframing and re-education.
References:
A meta-analytic review of the impact of ADHD medications on anxiety and depression in children and adolescents (2023)
link.springer.com/article/10....
Attachment and comorbid anxiety in ADHD (2024)
journals.sagepub.com/doi/10.1...
Early Development of Comorbidity Between Symptoms of ADHD and Anxiety (2021)
www.ncbi.nlm.nih.gov/pmc/arti...
Differential diagnosis and comorbidity of ADHD and anxiety in adults
bpspsychub.onlinelibrary.wile...
Is Clinical Anxiety a Risk or a Protective Factor for Executive Functioning in Youth with ADHD? A Meta-regression Analysis (2018)
link.springer.com/article/10....
General:
Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions. Subscribe if you're curious about how neuro-atypical brains can optimize their functioning in our shared, and somewhat strange, world.
Dr. Kruse has posted talks in both the "live" and the "video" sections of this channel. Thumbnails on ADHD topics have a pink background, and those on more general mental health topics have a purple background. A small collection of ADHD-Trump videos have an orange background.
You're welcome to email him with topics you want discussed, people you think he should interview, or if you would prefer a time for the weekly KZbin Live option other than Tuesdays at 6:00 pm (Pacific Standard Time).

[@PhumeleleKunju-ud5iq]

Hi DR. I currently take fluxotine 20mg for anxiety and recently started Ritalin 20mg 3 times a day. My anxiety is through the roof. But the Ritaline is working really well.

[@dr.johnkruse6708]

I hope that you find a combination that works for you.

[@louise9852]

Thank you so much for this video! In your opinion what would be a great course of activation for female 27 undiagnosed but definitely has had add (cognitive function problems, struggle to concentrate when I need to, getting frustrated easily, over stimulated, interrupting) her whole life and now in adulthood it’s coupled with severe anxiety? Would it be worth it to try a stimulant even with the risk it may increase anxiety?

[@dr.johnkruse6708]

Without doing a thorough evaluation it wouldn't be appropriate for me to make any recommendations. One good thing about stimulants is that people tend to see how they will respond very quickly. Within 1-3 days you would have a good idea of whether the dose of stimulant you try (and starting low would make sense) is helping with ADD symptoms and whether or not it is worsening anxiety.

[@louise9852]

@@dr.johnkruse6708thanks for your response😊

[@Ryan-ud9fk]

What would be your first go to treatment for someone who is on a stimulant and doing well but still experiences anxiety & overwhelm. I have a Doctors appt in a week and was going to ask about guanfacine, straterra or buspar but I dont know how much my Doctor would know. Do you have a particular one that stands out as the best option to start with?

[@dr.johnkruse6708]

My first approach is almost always to consider reducing the stimulant dose. Many times someone obtains all of the benefits that they had at a higher dose, but without any agitation/overwhelm. In my experience guanfacine and buspirone are considerably more likely to help reduce anxiety than strattera. Strattera on top of a stimulant has a reasonable likelihood of increasing anxiety.

[@Ryan-ud9fk]

Sorry I should have been more clear. The stimulant actually lowers my anxiety a little, but not completley. For someone who has mild anxiety would you recommend adding guanfacine to start? Im just worried that energy and motivation can be a challenge and guanfacine might make that worse. It could also be that the anxiety causes me to avoid painful tasks, and with lowered anxiety I mighr be able to approach the uncomfortable more easily. Thoughts?

[@dr.johnkruse6708]

@@Ryan-ud9fk your logic makes sense to me. But sometimes our brains don't act logically. In 2024 we still often need to try a medication to see what effect it has on our own neural circuits - and to try to adjust doses according to our response.

[@afser1533]

What's the difference between anxiety and hyperarousal / hyperactivity? I heard from Dr. William Dodson ADHD patients often confuse the two and that anxiety means to have a 'baseless apprehensive fear' most of the time. I don't have any fear except normal worry of not reaching my goals. But my mind is always thinking of random things, going 100 miles an hour which Dr Dodson says is the physical experience of hyperarousal. My mind can't go quiet for a single moment. I think most people confuse the two conditions, even educators in this field label hyperarousal symptoms as anxiety. If you don't have any fear can you say for sure that what you have is not anxiety?

[@dr.johnkruse6708]

I would not consider someone who is not experiencing fear, apprehension, or worrying to have an anxiety disorder just because their thoughts are jumping quickly from topic to topic.

[@user-lq3rv2jm7o]

I was taking buproprion 75mg (3 yrs) then adderral 15 mg (6months) and had a drug induced mania and tinnitus. I stopped and was prescribed buspirone and felt happier but low energy and hard time with focus so I tried Stratterra and stopped today because I was having severe dry mouth , cracked lips, scallopped tongue and problems swallowing , sore throat and stomach issues, as well a pain in upper right stomach. I also have BPD and feel that buspirone is helping with anger. I feel like the mix of wellbutrin was messing with sympathetic system and just need the adderral with buspirone but Dr. is afraid i may have mania . what do you suggest... I think possible combo Ritlin and buspar because adderal increasesed anger and impulksivity.

[@dr.johnkruse6708]

You didn't mention what your manic symptoms were. If it was just heightened activity and decreased sleep, it might be safe to retry Adderall at a lower dose. But if there was any element of psychosis, I would stay very far away from any amphetamine again, and check out my video on amphetamine induced psychosis kzbin.info/www/bejne/oJ-aZ3Z9f7CKh8k

[@nenadcubric2663]

Clonidine 💗👍

[@dr.johnkruse6708]

I have a video on guanfacine and ADHD kzbin.info/www/bejne/oaGck3qYrNBmeKM where I think on touch on clonidine. It clearly can help, but has substantially higher risk of withdrawal extreme hypertension than does guanfacine.

[@afser1533]

Hey doc, I have tried methylphenidate hydrochloride. 5mg, 10, 15mg did almost nothing for me. 20 mg worsened my daydreaming. I was expecting it to calm the voice in my head. Is this enough to know that methylphenidate is not for me? There aren't other forms of methylphenidate where I live. My other options are armodafinil, atomoxetine, clonidine and bupropion. Can you use clonidine acutely and quit abruptly without monitoring blood pressure if your bp is on the lower side? I want to try it but fearing it'll make me lethargic and give me rebound hypertension if I quit? I am not asking for medical advice, just wanted to know your experience with it.

[@dr.johnkruse6708]

Unless the reaction to the 20 mg methylphenidate was highly unpleasant, some people in that situation might try going higher, in the hopes of getting a positive response. The risk of hypertensive rebound, as far as I have heard, is not strongly dependent on baseline blood pressure. So the risk would be there with clonidine, but all research indicates is much lower with the generally similarly acting guanfacine. And both immediate release and extended release guanfacine have shown efficacy for ADHD.

[@afser1533]

@@dr.johnkruse6708 Just to be sure, I meant a single 20mg (short release) dose of methylphenidate not a daily dosage. Should I still try going higher? That'd mean a daily dose of 60-90 mg.

[@afser1533]

​@@dr.johnkruse6708 Just to be sure, I meant a single (short release) dose of 20mg methylphenidate, not a daily dose. Should I still try to increase my dosage? That'd mean a total daily dosage of 60-90 mg.

[@georgehales5039]

Hi Dr, I have tried all the stims but they all make me incredibly anxious, unsociable and restless. I am currently on Ituniv 2mg for 3 weeks but do not notice much. I have CPTSD from a bad childhood and have very bad social anxiety and anxiety in certain settings. Would SSRI be best to help combat this?

[@dr.johnkruse6708]

Guanfacine (kzbin.info/www/bejne/oaGck3qYrNBmeKM) often takes several weeks to work, and some people need doses higher than 2 mg for an optimal response. Even if you have not witnessed any benefit from the guanfacine, it is possible that you may be more able to tolerate stimulants while on the guanfacine. There are certainly some people who have PTSD related anxiety that respond to SSRIs. It is also possible that any ADHD symptoms are actually symptoms of your CPTSD.

[@tomsale5142]

I have adhd autism which is best to try whst you have found in your practice as can meds maked autism worse

[@dr.johnkruse6708]

It's hard to generalize since there is such a broad range of responses, but most of the research suggests that when ADHD and autism co-occur, traditional ADHD medications, like stimulants, are often useful in addressing the ADHD symptoms. Many people start with a low dose and adjust accordingly. For most people with autism spectrum issues, we don't have good clear choices for medications that help.

[@foxybyproxy]

i just sleep all the time now. well, i'm up at night, but i don't beat myself up for making up the time anymore. doesn't mean that my life isn't a smaller pile of s&*t cause i'm well rested, but i do get a bit of 'feeling better.' i'm interested in a non-stimulant stimulant to add to my adhd med. adderall was awesome at first but quickly created more panic and anxiety! bummer! so, i'm assuming i need the non-stimulant...can anyone relate? i'd love some feedback from viewers, thanks!

[@foxybyproxy]

and, yes, another book, please=quests not tests!

[@dr.johnkruse6708]

I have videos on this channel about guanfacine, Wellbutrin, Qelbree, and Strattera, and modafinil, which all might be of help.

[@mediumslime]

well... why'd my treatment get interrupted?

[@dr.johnkruse6708]

Not quite sure what you're referring to.

[@mediumslime]

@dr.johnkruse6708 never mind, I just think you're handsome ~

[@dr.johnkruse6708]

@@mediumslime thank you! I hope the content's useful too!

[@shanzashai7997]

Green tea and Green nutrient smoothie and flaxseed with omega 3