ADHD meds not working? This might be why.

At our Integrative Psychiatry practice in Scottsdale, AZ, we often see adult clients who come to us frustrated with their current ADHD treatment. Many describe symptoms of inattention, hyperactivity, or impulsivity that persist despite taking ADHD medication prescribed by a previous provider. When we delve deeper, we frequently find that ADHD is not the root cause (or at least not the only root cause) of their struggles. Instead, another condition is revealed to be masquerading as ADHD, or exacerbating their ADHD symptoms.

The reason for this is that various conditions can mimic ADHD.  One of the biggest challenges with this is that ADHD medication can often worsen the symptoms of these “other conditions”. 

To understand how this happens, let's briefly review what ADHD is.

Symptoms of other mental health conditions, such as anxiety, depression, or PTSD, can overlap with ADHD, leading to potential misdiagnosis. For instance, anxiety can cause restlessness and difficulty concentrating, while depression may result in forgetfulness and low motivation, all of which are also hallmark ADHD traits. Distinguishing these conditions requires a thorough evaluation to identify the root cause of the symptoms.

ADHD: What Is It?

ADHD, or Attention-Deficit/Hyperactivity Disorder, is a neurodevelopmental condition characterized by three primary symptom categories:

1. Hyperactivity Symptoms — e.g., excessive fidgeting, difficulty remaining seated, and an inability to relax quietly.

2. Impulsivity Symptoms — e.g., interrupting others, acting without thinking, and difficulty delaying gratification.

3. Inattention Symptoms — e.g., difficulty sustaining focus, disorganization, and forgetfulness.

While these symptoms are hallmark signs of ADHD, they can also be present in other conditions. Misdiagnosis can occur when these overlapping symptoms are not carefully evaluated in the context of a person’s full medical and psychological history. 

Conditions That Mimic ADHD Symptoms

Here are some of the more common conditions that I see being misdiagnosed as ADHD: Anxiety (Generalized Anxiety Disorder)

Anxiety can cause restlessness, difficulty concentrating, and irritability, which often look like ADHD symptoms. However, ADHD medications, especially stimulants like Adderall or Ritalin, can exacerbate anxiety by, among other potential effects, increasing heart rate and triggering feelings of nervousness. This can leave clients feeling even more overwhelmed, leading to a worsening of symptoms rather than relief.

Post-Traumatic Stress Disorder (PTSD)

Individuals with PTSD often experience hypervigilance, distractibility, and impulsivity. These symptoms can mirror hyperactivity and inattention in ADHD. Stimulant medications may intensify PTSD symptoms by heightening arousal, potentially increasing flashbacks, anxiety, or irritability.

Depression

Depression frequently leads to low energy, poor focus, and difficulty initiating tasks. These symptoms can overlap with the inattention seen in ADHD. However, ADHD medication can sometimes worsen depressive symptoms, as stimulants might temporarily boost energy but leave the underlying mood disorder untreated, causing mood swings or increased irritability.

Thyroid Dysfunction

Hypothyroidism can manifest as sluggishness, poor memory, and difficulty concentrating, while hyperthyroidism may cause restlessness and impulsivity. Both can be mistaken for ADHD. Treating the thyroid imbalance—rather than prescribing ADHD medication—is often the key to symptom resolution.

Bipolar Disorder

Bipolar disorder can present with episodes of impulsivity, distractibility, and restlessness during manic phases. Stimulants prescribed for ADHD can potentially trigger manic or hypomanic episodes in individuals with undiagnosed bipolar disorder, creating additional challenges for stability.

ADHD Comorbidities: A Complex Picture

It’s also important to recognize that ADHD often occurs with other psychiatric conditions. According to research:

• Adults with ADHD are 2.7 to 7.5 times more likely to have a mood disorder, such as depression or bipolar disorder.

• They are 1.5 to 5.5 times more likely to have an anxiety disorder.

• The odds of having a substance use disorder (SUD) are three times higher in individuals with ADHD.

• Intermittent Explosive Disorder is also significantly more common.

These comorbidities can complicate the clinical picture, making it harder to treat ADHD effectively without addressing the co-occurring conditions. For example, treating anxiety or depression with therapy or targeted medication can improve overall functioning, making ADHD symptoms easier to manage.

While ADHD medication, including stimulants and non-stimulants, can be life-changing for individuals with true ADHD, they are not a one-size-fits-all solution. This is why accurate diagnosis and a comprehensive approach to care are so critical.

About the Author: Dr. David George is clinical director of Neuregen Integrative Psychiatry and Neurologic Health in Scottsdale, Arizona. Neuregen is aimed at meeting the needs of clients with overlapping mental health and brain-based conditions, emphasizing a multi-disciplinary approach to care.