Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity that begins in childhood and often persists into adulthood. ADHD is estimated to affect around 5% of children and 2.5% of adults worldwide.
Anxiety disorders are another group of common mental health conditions. They are characterized by excessive and persistent fear, anxiety, and worry that interferes with daily activities. Some research suggests that up to 50-60% of people with ADHD also have a comorbid anxiety disorder. This high rate of co-occurrence has led researchers to explore whether ADHD medications used to treat ADHD symptoms can also help alleviate anxiety in people with both conditions.
How ADHD Medications Work
There are two main classes of medications used in the treatment of ADHD:
Stimulants
Stimulant medications like methylphenidate (Ritalin) and amphetamine-based drugs (Adderall) increase levels of dopamine and norepinephrine in the brain. This can help improve focus, attention, and impulse control in people with ADHD.
Non-Stimulants
Non-stimulant medications for ADHD include atomoxetine (Strattera) and certain antidepressants like bupropion (Wellbutrin). These medications regulate neurotransmitters like norepinephrine and dopamine differently than stimulants.
By improving ADHD symptoms, these medications allow people to concentrate better, finish tasks, control their impulses, and be less hyperactive and distracted.
Do ADHD Medications Help with Anxiety?
Given the high co-occurrence of ADHD and anxiety disorders, researchers have been studying whether ADHD medications can also help reduce anxiety symptoms. The evidence on this is mixed:
Stimulants
Some research shows that stimulant medications may help alleviate anxiety in people with ADHD, in addition to improving ADHD symptoms:
– A meta-analysis of 41 studies found that stimulant medications led to modest but statistically significant reductions in anxiety symptoms in children and adolescents with ADHD.
– Multiple studies have found methylphenidate and amphetamines can rapidly reduce anxiety, with effects observed within 1-2 hours after taking the medication.
– Stimulants may decrease anxiety by improving concentration and impulse control, allowing people with ADHD to feel more in control.
However, other studies suggest stimulants like methylphenidate and amphetamines do not improve anxiety in ADHD:
– A few randomized controlled trials found no significant differences in anxiety symptoms between stimulant medications and placebo in youth with ADHD.
– A study in adults found no difference in anxiety levels between those who received lisdexamfetamine (Vyvanse) and placebo.
– Stimulants may increase anxiety in some people, likely due to activation of the sympathetic nervous system. Anxiety is one of the most commonly reported side effects.
So the impact of stimulants on anxiety in ADHD is inconclusive, with some studies showing modest improvements and others showing no effect or worsening anxiety. More research is still needed.
Non-Stimulants
There is stronger evidence that non-stimulant medications used for ADHD can reduce anxiety:
– Multiple studies show the non-stimulant atomoxetine (Strattera) significantly decreases anxiety symptoms in children, adolescents, and adults with ADHD. The effects may be greater in those with comorbid anxiety disorders.
– Bupropion is considered useful for treating anxiety disorders. As an antidepressant, it can improve underlying anxiety in ADHD.
– Guanfacine and clonidine are non-stimulant medications that reduce hypertension. They may also have anti-anxiety effects by decreasing norepinephrine activity.
Overall, non-stimulant medications used for ADHD appear beneficial for anxiety symptoms in many people with both conditions.
Specific Anxiety Disorders
Researchers have also looked at how ADHD medication impacts specific types of anxiety disorders:
Generalized Anxiety Disorder (GAD)
GAD involves chronic and excessive worry about many areas of life. Studies show mixed results on whether stimulants help with GAD:
– Methylphenidate reduced anxiety and worry in adults with ADHD and mild GAD in one study.
– But two other trials found methylphenidate did not reduce GAD symptoms more than placebo in youth with ADHD.
The non-stimulant atomoxetine does appear to decrease anxiety and worry in people with ADHD and GAD based on several studies.
Social Anxiety Disorder
Social anxiety involves intense fear and avoidance of social situations. Research on ADHD medications for social anxiety is limited but shows:
– Methylphenidate significantly improved social anxiety symptoms compared to placebo over 8 weeks in adults with ADHD and social anxiety in one study.
– Clonidine has been found to reduce symptoms of social phobia, suggesting it may also help with social anxiety in ADHD.
So stimulant and non-stimulant medications may have benefits for social anxiety, but more studies are needed.
Obsessive-Compulsive Disorder (OCD)
OCD causes upsetting obsessive thoughts and compulsive repetition of behaviors. OCD is more common in ADHD. Findings on ADHD medications include:
– Multiple studies show methylphenidate and amphetamines can acutely worsen OCD symptoms like obsessions and compulsions in people with OCD or OCD tendencies.
– However, the non-stimulant atomoxetine has been found to decrease OCD symptoms in youth with ADHD and OCD after 10 weeks of treatment in a small trial.
Overall, stimulant medications appear to exacerbate rather than improve OCD symptoms and should be used cautiously in people with comorbid OCD. But atomoxetine may potentially benefit both ADHD and OCD.
Other Considerations
A few other important points about ADHD medications and anxiety:
– Effects likely depend on the individual. Some people may experience decreased anxiety with stimulants while others may have no change or worsening anxiety.
– Highest anxiety-reducing effects are seen in those with severe baseline anxiety or comorbid anxiety disorders. Mild anxiety may be less impacted.
– Optimal medications and dosages for both ADHD and anxiety symptoms should be determined on an individual basis.
– Adding an antidepressant or anti-anxiety medication can improve outcomes in those with insufficient anxiety reduction from ADHD medications alone.
– Non-pharmacological therapies like cognitive behavioral therapy (CBT) should also be included to help manage anxiety in ADHD.
Conclusion
In summary, some ADHD medications appear to modestly reduce anxiety, especially non-stimulants like atomoxetine, bupropion, guanfacine, and clonidine. However, the evidence is mixed when it comes to stimulants, with some studies showing benefit and others showing no effect or worsening anxiety.
The impact likely depends on the individual and severity of their anxiety. For optimal treatment of both conditions, medications can be combined with non-drug therapies like CBT. Working closely with a mental health professional can help determine the right treatment approach for alleviating both ADHD and anxiety symptoms.
