ADHD & Anxiety

Many adults struggle to understand whether their symptoms point to ADHD, anxiety, or a combination of both. Difficulty focusing, racing thoughts, restlessness, overwhelm, and trouble getting things done can all show up in both conditions which is why distinguishing between them is not always straightforward.

In this episode of Thriving with ADHD, Nada sits down with Carolyn 'Callie' Kundert, PA-C at Animo Sano Psychiatry to unpack the complex relationship between ADHD and anxiety. Together, they explore why anxiety is often diagnosed first, how ADHD can sometimes be overlooked or masked, and how clinicians work to tell the difference between the two conditions.

Callie also explains:

•  Common symptoms shared by ADHD and anxiety 
•  Why untreated ADHD can contribute to anxiety over time 
•  How ADHD and anxiety can interact and reinforce each other 
•  What clinicians look for during assessment 
•  Differences in treatment approaches for ADHD, anxiety, or both conditions together 
•  Why getting evaluated by a trained professional matters 

This episode offers practical insight, validation, and hope for anyone trying to better understand their mental health and the way their brain works.

Whether you’ve been diagnosed, are exploring your symptoms, or simply want to learn more, this conversation helps clarify one of the most common areas of confusion in adult mental health.

For more information about Animo Sano Psychiatry, visit our website.

Thank you for listening to Thriving with ADHD. This show is produced by Animo Sano Psychiatry. For more information about our clinic, please visit animosanopsychiatry.com. 

Animo Sano Psychiatry is constantly looking for the talent in behavioral health. If you are a psychiatrist, nurse practitioner, physician assistant, or mental health therapist, we'd love to hear from you. Visit our Careers pages to learn more about the available positions. https://animosanopsychiatry.com/careers/ 

Transcript

not all distraction is ADHD, and not all overwhelm is anxiety. We know that those two conditions come from different brain processes but they intermingle so much in terms of their symptom profile, so understanding what you're dealing with changes everything 📍 Welcome to Thriving With adhd, a podcast we'll share every day practical tips to thrive in life as an adult with adhd. This podcast is brought to you by Animo Sano Psychiatry, a behavioral health practice with a specialist ADHD clinic based in North Carolina. And this is your host Nada Pupovac. Welcome back to Thriving with ADHD, dear ADHD community. If you have ever struggled with things like difficulty focusing, racing thoughts, feeling overwhelmed, or just not being able to get things done, you're definitely not alone. But here is where it gets tricky. Those experiences don't always point to the same thing. Sometimes it's ADHD, sometimes it's anxiety, and very often it's both. In today's episode, we are unpacking how these conditions overlap, why anxiety is often identified first, and how clinicians actually tell them apart. I'm joined by Carly Kundert physician assistant at AnimoSano Psychiatry with a strong background in both emergency medicine and psychiatry. She works closely with adults navigating ADHD, anxiety, and other complex mental health conditions, providing services to our patients in Missouri, Arkansas, Oklahoma, and Arizona, and she serves as the office lead for those locations. Carly, you're very welcome to Thriving With ADHD podcast. It's great to have you here. Thank you for having me. I'm so happy to have you. Our patients love you, and I'm sure we will going to have a great conversation. So ADHD and anxiety, it's such an important topic because many people feel unsure whether they are dealing with anxiety, ADHD, or is it a mix of both? So I think this is going to be very important conversation, and I'm really looking forward to unpack this kind of tension with you. So- Yeah, absolutely ... to start off, my first question , for you would be, from your clinical experience, how often do you see ADHD and anxiety overlapping, and why is this such a common area of confusion? Yeah. It happens all the time. It's an incredibly common overlap. Oftentimes with these types of conditions, they're bi-directional, so there's a push me, pull me that, that happens with that. And most of the time, what we see is this kind of unforgiving cycle between the two. If you look at ADHD and the level of dysfunction that comes, especially when it's untreated it's like you have 18 balls in the air and you're trying to juggle all of them, and with ADHD, you're constantly adding more in. So that juggling match just becomes something where you're frantically trying to keep everything in the air. And that- Kind of activates the anxiety response, this threat detection system in in our brains that, that causes anxiety. And then the anxiety can pull blood flow from the brain because you're activating this fight or flight response, and if a bear was chasing you your body would say, "Hey, we need more blood flow to the central systems." And so it would, then make your make your brain more foggy, more fuzzy, and your attention and focus can get even more impaired, and then it just is this awful feedback loop. So very common overlap. They tend to play into each other pretty heavily. And there's also just some shared symptoms between the two that we could talk about, too. Yes. Yes. Yeah. We ... That ... This doesn't sound fun at all. No. But it- It can be- Yeah. It can be a really problematic feedback loop for a lot of people. Yes. Okay then. Then let's talk about these key symptoms that both conditions share and that then confuse not only the people dealing with mental health conditions, but even some clinicians early on. Yeah. Absolutely. So the overlap lies in focus issues. So anxiety can cause focus issues, exactly that mechanism that I was just talking about, where an overactive fight or flight system actually mechanistically pulls blood from the brain so that you can run away from the bear rapidly. The anxiety and ADHD, especially hyperactive ADHD, can both cause a lot of restlessness in patients. They can both cause fidgeting behaviors and those types of things. Both can impact your sleep. And so an ADHD brain that's hyperactive doesn't do very well shutting down for the night, but an anxious brain also tends to sit and worry constantly back and forth about things that could come up. Both can cause irritability so there's a lot of overlap there. And then, like I'd mentioned before when you're very anxious and you are worrying about the next thing and the next thing and the next thing it can cause issues with attention and focus. And so I think a lot of people have trouble picking that apart. Okay. Then how does it happen and why does it happen that anxiety gets diagnosed first? Why does it happen that ADHD gets overlooked, basically? Yeah. I think that anxiety a lot of times is the more visible distress. It's maybe even in some circles, a more socially acceptable diagnosis. You're worrying about the world, and ADHD sometimes is is something that some clinicians aren't as comfortable treating, and so it's a little bit easier maybe to to go with the anxiety diagnosis. I think there's a big level of fear clinically in some physicians that if they miss the anxiety or if they treat ADHD with something like a stimulant, which is the, most effective option for treating ADHD, that they're going to toss somebody into this anxiety spiral and worsen their anxiety. And so I think that makes a lot of fear in, in terms of approaching ADHD whenever you see both presenting. And then I think also in a lot of circles ADHD gets masked by patients. I think that- ... Especially in women we we see folks who didn't have ADHD diagnosed in childhood. They've lived with it their entire life. They've learned mechanisms surrounding the ADHD just to cope. Maybe that has worsened their anxiety. And so they themselves sometimes can't necessarily reveal the source of the problem as easily. That makes sense. And actually, we heard a- about masking from a few people who came to speak, Yeah ... on the podcast. So th- this absolutely does make sense. So When you are assessing a patient, how do you start teasing apart whether it's ADHD or anxiety or both? So how do you start this journey of discerning between the conditions? Absolutely. Yeah. When I'm looking at the two I like to look at whether the brain is consistently struggling to regulate or if it's seeming to react to perceived threats. Timelines are super important for this. In ADHD, we know that ADHD is a neurodevelopmental disorder, which means that it has to start when the brain is developing. And so timelines for ADHD tend to start between ages six and 12 and then very normal for it to persist into adulthood. There are not nearly as many six and 12-year-olds who are struggling with anxiety. And so what we'll see sometimes, especially if the interplay is ADHD came first and caused anxiety because of the functional impairments what we'll see for that is a kiddo who was maybe hyperactive, struggled in school, and otherwise happy and not anxious, over time and over... as the dysfunction builds and grows and they have more on their plate and more balls to juggle, then anxiety starts to present. And then maybe now they're getting labeled as a bad kid who has behavioral problems, and now in high school they're starting to realize that their grades aren't up to snuff, and they're gonna struggle with college applications, and then anxiety starts to come into play. That's a very different timeline than somebody who has a generalized anxiety disorder that is pervasive across, different areas of their life. They're worrying about getting in the car and if they're gonna have an accident. They're worrying about their health and their family and lots of different things over a lot of different areas. And and then with ADHD, like I said, early childhood and going on. The internal experience is also very different between the two. And so ADHD people have these kind of chronic struggles with, multiple balls in the air. They have executive dysfunction, which means that they have trouble with task prioritization and breakdown, with time management and then they have all of these, micro attention and focus pieces. And everything lives in, in those areas with ADHD versus anxiety, where we have this kind of overactive limbic system, and it's just worries all the time about every different thing, not necessarily just the functionality standpoint. A lot to unpack here. And my , next question would be, so you talked a lot about how it looks like for people having both conditions. So if there is anything else that you would like to add to this, but I think you covered this in the first question and even now. Yeah. But if there is anything else that you would like to emphasize and share. So how does it look like for someone who has both and- Yeah ... yeah, how they interact- I think- ... with each other, I think that we've talked a lot about the interplay with ADHD causing anxiety. But you can also have a generalized anxiety disorder where you worry all the time about lots of different things- and ADHD. And that's a little bit of a different beast. ... with that it would be both. It would be exactly that. Executive function, lots of balls in the air, maybe anxious about that, but also pervasive anxiety about lots of different things in the world, and this kind of overactive overactive system there. And I think what, when that happens there's even more fear about how do we treat, how do we, what if we over-correct, that type of thing. But the treatment options are there. We just sometimes have to focus on the thing that is causing the biggest impairment first, which might be the anxiety. ... and then once that's stable and we've used the right medicines to settle that, then we can be a little bit more targeted with the ADHD, and we can also use ADHD medicines that don't trigger or worsen those anxiety systems- ... like non-stimulants. And so there's a lot of options with that interplay. But yeah, it can be an enmeshed, intermingled pictures in some people. Sounds tricky, but not uncontrollable. And if- Definitely ... providers , are knowledgeable and know what they're doing- ... then there is definitely path forwards. Absolutely ... This sounds hopeful to me. For sure. Okay, for someone listening to this and who relates with both A- ADHD and anxiety symptoms, what would you recommend would be the first step toward getting clarity and support, from what you shared earlier there is definitely way forward. So what that would be? Yeah, absolutely. So I think first step is getting a full evaluation by somebody who's trained in these things, who's comfortable with both conditions so that they can really help you pick that apart. Somebody who has training in ADHD evaluation and management should be able to look at the patterns and the network of symptoms and how those fit into what we know about the brain and how it develops and be able to pick things apart and then set you on the right path for that. Because we wanna understand how your brain functions across your life and not just in a moment. And so understanding those patterns is really important. And they have ADHD evaluations called neuropsychiatric testing evaluations that can even do attention and focus testing. My little caveat to those evaluations is that the literature these days is actually showing that an ADHD evaluation by a trained professional is as effective in diagnosing ADHD as a neuropsychiatric test, because there's so many mimics that can steal your attention and focus that the neuropsychiatric testing can lead you astray a little bit. So that's a supportive test for some people where the picture is really muddy or complicated. But the first step for sure, and often the only step in, in getting that evaluation is talking to somebody who who's comfortable with these types of assessments. And trained and knowledgeable- Yeah about conditions, very important. And then how does the treatment differ when it's ADHD versus anxiety versus both? You- Yeah, absolutely ... mentioned a little bit, but if you wouldn't mind expanding on the topic of medication. Yeah, absolutely. So when we talk about treating ADHD we are trying to replace the dopamine that is impaired in patients who don't have enough dopamine in their brain to to help stabilize the neurons that are typically dealing with attention and focus. And so we, we wanna replace the dopamine with stimulant medications. That's the primary treatment. What those do is those work on the central nervous system to directly increase circulating dopamine and that improves function in the areas of our brain that are impaired with ADHD. And so primary treatment option for ADHD is stimulants. We have non-stimulant options for ADHD like Strattera and Qelbree. And those medications work primarily on norepinephrine and norepinephrine is another kind of downstream functional worker for dopamine as well but also is a little bit gentler on the system, not directly triggering that central nervous system. And so that's the intermediary for for things like ADHD and anxiety together where we maybe don't wanna be as triggering to the central nervous system and that fight or flight system with a stimulant. Anxiety primary treatment for anxiety is psychotherapy and SSRIs or SNRIs, so those are medicines that regulate serotonin or norepinephrine in our system and reduce overactivity in the limbic system, which is one of the systems in the brain that's responsible for anxiety. And then therapy helps us retrain that threat response. So anxiety alone SSRIs and SNRIs are gold standard. ADHD alone, stimulants are gold standard, and when we mix in between sometimes we'll do non-stimulant options or a combination of the two. Thank you. Thank you. Yeah. And if there is one thing that you would like our listeners to take away from everything you shared with us, what that would be? I think my biggest takeaway is that not all distraction is ADHD, and not all overwhelm is anxiety. We know that those two conditions come from different brain processes but they intermingle so much in terms of their symptom profile, so understanding what you're dealing with changes everything. And also just that, there are providers who Are not fearful of picking these things apart and and treating both. And those types of more intensive evaluations by a psychiatrist who can help you do that are really helpful. Yes. And help is available and, absolutely ... yes. And people don't have to figure it out alone and just suffer and not being able to tell what's going on. So- Yeah ... - Yeah, there's a lot of people out there who are comfortable with these things and- Yes ... who are knowledgeable about these things and- Exactly. Exactly ... yeah. Kelly, this was a charged, wonderful conversation. Thank you so much. I learned so much from you, and I hope our listeners learned too. Absolutely. Yeah, it's such a important topic. It's... The- these two conditions are intertwining, and I guess people are wondering all the time what is going on. Yeah. Yeah. So I hope that this conversation helped to clarify some of the things. So thank you so much. I hope so too. I hope so too. Thank you so much for bringing me on. I was really happy to talk to you. Wonderful. Thank you so much, and I hope to see you again. Absolutely. 📍 Thank you for listening to Thriving with adhd. This show is produced by Animo Sano Psychiatry. Please follow, rate or share our podcast on Spotify, Apple Podcast, or any other streaming app of your choice. Music is by Daddy's music from Pixabay. For more information about Animo Sano Psychiatry, please visit animosanopsychiatry.com