When Depression Was the Clue: ADHD Misdiagnosed as Bipolar Disorder

A personal story of neurodivergence, school struggles, and how effort was misunderstood at 17.

For years, I believed my struggles with focus, energy, and motivation were simply part of my depression — or evidence that I wasn’t trying hard enough. At 17, when I couldn’t read a book for a class assignment, that belief led to an adolescent psychiatric hospitalization and a diagnosis of bipolar disorder.

In this episode, I slow that story way down and look underneath the depression.

I share how undiagnosed ADHD — including challenges with task initiation, sustained attention, abstract sequencing, and delayed reward — was misunderstood as pathology rather than recognized as neurodivergence. Through a nervous system–informed lens, we explore how avoidance and shutdown can be protective responses, not personal failures.

This episode invites a rethinking of depression, effort, and self-blame — and offers a more compassionate, body-based way of understanding ourselves and our symptoms.

In this episode, we explore:

• What it means to look under depression rather than stopping at the diagnosis
• ADHD and executive functioning challenges that often show up as avoidance or shutdown
• How task initiation, sustained attention, abstract sequencing, and delayed reward affect learning
• The emotional cost of having effort misunderstood
• Neurodivergence, misdiagnosis, and the role of the nervous system in protection
• How self-blame can soften when symptoms are understood differently

Gentle note for listeners

This episode includes discussion of adolescent psychiatric hospitalization and psychiatric diagnosis. Please listen with care and reach out for support if anything feels activating.

If you’re in the U.S. and need immediate support, you can call or text 988 to reach the Suicide & Crisis Lifeline. If you’re outside the U.S., local crisis resources are available in many countries.

If you and your partner are ready to co-create the roadmap to the relationship of your dreams, join us for the next in-person "Getting the Love You Want" Weekend Couples Retreat! 

For support in how to have deeper connections and better communication in the relationships that matter most in your life, follow the host, Trish Sanders on Instagram , Bluesky or LinkedIn.

Transcript

Content Warning And Listener Options

Why Share Without Being “The Expert”

The High School Crisis Story

Labels, Medication, And Misdiagnosis

Reframing: ADHD Beneath The Depression

Task Initiation And Forgetting To Start

Sustained Attention And Arousal States

Abstract Sequencing And Delayed Rewards

Depression As Dorsal Shutdown

Support, Hope, And What’s Ahead

SPEAKER_00 0:01

Hello, and welcome to the When Depression is in your bed podcast. For a long time, I thought my struggles with focus, energy, and motivation were just a part of my depression. Or a personal failing, that I was in some way inherently defective. In this episode, I'm slowing that story way down so I can look underneath it. I'll explore how neurodivergence, attention, and nervous system regulation intersect, why these experiences are so often misunderstood as well as misdiagnosed, and how a more compassionate, body-based lens can change how we relate to ourselves and our symptoms. I'm your host, Trish Sanders, and I am delighted that you are here. Let's get started. Over the last month or so, I've touched on the relationship between my ADHD and my depression, and I wanted to continue that discussion today. Before I begin, I want to say that this episode will contain some discussion about suicidal thoughts, and that may be a sensitive topic for some listeners. So if you have concerns about how that may land for you, you certainly have the choice to shut this episode off, or you can fast forward probably five minutes or so to the real main topic of the episode, which is really about the link, as I've come to understand it between my depression and my ADHD. Or you may choose to just skip over this episode altogether and you can continue listening to my next few episodes where I will continue this discussion and I'll be talking more about how ADHD has shown up my adult life and also things that I have found that have been really helpful with how my ADHD and depression have expressed themselves, or in other words, how my symptoms have shown up over the course of my lifetime and what I have done to help them. So please make a decision that makes sense for you. I support whatever you decide to do. So as I've been thinking about this episode, I've had a lot of thoughts, not resistance exactly. I don't think that I'd call it resistance, but there was a lot of lack of clarity. Like I knew so strongly that I've wanted to talk about this topic. It's something I've been wanting to talk about all year, actually, since I started the podcast. And over the holiday season, that's really when I started touching on it more. And as I started talking about it, I was like, okay, this is something I really want to explore further. And I think that in part because I'm not trained officially as a therapist in working with neurodivergence or with ADHD. And I think that part of my resistance came from that, that I'm not a quote unquote expert professionally with ADHD. And I think that that was a little bit of my resistance or hesitation to move further. But the more I thought about that, the more I realized that I really wanted to share from my personal perspective, which is how I tend to share things and how I want to show up on the podcast. And so I was able to let go of sort of that not good enough piece that I think was kind of sneaking up for me. And then I was just trying to figure out what I wanted to share out of like a million things that I wanted to share. And as I continued to think about it, it really became clear for me where I wanted to begin my story. So I want to share with you an experience that I had when I was 17 years old, and how that experience really shaped so much of my identity and how I saw myself over really most of my life up until just five or seven years ago. So when I was 17 years old, I had an assignment at school to write this thesis paper. And the class was supposed to read a book and then I think write note cards and then map out some outline, I think, and then eventually get to the writing of the thesis paper. And in theory, it was supposed to be helping set us up for college assignments in our future education. And I think perhaps the class was supposed to be at the outline step or something like that. They were on like step, I don't know, two, three, or four in the process. Step one had been reading the book. And I had not been able to get myself to read the book. And I had been trying. And time and time again, I would pick up the book and I would either fall asleep or I would reread the first paragraph of the book over and over and over again. And a lot of time I would just forget to read, even though I had planned to or something like that. But it came down to the fact that I started feeling so overwhelmed and so behind that I started really going into some very, very dark places. And this is the trigger warning that I had alluded to earlier in the episode that I started having pretty intense suicidal ideation. And it was a weird experience because I knew that I didn't want to die. That was very clear even then. That was really not what I wanted. And I knew that, but the thoughts were so intense. And at the time, I literally couldn't figure out a way to get the work done to read the book and catch up to my class. It was so out of my grasp. I couldn't figure it out. Problem solving was absolutely not available to me at the time. And so it really felt to me, or at least the thoughts that I was having back then really were like, well, you're not going to be able to do this. So you're just going to have to kill yourself. Luckily, I was in therapy at the time with a therapist who I had excellent rapport with and trusted quite a bit. And so I had ended up contacting her. It was a Sunday night and telling her what was going on, that these thoughts were just getting really too intense and too overwhelming for me, and I didn't know what to do. And so she directed me to tell my parents what was going on. And I did. And they ended up bringing me to the emergency room. And subsequently, I was admitted into an inpatient adolescent mental health unit. I'm not going to share the whole story, although I'm sure in the future at some point I will share other pieces of this. But just the short version of the story is that I went to the inpatient unit for maybe five days or so. And then I ended up going to a transitional school program for maybe a month. And then I came back to my school and I did not have to write the thesis paper. My teachers all knew what had happened and they just took that assignment off my plate and I finished the year and all of that. But what that did to me, how I saw myself, how I defined who I was, deeply connected to that experience because I really identified as this depressed kid. And the inability to focus and my distractibility was all really written off to me being depressed. That was not even questioned. There wasn't even a second thought about it. It was like, oh, these are symptoms that come up with depression, period. And I was diagnosed at the time with a bipolar disorder and also then medicated in line with that diagnosis. And I ended up being on many different medications from that time on for several years, up until probably sometime in my mid to late 20s. Again, I'm also not going to talk in a lot of detail about my decision to stop taking medication, but I can certainly talk about medication in another episode. I think it can be a resource and a tool, certainly, and absolutely needed for some people. In my case, it was not something I felt like I needed at the time. And all these decades later, I've not been on medication. And I can confirm that medication for me was not something that was absolutely necessary, specifically antidepressants. And at the time, I was on mood stabilizers as well. And that was just not something that I needed. And as I went through my master's program for social work, I really started to understand that I really didn't meet the criteria for a bipolar disorder. And I do want to say that I would generally recommend not self-diagnosing. If you're questioning your diagnosis or think you might have a diagnosis going on and you're interested in medication, absolutely talk to a mental health professional and get the support that you need. There's a lot of different ways to be human, and there's a lot of different ways that we can struggle and a lot of different ways that we can get support. And everybody really needs to make a decision about what works best for them. I was just making a decision about what worked best for me. And I also want to say the diagnosis of bipolar disorder can carry a lot of stigma. And I'm in no way saying anything negative about the diagnosis. I'm simply saying it just wasn't actually a fit for what was showing up in me. It was just something that I was really just labeled with incorrectly, I would say, based on a lot of different things that were happening at the time. And I do think, as a quick aside, as a therapist myself, working with adolescents for many, many years after that experience, I have found that many teenagers are misdiagnosed, in my opinion, with bipolar disorder when there's a lot of other things coming on. What I really want to talk about today is what I came to believe more than 20 years after that experience. And what that is, is that I don't think that depression was really my primary diagnosis. I think that certainly I have been depressed for a huge amount of my life. But what was underneath that, at this point, I'm pretty confident in saying really was my neurodivergence, my ADHD, and the way my brain worked and how that created challenges that I didn't understand through the lens of neurodivergence. I understood them, as I said in the intro, as a personal failing. I have believed for my whole life, pretty much for as long as I can remember, even going back to early elementary school, that I was just defective. There was something wrong with me. I was definitely not good enough. I was an absolute failure. And I just wasn't really going to ever be happy. I wasn't allowed to be happy. That's how I have felt for a lot of my life. Happiness wasn't meant for me. So depression certainly has been pervasive and very present in my life. Also with my husband, of course, being with him for the last 20 plus years, and he has lived with depression. He hopefully one day we'll talk about his own experience with all of this. Really, this was about neurodivergence and me not understanding what was happening for me. And being that we're talking about at this point, 30 years ago, ADHD was not as understood. And certainly it was not understood in girls who were really committed to doing their schoolwork and getting good grades and following the rules and doing well in the classroom, which is what happened for me from kindergarten through maybe eighth grade or so. And then, and this is often the case for many people, when work started getting harder and I had to put more effort and I just couldn't put the effort in. I thought that there was something wrong with me and I thought I was an idiot. And I didn't understand how I could be so off base in what I thought I was able to do. Like I thought I was able to do a certain level of work and then couldn't. And when it came to high school, I put in very little effort, mostly did not do homework. I kind of just gave up on myself and really gave up on trying and caring. And that's really when depression hit hard for me when I was a teenager. As I said before, there's so many things that I want to talk to you about. But for today, I want to stick to this story and what was really happening for me as I understand it now. That was not a pure depression or me being in a depressive episode that led to me not being able to read that book. I now understand things like the difficulty that ADHD brains have with task initiation or sustaining attention. And I want to talk about how a few of those things as I understand them now led to my struggles back then, which were mislabeled or oversimplified as depression. Task initiation has definitely been something I've struggled with my entire life. And now that I see it through the lens of neurodivergence, I understand that it takes a lot of energy, they call high activation to be able to start a task. Being able to keep with the task is often easier for an ADHD brain. And that's absolutely true for me. If I can just start doing something, a lot of the time I can stick with it for at least a little while, but it really is that initial hurdle of getting started. And so I think about what this means for me back then writing that thesis and trying to read this book. There were some moments where I was able to open the book, but I would fall asleep or reread that first line, which I guess technically that is task initiation. I do think there were things that were happening in addition to my challenge with task initiation, which I'll talk more about in a moment. But so much of the time I would just forget that I wanted to read or that I had to read. That's how it got to the point where I was so far behind my class. And that's really when the pressure started to set in of like, I don't know how to do this. I can't even start the book, let alone finish the book. And so, how am I ever going to get to the actual writing part? And now that I understand this, if someone would have been able to catch that back then, that actually part of the real issue I was having was task initiation, there could have been different interventions that could have been made, or even accommodations perhaps that I could have received that would have helped support me in beginning this task of reading this book. Also, I mentioned sustained attention. Sustained attention can be very challenging for ADHD brains. And that's just really being able to stick with something that doesn't have a sense of urgency around it or isn't very interesting. And it could have a lot to do with our level of arousal, which is a nervous system experience. And if your nervous system has not enough arousal, you'll end up zoning out or getting sleepy or just being disengaged, which, as I mentioned, used to happen to me all the time. I used to fall asleep regularly trying to read this book. And that was also written off to, oh yeah, you're depressed, you don't have a lot of energy, you're just tired. It wasn't caught as a difficulty sustaining attention or certainly having not enough arousal in my nervous system. And if arousal is too high, then you might find yourself feeling really anxious or agitated, or I find this to be really funny because you might find yourself scanning what you're reading because you're too aroused, which when I realized that this was something that happens when you're too aroused, I was like, oh my gosh, this makes so much sense. These are issues that I've carried with me my whole life. I will often scan something and then be like, wait, what did I just read? And I have to slow myself down to be able to comprehend what I'm reading. And I've told myself my whole life that there's something wrong with my reading ability when there's really nothing wrong with my reading ability when I slow down. It's just very hard for me to sustain attention. And there's a lot of different layers that I could go into with that. But certainly between the starting to read the book and then being able to sit with the book and actually read it and get through it was something that I struggled with so deeply at the time. And to know now that this is all about nervous system regulation makes so much sense to me. And I can see it with so much more compassion than I was able to see it with all of those years ago. I also realized that there was something that's called abstract sequencing that was at play here. And basically, this means when you have this future goal that's there, but you can't see it, you can't touch it, and the steps feel a little abstract. They're not very clear. Like it may feel clear to say, oh, read the book, write your note cards, write your outline. That might, for a neurotypical brain, might seem very clear. But for my brain, those are not clear directions at all. Reading a book requires so many steps, opening the book and being able to turn the page, and then being able to read the first line with just the right amount of regulation so that I can actually comprehend the book and not want to skip over something or scan past it or fall asleep as I'm holding the book open. And then writing note cards is a hugely unclear task. What do you write on the note cards? Do I write everything on the note cards? This is also something that I am like, oh my gosh, this explains so much of my life. I have a very hard time figuring out what is really important information. Probably that's true when I talk as well, I think when I tell a story, but also when I am sitting in a class and I'm hearing something and it's important and I care about it, I write notes on every single thing that the teacher or the presenter is saying because it's really hard for me to filter out what I actually need to hold on to. And so writing note cards was so overwhelming and not clear at all. And how all of these little steps go together to get to a final goal of writing the paper that I never even got close to doing, how all of that kind of worked out and was all put together was very abstract. So that is also something that ADHD brains struggle with. And I had no idea back then. And then also when you're writing a paper, especially one that's spaced out over probably it was a couple of months. I honestly don't remember exactly how long, but it was some amount of time, maybe a month. I don't know. And there's a real strong delay of gratification in that. And ADHD brains often have some kind of thing going on with dopamine, like maybe it's lower than in neurotypical brains, or maybe it's inconsistent, or maybe it's dependent on the context of a particular situation. So you might not get it when you need it, like when you want to be able to have enough dopamine to be able to focus and do the thing that's not so immediately rewarding. But that's not a situation that brings dopamine. And so it's hard for me to find that focus. And even the dopamine hit that may have come with finishing the paper, perhaps, was so far away. And like I said, I got nowhere near it at the time. But certainly the grade or the you did a good job that wasn't coming forever. And so all of these things that were happening were what was really getting me stuck because that was, in fact, my first experience with such an assignment that was multiple steps over a long period of time. And so it hit me as a real struggle. And again, the story I was telling myself at the time, I was already in therapy, I was already being seen for being depressed, and that was already the narrative that was all around me. And it was not inaccurate to say I was depressed. I was depressed. But why I was depressed, why was that depression coming up in me? That was something totally different than what was really going on. And I think depression is looked at often in such a limited way. Like if somebody meets the criteria for depression, they just get that diagnosis. And many are often medicated, and I'm not knocking medication. Again, my decision for not taking medication was my decision. And what makes sense for somebody else can be something totally different. However, you're not looking underneath what's causing the symptoms. Why is the depression there? And if you think about depression as in nervous system terms that I often talk about, that depression is being stuck in that dorsal state of our nervous system, that immobilized, shutdown, avoidance state, right? And so if you're in that stuck state, the purpose of dorsal, the actual reason why dorsal exists in our nervous system is so that we can get rest and restoration, because humans need to be active and in movement and doing, but they also need to slow down and sleep and be restored and renewed and rejuvenated, right? Like it's pretty simple biology here. You can't stay in motion forever. You have to slow down and rest. That's why dorsal exists, uh, among other reasons, but that's a pretty big one. And so if dorsal exists to help us slow down so that we can rest and renew, what is happening that your system is going and getting stuck in a place where you need to rest and renew? For me, one of the top things that I've come to understand is that my brain was so overwhelmed. And there's a lot here too that I could talk about. But just going through my day and paying attention in school, doing my best, I did care. I wanted to do better, you know, I wanted to be better. I mean, that's definitely how I thought about it, but it was so hard that I kind of just gave up. But going to school, doing all the things that I had to do, feeling so incredibly stressed and overwhelmed by the outside world and the demands that were placed on me, and feeling like I didn't know how to do what I needed to do, even though I thought I should know what I needed to do and how to do it, and feeling so stupid and dumb and again not good enough, and just like this total failure in life was really exhausting. And so I would crash into dorsal, into depression. And it makes so much sense. I've described this and I'm sure I've referenced this on other podcast episodes, but I have described being depressed as just wrapping yourself in a warm, comfy blanket of misery and how comfortable and familiar that feels. And it makes sense that when you're thinking that you're an idiot and you're a failure, that kind of just saying, like, no, shut down, avoidance, let me just curl up in a little ball and stop dealing with this outside world that keeps making me feel like I'm an idiot and horrible and a worthless human being. Yeah, that's a way better way to feel. Being depressed is way better than that. I mean, of course, being depressed is its own miserable experience, but there's a break. There's a little break, there's a little rest. It's like a little really awful mini vacation from that overwhelm and all of that other stuff that for me, as I understand it now, came along with my neurodivergence and my ADHD. So I do want to say that if you're listening to this podcast because you are living with depression, or if a loved one of yours is living with depression, you may identify with some of these symptoms that are more neurodivergent. And if that's the case and you're interested and you're curious, then I highly recommend that you talk to a professional and get some support, whatever that means. Like I said, there's a lot of different people out there and there's a lot of different ways to get support. But whatever you decide, you Deserve support and you deserve to do things that help you feel better about yourself and help you live the life and create the life that you really want to live and create for yourself and with your partner. If either of you or both of you are living with the struggle that often comes with being depressed. And if you do not relate to neurodivergence, but you're still struggling with depression, then I really do invite you to think about what's underneath. Why is that depression there? Maybe there's something else going on. Certainly, trauma, chronic stress, lots of other things can be underneath what looks like depression on top and is depression on top. I certainly, like I said, I own that I have absolutely been depressed for a huge amount of my life. But if I had been able to see things through a different lens back then, spoiler alert, that's a little bit of what has helped now in my life and how I look at myself now. So stay tuned to hear more about that in the next episode or two. But if I had been able to see myself differently and really understand what was going on, especially being able to see it as something biological, if you can say, like, oh, there's a reason, it's a real valid reason that my body needed rest, that I needed to protect myself by going into my little cocoon. If you can have compassion for that, you're probably gonna have a reduction of symptoms in your depression, at least a bit. And if you can have compassion for yourself, maybe you'll end up being curious. Like I eventually ended up being curious. Like, well, what can I do to help here? And for me, I found nervous system regulation, which again, spoiler alert, you'll hear a lot more about in the next couple of episodes as I continue this conversation. But if you are struggling, please, please don't chalk it up to you're stuck with a diagnosis, then that's a dead end that you have to just live with it for the rest of your life. Because depression as a diagnosis is often something that we actually can truly be empowered to do something about. We can actually heal through the experience if we can feel safe enough and supported enough to be able to see what's really happening underneath all of that. And again, everyone's unique and everyone's path is different, but there certainly could be similarities and overlap. And if something that I'm talking about connects to you or resonates for you, then that could be an indicator that there's something there for you to explore. So, in short, when it comes to depression, there's actually more hope than we often think or than we associate with depression or people who are depressed. We just have to have a different understanding, a different lens to look through, and often a lot more possibilities open up. And I don't mean that if you can understand this, you'll never be depressed again because our dorsal nervous system state is one of the states we have. We have shutdown. If you have a tendency towards depression, you have neural pathways that are worn. If you have some sort of neurological thing going on that's creating depression, or there's genetics, or there's ancestral stuff. I mean, there's so many layers. This isn't a guarantee or a promise that you'll never be depressed again in your life, but there is a possibility that you can actually live a life with depression that feels way different, and maybe even a life that doesn't have a lot of depression present or pervasively showing up. And it can certainly feel a lot different than the life that you're living today. I am one example of living proof of that being true. And if you're curious to see how that could be true for you, or how you can hopefully find a path that leads you to feeling differently and better in the future, keep listening as I talk more about what I've learned and what has helped. As our time comes to a close, I ask you to keep listening for just a few more moments because I want to thank you for showing up today. And I want to leave you with an invitation as you hit stop and move back out into the world on your own unique wellness journey. In order to move from where you are today to the place where you want to be, the path may seem long or unclear or unknown. And I want you to know that if that seems scary or daunting or downright terrifying or anything else, that is totally okay. Know that you do not have to create the whole way all at once. We don't travel a whole journey in one stride. And that is why my invitation to you today is to take a step, just one. Any type, any size, in any direction. It can be an external step that can be observed or measured, or it could be a step you visualize taking in your mind. It can be a step towards action or towards rest or connection or self-care or whatever step makes sense to you. I invite you to take a step today because getting to a place that feels better, more joyful, more connected than the place where you are today is possible for everyone, including you, and even when depression is in your bed. If today's episode resonated with you, please subscribe so you can be notified when each weekly episode gets released. I encourage you to leave a review and reach out to me on social media at trish.sanders.lcsw. Your feedback will help guide future episodes, and I love hearing from you. Also, please share this podcast with anyone who you think may be interested or who may get something from what I have shared. Until the next time we connect, take care of yourself and take a step.