Dysthymia and ADHD: Understanding Their Complex Connection

Dythymia and ADHD women

Understanding Dysthymia or Persistent Depressive Disorder (PDD)

Dysthymia, once known as chronic depression or simply dysthymia, is now referred to as Persistent Depressive Disorder (PDD). Despite its various names, the essence of this disorder remains consistent — a prolonged and often debilitating depression that may go unnoticed or undetected for years.

Understanding Dysthymia and ADHD: The Most Common Form of Depression among ADHDers

For many, the connection between ADHD (Attention-Deficit/Hyperactivity Disorder) and depression may not seem immediately evident. However, digging deeper into the statistics and lived experiences of ADHD individuals reveals a compelling narrative.

A groundbreaking revelation from the National Comorbidity Survey Replication study posits that adult patients diagnosed with ADHD are seven times more likely to develop dysthymia than those without the disorder (Kessler et al., 2006). But the question that remains largely unanswered is, "Why?"

Much of the research surrounding this link has approached it from a purely pathological perspective. There's been speculation about whether the executive functioning deficits, often synonymous with ADHD, might lead to this increased susceptibility to dysthymia. Could the characteristic behaviors of ADHD, such as impulsivity or inattentiveness, be the trigger for such profound depressive states?

Yet, there’s a glaring oversight in this line of inquiry. Much of the research hasn't adequately considered the societal and psychological ramifications of living with ADHD, especially for women. They often grapple with feelings of inadequacy, stemming from constant societal criticisms. They're frequently told they aren't "good enough," urged to "try harder," and are tacitly encouraged to suppress or 'mask' their ADHD traits to fit societal norms.

Now, imagine the psychological toll of experiencing these stigmatizing events day in and day out. Over time, these incidents don't just leave a mark; they contribute to a pervasive sense of low self-worth, which can be a fertile ground for dysthymia to take root.

Further complicating this issue is the experience of late diagnosis, especially prevalent among women. The symptoms of ADHD in women often manifest differently than in men, leading to potential misdiagnoses or complete oversight. When a diagnosis finally does occur, it's often accompanied by a whirlwind of emotions—relief at having an explanation for one's struggles but also grief over the lost years spent battling an unnamed adversary. The weight of these feelings, combined with the existing societal pressures, might further entrench the roots of dysthymia.

It's evident that while the biochemical and neurological intricacies of ADHD play a role in predisposing individuals to dysthymia, there's an undeniable psychological and societal dimension that remains largely uncharted. As research continues, it's crucial to adopt a more holistic perspective, factoring in the lived experiences of ADHD individuals and understanding how societal perceptions and treatments influence their mental health trajectories.

How ADHD Helps Dysthymia Develop in Women

ADHD in women is often an underrepresented area of study. The symptoms that women exhibit can differ from the "classic" ADHD symptoms more commonly associated with men. Instead of the overt hyperactivity often seen in boys, girls and women may present with inattentiveness, daydreaming, and emotional dysregulation. This difference in symptom presentation can lead to misdiagnoses, late diagnoses, or even no diagnosis at all.

The societal narrative around women also plays a role. Women are often expected to be organized, attentive, and emotionally intuitive. Those with ADHD might find themselves struggling to meet these societal standards, leading to feelings of inadequacy or self-doubt. Over time, these negative self-perceptions can feed into the development of dysthymia.

Moreover, the experience of 'masking' is amplified for women with ADHD. The societal pressure to conform and be 'normal' can push them to hide their symptoms, leading to internal distress. This constant act of suppressing one's true self can be emotionally exhausting and further compounds the risk of developing dysthymia.

In essence, for women with ADHD, it's not just the disorder itself, but a combination of societal expectations, the nuances of female ADHD symptomatology, and the emotional toll of 'masking' that can pave the way for dysthymia's onset.


The intricate relationship between ADHD and dysthymia is a testament to the complexity of mental health. As our understanding evolves, so does our approach to treatment. It's imperative to recognize the interplay of factors - biological, psychological, and societal - in addressing these conditions effectively.

DSM-V Criteria for Dysthymia (Persistent Depressive Disorder)

  • Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least two years.
  • Presence, while depressed, of two (or more) of the following:
    1. Poor appetite or overeating.
    2. Insomnia or hypersomnia.
    3. Low energy or fatigue.
    4. Low self-esteem.
    5. Poor concentration or difficulty making decisions.
    6. Feelings of hopelessness.
    7. Facts about Dysthymia Depression
      • Most cases of dysthymic depression occur before the age of 21.
      • Struggling with depression at a young age can predict struggles with the illness later in life.
      • Early therapy is crucial to develop healthy coping mechanisms and tools against depression.
      • Risk factors for dysthymia include early trauma, family history of depression, and ADHD.
      • Dysthymia has a genetic component, often seen in those with first-degree relatives diagnosed with major depression.
      • There's a higher risk of substance abuse in later life.
      • Dysthymia is more common in females than males.
      • Those diagnosed often face declines in quality of life, social support, and marital satisfaction.
      • Some with dysthymia may later be diagnosed with bipolar disorder.
      • Dysthymia can impact workplace performance, earnings, and personal relationships.
      • Links exist between dysthymia and a weakened immune system, inflammation, neurological brain changes, and cognitive distortions.
      • Those with dysthymia are at risk for diabetes, arthritis, other mental health conditions, and have increased suicidality risks.

Think You Have ADHD and Dysthymia? Here's What You Can Do

Self-care and Self-accommodation: One of the first steps is to prioritize your well-being. This includes ensuring a consistent sleep pattern, maintaining a balanced diet, and engaging in regular physical activity. Consider mindfulness and relaxation techniques to help manage symptoms.

Accept Help: Both ADHD and dysthymia can be overwhelming. Accepting help, whether it's from professionals, family, or support groups, can be beneficial. Therapy, particularly Cognitive Behavioral Therapy (CBT), has shown effectiveness in treating both conditions.

How to Help Someone with Dysthymia and ADHD

  1. Educate Yourself: Understand the challenges they face by reading about ADHD and dysthymia.
  2. Listen Actively: Sometimes, just having someone to talk to can make all the difference.
  3. Encourage Professional Help: If they haven't already, suggest seeking a diagnosis and potential therapeutic interventions.
  4. Be Patient: Remember, both conditions come with their unique challenges. Patience and understanding can go a long way.

Relevant Research

  • A study published in the Journal of Affective Disorders found a strong co-morbidity between ADHD and various depressive disorders, including dysthymia (Biederman et al., 2008).
  • Research in the Journal of Clinical Psychiatry suggests that cognitive-behavioral interventions can be effective in treating ADHD symptoms in adults, potentially reducing the risk of developing co-morbid conditions like dysthymia (Solanto et al., 2010).
  • A study in the Archives of General Psychiatry highlights the importance of early detection and treatment of ADHD to prevent the development of co-morbid conditions, including dysthymia (Kessler et al., 2011).


  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  • Johnson, D., Dupuis, G., Piche, J., Clayborne, Z., & Colman, I. (2018). Adult mental health outcomes of adolescent depression: A systematic review. Depression and Anxiety, 35(8), 700-716.
  • Junko Ishizaki and Masaru Mimura, “Dysthymia and Apathy: Diagnosis and Treatment,” Depression Research and Treatment, vol. 2011.
  • Kessler, R.C., Adler, L., Barkley, R., Biederman, J., Conners, C.K., Demler, O., ... & Zaslavsky, A.M. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. The American journal of psychiatry, 163(4), 716-723.

Note: Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.

More at the National Institute of Mental Health

More pages on Depression

Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.


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