ADHD and Anxiety Together: Treat Both at Once

By the clinical team at Next Step Psychiatry • Lilburn, GA

The ADHD-Anxiety Overlap

If you have ADHD, there’s roughly a 50% chance you also have an anxiety disorder. And if you have anxiety, your risk of having undiagnosed ADHD is significantly higher than the general population. These two conditions feed off each other in ways that make both harder to treat—unless your provider understands the relationship.

At Next Step Psychiatry, co-occurring ADHD and anxiety is one of the most common presentations we see. The key is determining which came first and which is driving which, because the treatment approach depends on it.

Why They Co-Occur So Often

ADHD creates the perfect conditions for anxiety to develop. Years of missed deadlines, forgotten commitments, and underperformance lead to a constant state of anticipatory dread. You develop anxiety about the next thing you’ll forget, the next ball you’ll drop. This is sometimes called “secondary anxiety”—anxiety that developed as a consequence of living with untreated ADHD.

On the other hand, some people have both conditions independently—a genetic predisposition to ADHD plus a separate genetic predisposition to anxiety. The distinction matters because secondary anxiety often improves dramatically when ADHD is properly treated, while primary anxiety requires its own targeted treatment.

The Treatment Dilemma

Here’s where it gets tricky: the first-line medication for ADHD (stimulants) can sometimes worsen anxiety. And the first-line medication for anxiety (SSRIs) can sometimes worsen ADHD symptoms like emotional blunting and decreased motivation. A skilled psychiatrist navigates this carefully.

• Start with the dominant condition: If ADHD is driving the anxiety, treating ADHD first often resolves much of the anxiety
• Non-stimulant ADHD medications: Atomoxetine (Strattera), guanfacine (Intuniv), and viloxazine (Qelbree) treat ADHD without the anxiety-increasing potential of stimulants
• Combination therapy: Low-dose stimulant + SSRI or buspirone can address both conditions simultaneously
• Start low, go slow: Beginning stimulants at the lowest dose and titrating carefully while monitoring anxiety levels

Beyond Medication

CBT adapted for both ADHD and anxiety is highly effective. It teaches ADHD-friendly organizational strategies (reducing the chaos that feeds anxiety) while simultaneously addressing anxious thought patterns. Mindfulness training can also help by improving attention regulation and reducing the anxiety amplification cycle.

At Next Step Psychiatry, our ADHD treatment program always screens for co-occurring anxiety and tailors the treatment plan accordingly. We offer same-day appointments and telepsychiatry across Georgia.

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider. If you or someone you know is in crisis, call 911 or the 988 Suicide & Crisis Lifeline.