You can download this information: Managing Mood with ADHD[docx] 98KB

ADHD and sleep

Attention Deficit Hyperactivity Disorder or ADHD, is a neurodevelopmental difference in the way the brain functions. There are three underlying sets of symptoms that people with ADHD experience, which are inattentiveness, hyperactivity and impulsivity. People with ADHD can experience some or all of these symptoms, which can be mild, moderate or severe (see  ‘What is ADHD?’ for more information). 

It is therefore not surprising then, when trying to manage these difficulties it is common for individuals with ADHD to experience variations in their mood. This can include periods of low mood and or emotional ups and downs. These shifts in mood in turn can have a noticeable daily impact on focus, motivation, and behaviour.

When mood drops, it can become harder to concentrate or stay engaged with tasks. This can cause further problems with inattentiveness. At the same time, rapid or intense changes in emotions may make it challenging to manage reactions effectively. 

These reactions are further impacted by the underlying problems of hyperactivity and impulsivity. Sometimes strong emotions can lead to impulsive responses, which can have negative consequences. Where things are said or done in the moment, it may not reflect how you truly feel afterwards. Unfortunately, by then you may be unable to retract what you said or what you did.

Low mood and depression in ADHD

Individuals with ADHD may have a higher vulnerability to symptoms of low mood for a range of reasons. These reasons for increased vulnerability appear to be due to a several complexities. Studies have found that vulnerability can be genetical, biological and due to a person’s environment, including upbringing. For example, we know the genetical studies have found a strong inheritance link between family members having ADHD, somewhere between 77-88% of cases. 

Other studies have suggested that depression can be accounted for by 40-50%, due to a range of genetic inheritance. However, environmental factors such as social isolation, long-term unemployment or chronic stress at work, poor housing conditions can all increase low mood and lead to depression.

Biological studies have found environmental factors can have a negative effect on our brain chemistry. An example is lack of sunlight for some people can have a profound negative effect on their mood. It is generally agreed by researchers, that there is no one factor which contributes to low mood which can develop into depression. However, it is the combination of genetical, biological and environmental factors which makes people vulnerable. 

Functional impairment and low mood

The inability to manage every daily living is what mental health professionals call functional impairment. Some examples of functional impairment reported by people with ADHD are:

• Repeatedly being late for work or other important events.
• Forgetting important events/dates or items when needed.
• Unable to follow instructions leading to significant consequences.
• Leaving tasks unfinished once started.
• Leaving problems or tasks to the last minute, although you have planned to do it earlier.

Many people with ADHD describe the core symptoms, inattentiveness, hyperactivity and impulsivity, working against them and feels like it’s sabotaging their life. 

Therefore, it is not surprising that people with ADHD because of functional impairment encounter more frequent challenges in life. These repeat challenges have a knock-on effect seen in strong emotional reactions to stressful situations. Many people with ADHD described a sense of feeling overwhelmed, which can occur daily, which can take an emotional toll. Being short-tempered and having angry leading to outburst is also reported as a common problem. 

Sometimes overlooked are how emotional reactions to the daily challenges in life of the ADHD person can lead to difficulties in relationships. Problems with relationships is also seen as a functional impairment. Studies have reported relationship difficulties with teachers at school, colleagues at work, with friend, in intimate relationships and with family members. 

Emotions and low mood

It is understandable, not encouraged, that some individuals with ADHD may use unhelpful coping strategies, like drinking alcohol or taking recreational drugs to help manage their moods. This can then lead to problems with disrupted sleep and in-turn increase functional impairment further. It is recognised due to due to symptoms of hyperactivity and impulsivity sleep can also be effect without drinking or using substances.

Many people with ADHD described their brain simply not switching off at the end of the day. Being deprived of sleep, not only feels awful but you will be more susceptible to low mood and emotional outbursts. Below in not an exhaustive list but some of the more common emotions described by people with ADHD. Included are examples of the situations which may trigger emotions: 

• Frustration in not completing tasks on time or at all.
• Anger when criticised by others, in particular after not managing a problem.
• Anxiety and even fear when trying to manage a situation where you are routinely unsuccessful at the task.
• Humiliated when things don’t go to plan, which to an outsider may appear simple. 
• Rejected by peers, colleagues, friends, partners and even family who don’t understand or empathise with your difficulties.  
• Disappointment from others and in ones self-due to inconsistency leading to a sense of underachievement.
• Sadness / hopelessness, a sense thing will never change. 
• Guilt / shame, despite your best efforts the situation has gone wrong again leaving an emotional state of blaming yourself. 
• Despair due to repeated difficulties despite trying different strategies, and nothing appears to work! 
• Bored / boredom, common in ADHD, daily life, tasks or employment does not provide the level of stimulus you need to get motivated. 
• Vulnerability or sense of, due to repeated negative experiences from childhood, adolescence and into adulthood.
• Powerless to change your situation. 
• Overwhelmed with sound, sights, information, following instructions and sudden changes in your mood. 

These range of emotions can lead to much deeper psychological problems which can occur in the form of negative beliefs about oneself, and over time lead to low self-esteem. Low self-esteem can also contribute to lowering one’s mood, over time can lead to depression and an acute sense of hopelessness. These feelings combined with impulsivity can place the ADHD person at risk to themselves (please see advice and guidance information of suicide and self-harm). However, there is hope! 

Working on low mood

Much of what we do, our emotional reactions and behaviour has been learnt. Put simply what we learnt can be relearnt. Changing our mood through different strategies and techniques happens over months and not days. So, although the ADHD brain struggles to be patience and you may desire changes straight away, these suggested strategies will take time. Referred to as ‘the 1% rule’ or ‘the rule of small changes’ finds that many little and easy changes to one’s life can compound overtime to have a great effect.

Therefore, to start making changes to improve your mood, we are going to introduce strategies you can start now and build over time. When your mood is low, you may also find you are not motivated to do anything. This symptom of low mood sometime call lethargy. Those who experience lethargy report a sense of mental and physical exhaustion. 

Below are some strategies to try and shift your mood for the better. As a rule, studies have found we can make lifelong behaviour changes or new routine habit in just 30 days! However, the ADHD person may find is exciting and motivating to try and do all of them at once. 

As a guide try each strategy one at a time, once you believe you have mastered it, in other words, it is a new habit then work on the next one. All of these techniques have been found to improve the ADHD persons’ mood. 

Change your routine: 

• Start a routine, write down a list of essential tasks which you must do every day, attached times, e.g. get up 07:00, wash dress 07:00 – 07:30, breakfast 07:30-08:00. Do your best to stick to the routine but be flexible and understanding routines take time to develop.
• Eat breakfast, lunch and dinner, don’t skip meals, and aim to eat a high protein diet, which has been found to help with symptoms of ADHD.
• Don’t lay in bed, or oversleep, get up at the same time every day. 
• Aim to go to bed same time each night, don’t do any activities in bed, other than sleeping, you need to teach your brain, bed is for sleep and sleep only (please see advice and guidance information on ADHD & sleep).
• Take medication as prescribed, if your forgetful set alarms on your mobile.
• Ask yourself, what one thing, one goal, you could do this week that would improve your life in the longer term. 
• Write the goal down, break it down into smaller steps (write the steps down & make it concrete) and complete one step each day. Drawn a line through each step as you complete the steps over the week. 
• Complete brief tasks, you know you need to complete, simply spend 5 minutes working on a task you have been putting off due to low mood.
• Get active, go for a short walk, then either build time or distance each day. Best physical actives are something you enjoy, e.g. going for a bike ride.
• Watch, a favourite TV series, listen to an old album you have not listen to in a while and play a game by self or with others.
• Reduce or avoid high levels of caffeine, alcohol, and recreational substances.
• Have a meaningful conversation each day, aim to socialise throughout the week, avoid self-isolation, decreasing texting, and increasing chatting with others, including telephoning friends and family. 
• Plan something enjoyable each day, even if it’s just 30 minutes, don’t let a day pass without doing something you enjoy.
• Do tasks and activities for others, studies have found people who help others have a stronger sense of emotional wellbeing.

When emotional

Being emotional over time unsurprisingly can lead to low mood and even depression. Angry and outburst of emotion can be very problematic, so below are some things to think about and practice when you notice anger or negative emotions.

• Write down what make you angry or other negative emotions (what’s the triggers).
• Don’t make decisions when you angry or feeling other negative emotions.
• Time out, take you self away if angry, especially when with other people.
• Avoid answering emails, texts or calling people when angry or feeling other negative emotions.
• Leave problem solving for when anger or negative emotions have passed.
• Emotions are temporary, remind yourself emotions are temporary and the negative feelings will pass. 

Professional support for ADHD and low mood

Continues bounds of low mood, over time can lead to depression. Depression is recognised as a serious mood disorder, which goes beyond being sad, can last for weeks, months and unfortunately for some years. 

Considering medication

Medication is one possible option, but it isn’t suitable for everyone. It’s important to think about how ADHD affects your wellbeing and daily life. If it seems appropriate, you will be offered an appointment to discuss medication in more detail. It may be found combination of ADHD medication and anti-depressants may be required. However, the adult ADHD service is able to offer other intervention, from more practical help to adapted talking therapies designed with ADHD in mind. 

Final reminder

Although emotions and low mood can sometimes feel very intense, but they are often temporary. With time, support, and the right help, these feelings can change and become more manageable.

Other Adult ADHD service support 

Please consider evidence-based treatments. If your find your inattentiveness, hyperactivity-impulsivity causes significant problems with daily functioning across different areas of your life leading for low mood or depression. You may want to consider:

• Adapt ADHD medication assessment (if not already prescribed).
• CBT for ADHD, available for those with depression and anxiety in your local NHS trust NELFT.
• ADHD coaching, for those who want to focus on practical problems due to inattentiveness.
• Occupational Therapy for developing strategies for work or education.

We have a range of professionals who form the multidisciplinary team who can support you. We offer support from ADHD coaches and specialist occupational therapist, to help with the practical difficulties throughout the diagnosis processes. We have medical staff such as specialist nurses, psychiatrists and pharmacist, who will support you with the diagnosis, and if you decided to take medication. Finally, we have psychology staff, which includes assistant psychologist, practitioner psychologists and cognitive behavioural psychotherapists, to help support you with your mental health needs. The multidisciplinary approach allows the service offer tailored support for your current needs, now and into the future.

National support

• Samaritans: Call 116 123 (available 24 hours a day)
• SANEline: Call 0300 304 7000 (open daily, 4:30pm–10:30pm)
• Shout: Text SHOUT to 85258
• Stay Alive app: A suicide prevention resource available to download
• CALM (Campaign Against Living Miserably): Visit thecalmzone.net for guidance and support
• Papyrus HOPELINE UK – For young people under 35, telephone: 0800 068 4141, and text: 07860 039967
• The Listening Place – Suicide Prevention, telephone: 020 3906 7676,
• The mix (support service for young people aged 25 and under): 08088084994
• The silver line (support for adults over the age of 55): 0800 995 1000