Can untreated attention-deficit/hyperactivity disorder (ADHD) cause depression and anxiety?

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Last updated: November 5, 2026 • View editorial policy

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Yes, untreated ADHD significantly increases the risk of developing both depression and anxiety in children and adolescents.

Untreated ADHD more than doubles the risk of depression (2.27-fold increase) and substantially elevates anxiety risk, making screening and treatment of ADHD critical for preventing these serious comorbidities 1.

The Evidence for ADHD Causing Depression and Anxiety

The relationship between ADHD and these mood disorders is well-established through multiple pathways:

Depression Risk

  • Children and adolescents with ADHD have a 2.27 times higher risk of depressive disorder compared to those without ADHD 1
  • The risk for major depressive disorder specifically is 2.20 times higher 1
  • Comorbid depression is present in 36% of children with diagnosed ADHD, compared to only 14% in children without ADHD 2

Anxiety Risk

  • ADHD significantly increases risk for multiple anxiety disorders 1:
    • Specific phobia: 1.68 times higher risk
    • Social phobia: 1.71 times higher risk
    • Agoraphobia: 4.99 times higher risk
  • Adults with ADHD show moderate-to-large elevations in anxiety symptoms (effect size = 0.77) 3

How ADHD Leads to Depression and Anxiety

The pathway from ADHD to these conditions is indirect and mediated through several mechanisms 2, 4:

Primary Mediating Factors (in order of importance):

  1. Irritability symptoms - accounts for 37-39% of the pathway from ADHD to depression 2, 4
  2. Depression symptoms themselves - accounts for 39-45% of the effect 2, 4
  3. Anxiety symptoms - accounts for 19% of the pathway 4
  4. Disruptive behavior disorders - significant mediator, particularly in boys 2

Developmental Stage Matters:

The mechanisms vary by age 5:

  • Childhood: Clinical factors (irritability, anxiety) contribute 30% to the ADHD-depression pathway
  • Adolescence: Negative thought patterns (external locus of control, negative cognitive style) contribute 39%; clinical factors contribute 46-48%
  • Young adulthood: Clinical factors again dominate (29-42%), particularly in females

Social Skills Pathway:

  • Impaired social skills in ADHD adolescents mediate the relationship to depression 6
  • Specifically, deficits in cooperation, communication, empathy, and responsibility drive increased depression risk
  • This leads to failed social connections, low self-worth, and ultimately depression

Critical Clinical Implications

Screening Requirements

The 2019 AAP guideline mandates that clinicians must screen for comorbid anxiety and depression when evaluating any child or adolescent for ADHD 7. This is a Grade B strong recommendation.

For adolescents (ages 12-18), at minimum assess for anxiety, depression, substance use, and learning disabilities at diagnosis 7.

The Protective Effect of Treatment

Stimulant medication for ADHD reduces depression risk by 20% (RR = 0.80) 1. This is crucial evidence that treating ADHD itself helps prevent depression, not just manage ADHD symptoms.

Common Pitfalls to Avoid:

  1. Don't assume ADHD symptoms are "just ADHD" - the majority of children with ADHD meet criteria for another mental disorder 7
  2. Don't wait to screen for mood disorders - anxiety and depression often develop as consequences of untreated ADHD
  3. Don't ignore irritability - it's the strongest predictor of progression to depression in ADHD 2, 4
  4. Don't overlook gender differences - in young adulthood, mediating pathways to depression are particularly strong in females (42% of effect) 5

Treatment Sequencing

When comorbid conditions are present, consider sequencing treatments to address areas of greatest risk first 7. The presence of comorbid anxiety or depression alters the treatment approach for ADHD.

The Bottom Line

Untreated ADHD doesn't directly "cause" depression and anxiety in a simple linear fashion, but rather creates a cascade of clinical symptoms (irritability, anxiety), cognitive patterns (negative thinking, external locus of control), and social impairments that collectively drive the development of these mood disorders 5, 2, 4. The relationship is fully mediated through these pathways - there is no direct effect once these mediators are controlled 4.

This makes early identification and treatment of ADHD essential for preventing depression and anxiety, and mandates routine screening for these comorbidities throughout the course of ADHD management 7.

References

6
Research

Linking ADHD to Depression in Adolescents: the Mediating Role of Social Skills.

Research on child and adolescent psychopathology, 2026

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