ADHD and Anxiety in the UK: Why They Go Together and What Helps

One of the most significant clinical challenges with ADHD and anxiety is that they can mask each other, leading to misdiagnosis or incomplete diagnosis. Anxiety is often diagnosed first - particularly in women - because its symptoms are more widely recognised by GPs and because it fits the picture the clinician is expecting to see.

A person with undiagnosed ADHD might present to their GP with difficulty sleeping, racing thoughts, inability to relax, and a constant sense of being overwhelmed. These are textbook anxiety symptoms. But they might also be the result of an ADHD brain that cannot switch off, cannot prioritise the flood of incoming thoughts, and is chronically overstimulated by the demands of daily life. The standard ADHD symptoms in adults - difficulty with focus, organisation, time management, emotional regulation - can all be misinterpreted as anxiety symptoms when viewed in isolation.

The reverse can also happen. Someone with significant anxiety might be told their inability to concentrate is "just the anxiety" and that treating the anxiety will resolve the attention difficulties. If ADHD is the underlying cause, treating only the anxiety will help with some symptoms but leave the core executive function difficulties untouched.

Clinicians assessing for ADHD are trained to consider whether attention and concentration difficulties might be better explained by anxiety alone. This is a valid clinical question, but it can become a barrier to diagnosis when the answer is assumed rather than properly investigated.

The key diagnostic distinction is timing. ADHD is a neurodevelopmental condition - its symptoms must have been present since childhood (before age twelve). Anxiety can develop at any age. If a person has experienced attention difficulties, impulsivity and disorganisation since childhood, those are unlikely to be caused by anxiety that developed in adulthood. If the attention difficulties only appeared alongside a period of significant anxiety, the picture is less clear.

A thorough assessment should explore both possibilities and consider whether both conditions are present simultaneously. If you are going through an ADHD assessment and you also experience anxiety, mention both to the assessing clinician. Withholding information about anxiety out of concern it might "explain away" your ADHD symptoms actually makes the assessment less accurate, not more.

Treating co-occurring ADHD and anxiety requires careful thought about medication. Stimulant medications - methylphenidate (Concerta, Equasym) and lisdexamfetamine (Elvanse) - are the first-line treatment for ADHD as outlined in our ADHD medication guide. However, stimulants can sometimes increase anxiety as a side effect, particularly during titration or if the dose is too high.

For many people with ADHD and anxiety, the relationship with stimulant medication is more positive than they expect. When ADHD is properly treated, the anxiety that was driven by executive function failure often reduces significantly. The person can now meet deadlines, follow through on commitments and organise their thoughts - and the anxiety that came from chronically failing at those things diminishes as a result.

When anxiety persists despite effective ADHD treatment, or when it is severe enough to need direct treatment alongside ADHD medication, SSRIs (such as sertraline) are commonly prescribed. SSRIs and ADHD stimulants can generally be taken together safely, though your prescriber should monitor the combination. Non-stimulant ADHD medications like atomoxetine (Strattera) are another option - atomoxetine has some evidence for reducing anxiety symptoms alongside treating ADHD, making it a useful choice when both conditions are prominent.

In the UK, ADHD and anxiety are typically managed by different NHS services. ADHD sits within psychiatry (or neurodevelopmental services), while anxiety is often managed through IAPT (Improving Access to Psychological Therapies) - now increasingly called NHS Talking Therapies - or through your GP. This can create a coordination gap where neither service is looking at the full picture.

If you have both diagnoses, your GP becomes the key coordinator. They manage your repeat prescriptions for both conditions and should be aware of how the medications interact. If you are under a specialist ADHD service, make sure they know about your anxiety treatment, and vice versa.

NICE guidelines recommend that when ADHD and anxiety co-occur, the condition causing the most impairment should be treated first. In practice, this often means starting ADHD treatment to see whether the anxiety reduces before adding anxiety-specific treatment. However, if your anxiety is so severe that it prevents you from engaging with ADHD assessment or treatment, addressing the anxiety first (or simultaneously) may be more practical.

Beyond medication, several practical approaches can help manage the overlap between ADHD and anxiety. Externalising your working memory - using calendars, reminders, written lists and task management apps - reduces the cognitive load that drives much of ADHD-related anxiety. When you can trust a system to remember things for you, the background worry about forgetting decreases.

Physical exercise is consistently supported by evidence for both ADHD and anxiety. Even 20 minutes of moderate activity can improve focus and reduce anxious feelings for several hours afterwards. Building regular movement into your routine is one of the most effective non-pharmaceutical interventions available.

Mindfulness-based approaches can be helpful, though they often need adapting for ADHD. Traditional meditation that asks you to sit still and clear your mind can be counterproductive for someone with ADHD - it becomes another thing to fail at. Movement-based mindfulness, brief guided exercises (five minutes rather than thirty), and body-scan techniques tend to work better.

Finally, reducing the number of decisions you make each day can help. Decision fatigue is a significant anxiety trigger for people with ADHD. Automating routine choices - meal plans, standard outfits, fixed morning routines - frees up mental capacity for the decisions that actually matter.

If you are experiencing symptoms of both ADHD and anxiety, seeking professional assessment is worthwhile. A proper evaluation can determine whether you have one or both conditions and guide appropriate treatment. Many people spend years treating anxiety alone without improvement because the underlying ADHD has never been identified.

Speak to your GP as a starting point. If you suspect ADHD, be direct about that. Explain that you have experienced attention and organisational difficulties since childhood and that you would like to be assessed. If you are already being treated for anxiety and it is not fully resolving your difficulties, mention that too - it may prompt a broader assessment.

This information is for general guidance only and does not constitute medical advice. Always discuss your individual symptoms and treatment options with a qualified healthcare professional. ADHD UK and Anxiety UK both offer free helplines and resources that can support you while you navigate the assessment and treatment process.