Which one should I treat, anxiety or ADHD

Описание: The DSM-5 provided as guidelines for diagnosis but recommendations for specific evidence-based treatment options are beyond its scope. Comorbidity is the rule rather than the exception in psychiatry. Anxiety can manifest with symptoms like overactivity and easy distractibility, which can also be cardinal symptoms of ADHD. When ADHD and anxiety coexist, the untreated anxiety disorder may diminish the patient's response to stimulant medications or decrease their ability to tolerate them. Some symptoms of ADHD, such as excessive talking and distractibility, may also overlap with symptoms of mood states like hypomania, necessitating careful distinction.
Psychiatric diagnoses are a guide, but treatment is fundamentally centered on symptoms and the individual's needs. Symptom relief or removal is considered an essential goal in any psychotherapeutic program. Clinicians must consider symptom severity, the individual’s distress associated with the symptoms, and disability related to the individual’s symptoms. In general, treatment plans should prioritize the symptom or problem that is causing the greatest distress or impairment to the individual.
A clinician must first conduct a thorough evaluation to formulate a specific, person-centered plan, asking: Is the anxiety primary, or is it a reactive symptom (stress or frustration) driven by the untreated ADHD symptoms (like difficulty concentrating)? Since the conditions often interact and worsen prognosis, the most robust approach is often to treat the key driving symptoms of both disorders concurrently using multimodal strategies.
To prioritize treatment, it is crucial to determine if the symptoms are due to a treatable medical etiology (hyperthyroidism can cause anxiety) or a primary psychiatric illness that causes life-threatening condition such as self-harm and suicide. If anxiety is prominent, non-stimulant ADHD medications like selective norepinephrine reuptake inhibitors (such as atomoxetine) may be preferred, as they carry no abuse potential and are less likely to worsen anxiety or cause insomnia compared to stimulants.
Find out what is causing the anxiety, which could be trauma. Treatment should be focused on alleviating functional impairment and distress. Successful intervention, which often involves multimodal treatment (medication and psychosocial modalities), aims not just at symptom reduction, but at enhancing competencies and promoting essential skills for social, occupational or academic functioning.