College Student with Depression, ADHD, and Possible OCD

Reader’s Question

I am a 22-year-old college student. When I was 19 I was diagnosed with Dysthymic depression. The medication and counseling I received helped a lot, but there were still some issues that I was dealing with that weren’t resolved, such as an inability to focus, being easily distracted, spending hours more in the library studying (because of how hard it is to focus), impulsivity, and just feeling too hyper. I have read a lot and went and saw the school psychologist. From what I read and what she thought, she thinks it might be ADHD. She suggested that I schedule an appointment over the break with a psychologist to get a diagnosis. I have an appointment tomorrow.

Today I was reading and ran into some information about OCD. One thing that I also have a problem with is having unpleasant, recurring thoughts — thoughts that are totally out of my character. I feel evil for having these thoughts. And it isn’t just unpleasant thoughts — it’s just like for a period of time my mind will have recurring thoughts about one single thing. It might go on for weeks, and I can’t stop thinking about it. Sometimes I just feel like my mind is racing. It’s affecting every part of my life.

Was I misdiagnosed with depression? I don’t know if there is a link between ADHD and OCD or what. I am just trying to find some answers. I would appreciate any advice/information. Thank you.

Psychologist’s Reply

There are links everywhere in this situation. First, there is a major link between Depression and Obsessive-Compulsive Disorder (OCD) or having OCD behaviors (obsessive thoughts, rituals, phobias, etc.). Both Depression and OCD are thought to be related to low Serotonin (a neurotransmitter) in the brain. This is why depressed folks often develop obsessive thoughts, despite having no history of OCD prior to their depression.

ADHD and OCD are also linked. In one study, 25% of children and adolescents with OCD also had ADHD (Clinical Psychiatry News, February 2006). There is some controversy about the link however, with some researchers feeling ADHD and OCD develop as two distinct conditions rather than sharing a strong neurochemical link.

Most importantly, all three conditions are strongly associated with the brain’s neurochemical system and for that reason, can be treated. I don’t think your depression was misdiagnosed at all. In fact, it may just be the last condition to arrive.

Here are some thoughts:

• If you have ADHD — and not the poor concentration associated with depression — those symptoms will have arrived first. ADHD surfaces during childhood, and it’s extremely rare for someone to suddenly develop ADHD as a young adult without a history of ADHD in childhood. We can experience ADHD symptoms of restlessness, inattention, poor impulse control, etc. as an adult, but the symptoms are likely caused by another condition such as anxiety, stress, depression, Bipolar Disorder, etc.
• If your OCD features (obsessive thoughts) arrived before your depression, then the OCD is likely linked to your ADHD or is a separate condition. In this case, the OCD may need a separate treatment approach.
• If your OCD and Depression arrived at the same time, about three years ago as you reported, then you are likely to have only OCD symptoms (due to low Serotonin) and not full-blown OCD. Why does that make a difference? Depression with OCD features can be treated with specific antidepressants and as the depressive symptoms decrease, so will the OCD symptoms.

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Going to a psychologist to clarify your diagnosis is a great idea. However, don’t stop there. I would recommend a psychiatric consultation as well. We now have excellent medications that work on two or more neurotransmitters. A psychiatrist is best trained to chose the correct medication (s) for your symptoms. Be sure to report all your symptoms to your psychologist and psychiatrist. People are sometimes shy about reporting obsessive thoughts, but such thoughts are a window into your neurotransmitter activity — depending upon the intensity, duration, frequency, content, and volume of these thoughts. You should be able to stabilize these symptoms and continue your studies without difficulty.