I take two different kinds of neural reuptake inhibitors: one works on serotonin, the other on norepinephrine. Those two neurotransmitters like to mess up my brain in different, yet related, ways. I started thinking about this because I’ve had the serotonin under control for a long while, long enough that when it, in the past two weeks, started slipping out of control again, I could recognize it. This is different. Depression and ADHD both make it hard to focus; hard to accomplish anything. They can both make you absurdly sleepy in the middle of the day and yet keep you up at night. But they’re not the same thing, and misinterpreting the overlap can cause treatments to fail and confidence to spiral downward.
A couple of years ago I posted an article that asked, Does it really matter what label you’re given if it’s the symptoms that are most important? I actually wasn’t sure about the answer then. This article is going to take a side: yes, it does matter. The Zoloft helps fix the depression, the Strattera helps fix the ADHD. Some people just need the one to function well, some people need the other, and I need both. If a doctor just hears “I can’t seem to accomplish anything” and immediately assumes, “Ah, depression!” or “That sounds like ADHD!” there’s a strong chance the problem won’t be fixed.
Neurodivergence vs. Mental Illness, Revisited
I discussed this in my article about Mental Health Awareness through Fiction, but it’s worth repeating. Neurodivergence is not a mental illness. Both can interfere with the day to day functionality of a person. But neurodivergence is only a problem because society isn’t designed to work with it. If we didn’t live in a society that relied so heavily on clocks, for example, it wouldn’t matter that I’m time blind. I wouldn’t be late if nobody else noticed the passing of those five minutes, either. But because people expect me to be places at a certain time on a clock, I now have a problem. I have to employ strategies that other people don’t have to, to counteract my neurodivergence, in order to function as part of this society as it is.
But depression doesn’t care about societal differences: it will spin whatever situation I’m in, no matter how comfortable, into a hopeless tragedy no matter what. It’s the brain not working right at all, not just in a particular setting. You cannot design a society that allows depressed people to just be their depressed selves to their hearts’ content, because depression will make a problem of any situation. It’s a mental illness, and no amount of acceptance by society can fix it.
There is a high rate of mental illness diagnoses among women whose neurodivergences were never diagnosed in childhood (because diagnosis standards were designed around the behaviors of young boys, not girls). It makes sense. Constantly feeling like you don’t fit into society but not knowing why can take a major toll on your self-esteem. It made me depressed. Others, in their panic, developed anxiety disorders. But sometimes all these symptoms get conflated, and we’re not sure what’s a quirk and what’s an illness.
We hear occasionally of misdiagnoses, of women who were unknowingly battling the lack of focus, inability to complete tasks, and Intrusive Sleep of ADHD, and psychologists who didn’t know much about how ADHD appears in women interpreted that as the despondency, low motivation, and lethargy of depression. Someone else’s racing thoughts and insomnia from ADHD were interpreted as anxiety, instead. Now when we talk about it among ourselves we sometimes have trouble figuring out what was really ADHD all along and what was an actual mental illness that set in as a result of our struggles with ADHD.
But now that I know what to look for, I can tell the difference. There’s a hopelessness in depression that turns the inability to focus into what’s the point of focusing, that turns drifting off out of boredom into there is nothing worth waking up for. That’s how I know my serotonin levels are what’s going off now. It feels different than ADHD.
Likewise, I can tell the difference between anxiety and neurodivergence by what I don’t feel. I am highly sensitive, my brain never slows down, and I was afraid of everything as a child. Some other neurodivergent women link these traits with their own diagnosis of clinical anxiety. Now, I have experienced out of control anxiety as a physical feeling before, the times my psychiatrists would try me out on stimulant medications. Stimulant meds make my heart freak out. I once spent three hours in the ER trying to assure the doctors that I was okay, honest, I KNEW I was having a panic attack, not a heart attack, it’s just the new meds, I just wondered if there was a way to stop it. Last year my car got T-boned in the passenger door: no one was hurt, but for months afterward (and sometimes still), every time I drove through an intersection, my body would shoot through with the same feeling the stimulants had given me, for just a moment. Ah, I thought, this is how anxiety is SUPPOSED to work, protecting you from known dangers with a surge of adrenaline. People with anxiety disorders feel this way all the time… or at least other weird, non-dangerous times. So although I may scare easily and ruminate frequently, I know I don’t have an anxiety disorder, because I only feel that anxiety in times of actual stress or when I’m having a reaction to stimulants. An anxiety disorder is a different thing that just happens to overlap with ADHD a bit.
You can have a mental illness while being otherwise neurotypical. You can be neurodivergent without having a mental illness. And you can have neurodivergence and mental illness feeding into each other and making major nuisances of themselves. But you can also have more than one type of mental illness or neurodivergence feeding into each other. Or, again, overlapping symptoms can suggest issues that aren’t even there.
More Than One Way to Be Neurodivergent
Ever since my little brother, ten years my junior, was diagnosed with an autistic spectrum disorder (at the time it was “PPD-NOS,” but they’ve lumped that into ASD nowadays), I’d wondered if that was my problem. After all, I, too, had trouble verbalizing my thoughts. I was academically gifted and socially hopeless. I, too, felt like the proverbial square peg, or that everyone else knew some secret rules to living in society that I just didn’t get. I, too, was super-sensitive to noise and some touch sensations, and had been known to have uncontrollable meltdowns when everyone thought I should have long outgrown them. I got along better with people younger or older than me than with people my own age.
Sure, it wasn’t an exact match. I never had trouble with metaphor, for instance—I love metaphor—I probably think more in metaphor than I ever do literally. And I absolutely had no trouble putting myself in another person’s shoes—I’m empathic, let alone empathetic. I so easily feel for other people that pratfall humor would devastate me as a child, as I was sure the butt of the joke had been hurt (even if they were a cartoon). But I chalked these differences up to me being a girl, and autism manifesting differently in girls. Even when I met girls who were clearly on the spectrum, and was aware that they, too, were different from me, it still seemed like the most likely explanation.
I didn’t suspect ADHD—or even simple ADD, as it used to be called when describing non-hyperactive types like myself—until my son’s first psychologist pointed out that I was answering every symptom in his checklist with a yes for myself even more than for my son. Even when my own psychologist confirmed it a few years later, I thought, it must be that and an ASD. Surely it’s been autistic symptoms that have caused me more trouble over the course of my life than ADHD.
Last fall I listened to this webinar at the ADDitude site, “Is it ADHD, Autism, or Both?” To my shock, every one of my supposedly autistic traits was addressed and shown how they can just as easily be caused by ADHD: and my own experiences lined up far more closely with the ADHD manifestations of the traits than the ASD manifestations. Sure, we’re both socially awkward, but someone on the autistic side wouldn’t notice when a faux pas causes their peers to subtly react, while I—and other awkward nerds with ADHD—was all too aware when my peers were suppressing their laughter at my mistakes; I just didn’t have the ability to keep from making them. Sure, I have trouble verbalizing,*** but not because of an innate problem with communication itself, but just because my brain moves too fast for my mouth to catch up, and leaves me stuttering and confused in the middle of a sentence. Sure, I have trouble with eye contact, but not with making eye contact—I like that, I like looking people in the eye and smiling when I meet them; it’s keeping eye contact that’s impossible, because my eyes just have too many other places to be. Sure, I was hypersensitive and prone to meltdowns in my youth, but of course I would be hypersensitive if my mind had trouble sorting out the barrage of sensations it experiences, and trouble regulating emotions is simply a trait caused by both ADHD and ASD.
Recently GeekMom K. Tilden Frost and I compared the differences between her stimming and my fidgeting. Both are movements made often subconsciously in order to regulate the stimuli entering the brain, but what she feels is a much more direct and conscious need to move in particular organized, repetitive ways, rather than my often unconscious and more random movements. Both of our brains are neurodivergent in a way that requires us to regulate incoming stimuli through movement, but not in the same way.
Autism and ADHD are both well-known and broadly-encompassing ways to be neurodivergent,* and there are so many overlapping symptoms that some people see them as merely different facets of the same condition. But there are other conditions that affect executive functions, whether genetic neurodivergences like Tourettes or traumas and illnesses like physical brain damage or dementia. There are sensory processing disorders that affect sensitivity and disorders that affect how the brain interacts with the muscles. A lot of people who have the broader condition of ADHD also have the co-morbid condition of Dyslexia, but it’s not a requirement of the condition: in this ADHD household, the dad and daughter also have dysgraphia and dyscalculia, but the son and I have no dyslexic tendencies at all, beyond messy handwriting.
It can be easy to project what someone with a different neurological condition says about it onto ourselves, and vice versa, when we find ourselves talking about the same executive dysfunction or sensitivity, but it takes a lot of research and good professional judgment to actually detangle all the co-morbid possibilities and determine the best course of action for your own specific interventions.
Possible side point: a common executive function I personally had trouble with is finishing things. Is this a satisfactory conclusion to this article? I…I’m going to leave it there. Let’s hope it is.
*It was at this point in the narrative that I became suddenly aware that there were two holes in my bean-bag wrist-rest that could leak pellets through, and after squeezing pellets in and out for a bit, felt compelled to glue them shut, and forgot I was writing an article, does somebody have ADHD here or something? Hey, look, you should be impressed with me, it took 1700 words before I got to this, my first footnote in this entire article!**
**It’s by no means the first time I’ve been distracted while writing this, though, considering this is my third day of working on it, and by the way I have to get some lunch now….
***Okay, this is now technically the first footnote in the article, but I just added it at the last minute because I only now realized I’d almost missed the opportunity to link to my article about Mrs Who, and then I had to point it out because it’s my article about Mrs Who and it’s relevant.
