How I manage multiple mental health diagnoses

Attention-deficit/hyperactivity disorder (ADHD), generalized anxiety disorder (GAD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD). The health summary section of my medical record reads like alphabet soup—and I’m perfectly OK with that. Why? Because it means I know who I am. I know what’s going on in my brain. And I know how to live with my multiple mental health disorders rather than in spite of them. 

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While I am fortunate in that I can see the big picture now that I’m in my 30s, I wasn’t diagnosed with all of these conditions at the same time. My journey took years, and over those years I’ve come to see the relationship between the different conditions, including overlapping symptoms and, in some cases, overlapping treatments.

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While it would have been nice to have been diagnosed with everything all at once, that’s just not how it played out. Looking back, I wonder if the dots would’ve been connected more quickly if there had been more information readily available at the time. In the hopes of helping someone else who may still be connecting their own dots, though, I began researching the science behind co-existing mental health conditions and examining how it relates to my personal experiences. Here’s what I found out.

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Co-existing mental health conditions: what they are, their prevalence, and why they happen

Co-existing conditions or comorbidities in people with mental illnesses are more common than you may think. Studies show that comorbid depression and anxiety may have a prevalence of about 60% to 70%—meaning that about 2 out of 3 people who have depression also have anxiety (and vice versa).

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People with attention-deficit/hyperactivity disorder (ADHD) are also more likely to experience:

• Anxiety disorders
• Bipolar disorder
• Depression
• Personality disorders

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Scientists don’t fully understand why so many mental health diagnoses present together, but as a 2020 article in Nature explains, the most likely, albeit obvious, connection is the brain. 

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Mental health conditions and your brain: what’s the connection?

When we talk about treating mental health conditions like depression and anxiety, we talk a lot about neurotransmitters—like serotonin—and correcting chemical imbalances. And while it’s true that medications like selective serotonin reuptake inhibitors (SSRIs) can be used to treat both depression and anxiety because of the role that neurotransmitters play in these conditions, there are specific areas of the brain that are also affected by both conditions.

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For instance, studies have found that the amygdala, hippocampus, and thalamus are all affected by depression. These are all part of the limbic system, which plays a role in how our brains process emotions. Research has shown that people with anxiety have increased activity in this area of the brain as well. And differences in the limbic areas of the brain have also been found in young adults with ADHD. In hindsight, this makes a lot of sense to me. With all of this overlap, it’s no wonder that my diagnosis journey was exactly that—a journey that spanned years. 

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At this point, I want to pause to say that none of this means that these differences are defects. While I’m certainly not dancing in the street and celebrating my diagnoses (aside from the fact that I can’t dance in the first place), I do take comfort in understanding them, and I feel confident in my ability to work with healthcare providers to maintain an effective treatment plan. As I said at the start, I live with my conditions. But it wasn’t easy getting to this point.

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My journey to multiple mental health diagnoses

I am fortunate to have parents who recognized that something was “off” with me from a young age and advocated relentlessly for my wellbeing. They took me to doctor after doctor until someone figured out what was going on in my brain. 

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To be honest, emotionally, I was a hot mess of a child. I did not like being away from my parents—even to go to school. Sleepovers were not a thing for me. If I had a playdate, I preferred if my mom came along. I did not cope well with changes in plans. At all. I was talented academically (I even tested into the gifted program in fifth grade), but everything took me 10 times longer to do compared to my peers. Homework was a battle of wills between my parents and me every single day. 

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But that was because I was undiagnosed and untreated. Fortunately, once the diagnoses started falling in place, so did my life.

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My first diagnosis of generalized anxiety disorder (GAD) came in sixth grade. That year, I started both medication and therapy, but while the diagnosis definitely fit some of my symptoms, the treatment felt like it was only a Band-Aid on a much bigger issue.

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I went from feeling like I was always just barely missing something—like life was one inside joke that everyone got except for me, and that I had to struggle to pretend to keep up with the punchline—to finally realizing that there was no inside joke."

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My next diagnosis was attention-deficit/hyperactivity disorder (ADHD). This is the one I consider to be the most pivotal diagnosis of my life, even though there were more to come that also led to significant improvements in my wellbeing. I was diagnosed with ADHD the summer before my freshman year of high school. At this point, I had seen a plethora of healthcare providers and mental health professionals and had been evaluated for who knows how many medical conditions and psychiatric disorders.

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To this day, I credit a single symptom my mom mentioned (completely by happenstance, she later told me) with sparking my diagnosis. 

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“She’s very sensitive to noises,” my mom told the psychiatrist.

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He raised his eyebrows, got up from his chair, walked to his bookshelf, and plucked the Diagnostic and Statistical Manual of Mental Disorders (DSM) off of his shelf. He then asked a series of questions that I would later find out were the diagnostic criteria for ADHD. Over the next few weeks, I underwent further testing to confirm the diagnosis. Within a few weeks, I started my first dose of ADHD medication. 

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It was life-changing. The difference was night and day. All of a sudden I went from feeling like I was always just barely missing something—like life was one inside joke that everyone got except for me, and that I had to struggle to pretend to keep up with the punchline—to finally realizing that there was no inside joke. I had just been struggling to keep up with life, generally. And now I could live life minus the struggle. 

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Editor’s note: Minded does not prescribe schedule II medications (stimulants like Ritalin, Adderall, and other medications with methlyphenidate or amphetamine in their name), but our psychiatry providers can prescribe other non-stimulant medications when appropriate. Visit Minded to see if ADHD treatment with us is right for you.

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The timeline for my other diagnoses—obsessive-compulsive disorder (OCD) and major depressive disorder (MDD)—is slightly less clear in my memory, and because I moved around the country a lot growing up, there are some small gaps in my medical record that make filling in the little details in the history of mental health services I’ve received somewhat difficult. 

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What I do remember is that before starting medication for OCD (some time after my sophomore year of high school), finishing my homework would still take me hours. It was not because of my ADHD (because that was now being properly treated), but because I would not consider it complete until I had rewritten it just right. Those Gs don’t look the same. Guess I have to rewrite that sentence. Erase. Rewrite. Does it look OK now? No, now the paper is smudged. Start over with a fresh sheet. Good now? Phew! I went through a lot of paper and pencils during that time. 

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I struggled the most with major depression in college and grad school, and there was some back and forth over the years among my psychiatrists (I had to change providers as my insurance changed) about whether I had MDD or another mood disorder, specifically bipolar II. Everyone agreed that I had depressive episodes. There was disagreement about whether I had hypomanic episodes, which are a part of the diagnostic criteria for bipolar II.

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What I realized at that point was that the label was less important to me than the treatment plan. While the correct diagnosis was needed to secure insurance approval for the prescriptions—a whole other headache I’ve learned to deal with over the years—with the right combination of medications (and therapy, as-needed), I am finally able to be, well, me. 

How I manage multiple mental health diagnoses

As I’ve come to understand my multiple diagnoses and learned to live with them, I’ve also learned a few other valuable lessons about managing my diagnoses:

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1. It’s OK for me to lean on family members and loved ones

I am fortunate to have a small but mighty support network of friends and family members who I can rely on in times of need. Everyone in my network knows my diagnoses and knows what they personally can do to help me if I reach out to them. We’ve talked about how I respond to certain triggers and situations, and what I need from each of them, both in the moment and afterward. I am grateful to each of them for every tearful or panicked video call they have taken from me over the years.

2. I need to take care of my physical health, too

Physical and mental health go hand-in-hand (or hand-in-brain?), and while I absolutely hate exercising, I am a creature of habit and have incorporated ways to get physical activity into my daily routine in order to make sure I’m taking care of my body and mind. For instance, I get around 15,000 steps every day at my standing desk while I work.

And my sleep is sacred. I am in bed and asleep by 9:30 PM in order to get my needed 8 to 9 hours of Zzzs in. 

3. Being aware of—and avoiding—risk factors has kept me safe

I do not drink alcohol at all. I am on antidepressant medications that should not be taken with alcohol. And studies suggest that people with ADHD may be at an increased risk for substance abuse. I know that not everyone with these conditions will take this all-or-nothing mindset, but it works for me.

4. I need to always be on top of my meds

Managing my half-dozen meds—two for ADHD, one for OCD, anxiety, and depression, one for mood stabilization, and two for other medical issues—is a delicate balance of being on the lookout for side effects or interactions, ensuring I’m on the right doses of each medication, and staying on top of my refills. 

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Getting to this combination took years. The trickiest part for me has been balancing the side effects of the ADHD meds (daytime appetite loss and nausea, nighttime hunger) with the right dose to allow me to concentrate and function throughout the day. I also struggled with weight gain when I initially started my antidepressant (which I take for depression, anxiety, and OCD)—but I have finally found the right dose for me that provides symptom relief without the weight gain.

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While some people may question who would want to go through so much fuss, I understand that my meds help me be my real self. I don’t ever pretend that having multiple mental health diagnoses is easy. But it is my reality. And honestly, I can’t imagine who I would be otherwise.

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