ADHD or Depression? Adult Evaluation in NYC and New Jersey

Trouble concentrating, low motivation, unfinished work and poor sleep can come from depression, from ADHD, or from both at once. Many adults have been treated for depression, felt their mood improve, and still could not get organized. Others wonder whether years of struggling with undiagnosed ADHD wore their mood down. This page explains how an adult ADHD evaluation with Dr. Shershow approaches depression, and what published guidance says about which to treat first.

Where the symptoms overlap

The National Institute of Mental Health lists difficulty concentrating, remembering or making decisions; restlessness; fatigue; and sleep changes among the symptoms of depression. All of these can also appear in adult ADHD. The criteria differ in timing and shape:

A 2017 review in BMC Psychiatry names a persistently low mood, appetite changes and thoughts of suicide as signs that point to a depressive disorder alongside ADHD. NIMH also describes persistent depressive disorder (dysthymia), a milder depression that lasts for years. Because it is long-lasting, it can look like a personality trait, and it is one of the conditions an evaluation looks for. More symptom-level detail is in ADHD or depression and ADHD and depression in adults.

How often they occur together

In the National Comorbidity Survey Replication, 38.3% of US adults with ADHD had a mood disorder in the previous 12 months: major depressive disorder in 18.6%, dysthymia in 12.8% and bipolar disorder in 19.4%. Among adults with ADHD who had received any mental health or substance treatment that year, only 25.2% had been treated for ADHD.

A 2017 review in BMC Psychiatry cites a study in which 28% of people referred to a specialty clinic for mood and anxiety assessment had undetected ADHD, and the number of SSRI antidepressants a person had already tried predicted it. The review notes that serotonin-focused antidepressants alone would not be expected to improve ADHD symptoms. It also describes a pattern in which low mood is demoralization after years of ADHD-related setbacks rather than a separate depressive disorder.

How the evaluation sorts it out

The evaluation with Dr. Shershow covers current symptoms; childhood, school and work history; health, including medical history, medications, sleep and substances; and other explanations such as depression, anxiety, sleep problems or stress, alone or alongside ADHD. It ends with what it found and the treatment options that fit. No diagnosis is guaranteed.

For someone with a depression history, these questions matter most:

• Before and between episodes. What were attention and organization like in childhood, and during stretches when your mood was good?
• Response to past treatment. Which antidepressants or therapy helped mood, and did focus, lateness or forgetfulness change with them?
• Mood highs. Periods of unusually elevated mood, little need for sleep or racing activity matter, because bipolar disorder changes the plan. See ADHD or bipolar disorder.
• Safety. Thoughts of suicide are always asked about, because they change what needs to happen first.

Self-report screeners are less reliable here. In a 2018 study of 40 adults with major depression, 50% reported enough symptoms on a structured interview to meet ADHD symptom counts, but only 12.5% had full-syndrome ADHD. A positive result on the standard adult ADHD screener was more likely to be a false positive than a true one in this group. The authors concluded that symptom counts and screening alone cannot decide an ADHD diagnosis. That is the reason the history and the timeline carry so much weight.

Which is treated first

The 2017 review summarizes Canadian (CADDRA) guidance this way:

• Moderate or severe depression: treat the depression first and assess suicide risk. Stimulants can be combined with most antidepressants, with monitoring.
• Mild depression or dysthymia: treat the most impairing condition first, and consider treating ADHD first.
• Bipolar disorder: treat it first and address ADHD once mood is stable.

Some medication facts shape these choices. Amphetamine products such as Adderall XR are contraindicated during or within 14 days after use of an MAOI antidepressant, according to the FDA label. Bupropion is an antidepressant that a 2024 American Family Physician review lists as an option for adults with ADHD and concurrent depression, although it is not FDA-approved for ADHD. More on mood effects is in ADHD medication and mood changes.

Dr. Shershow provides medication management for ADHD when medication is appropriate and ongoing psychiatric follow-up by secure video. Depression is something the evaluation considers, not a standalone service of the practice, and the practice does not provide therapy. If depression explains the symptoms better than ADHD, or needs to be treated first, you will be told so and can pursue that care with your primary care clinician, a therapist or another psychiatric program.

New York and New Jersey rules that apply to your visits

Dr. Shershow is licensed in both New York and New Jersey, and the rule that matters is where you are physically located during each visit, not your home address. New York's Office of the Professions says a practitioner must hold a New York license when the patient is located in New York, and New Jersey's telehealth law requires a New Jersey license for services provided to a patient in New Jersey. For a video visit you must be in New York or New Jersey at the time of the visit.

If stimulant medication becomes part of the plan and you are located in New Jersey, P.L.2026, c.40 (effective July 8, 2026) applies to adults on a Schedule II stimulant who start by telehealth: an in-person visit within 30 days, a contact at least every three months (in person or by real-time audio-video), and an in-person visit at least once a year. The office will explain how visits are arranged for patients located in New Jersey. In New York, as of October 2026, telehealth prescribing of controlled substances follows the federal telemedicine flexibilities, which run through December 31, 2026.

Visit details are on the appointments and telehealth page. For current fees and how insurance works with the practice, call the office or see fees and insurance.

If you are in crisis

If you are thinking about suicide, do not wait for an appointment. Call or text 988, or chat at 988lifeline.org, 24 hours a day in New York and New Jersey. In immediate danger, call 911. State-specific options are listed in crisis lines in New York and crisis resources in New Jersey.