How do you treat ADHD when someone has panic episodes too?

This is a very common and very reasonable concern, and it’s something clinicians approach carefully rather than with a one-size-fits-all plan. When someone has ADHD with panic episodes, the first step is understanding the pattern. How frequent are the panic spikes, what triggers them, and how stable things are between episodes. Panic that’s occasional and situational is handled differently than panic that’s frequent or unpredictable. If panic is severe, frequent, or poorly controlled, I usually prioritize stabilizing that first. Untreated panic can make it very hard to assess ADHD treatment and can be worsened by anything that increases physical arousal. In those cases, therapy focused on panic, sometimes along with medication, often comes before or alongside ADHD treatment. If panic is infrequent and the person is relatively stable, we can often still treat ADHD, but cautiously. That usually means starting at very low doses, titrating slowly, and paying close attention to physical sensations like heart rate, jitteriness, or sleep changes. Some adults actually find that treating ADHD reduces panic over time, because there’s less baseline stress and fewer moments of overwhelm. Non-stimulants are also part of the conversation. Options like atomoxetine or guanfacine can be gentler on the nervous system and may be preferred if panic is easily triggered. Throughout, monitoring is key. A brief spike in anxiety early on can be part of adjustment. Panic that becomes more frequent, intense, or harder to recover from is a signal to reassess. The goal isn’t to avoid ADHD treatment out of fear, but to sequence and tailor it so both conditions are supported. With a careful approach, many adults find they can treat ADHD without worsening panic, and sometimes with overall improvement in both.