Can ADHD look like constant rumination and mental fatigue?

Hi everyone,

I’m a woman in my mid-20s trying to understand long-standing symptoms that haven’t responded well to standard treatments.

I was diagnosed in 2019 with anxiety/depression. SSRIs have helped so far just with physical anxiety, but never with my main issue: constant mental overactivity.

Core symptoms (since childhood/adolescence): • nonstop internal monologue / racing thoughts • replaying past conversations, imagining future ones • difficulty mentally “switching off” • extreme mental fatigue, low energy, hard mornings • anhedonia (low motivation, no libido) • procrastination but still high functioning • hyperfocus on interests + emotional sensitivity

I’ve always been a good student and outwardly functional, which I think delayed other explanations.

Medications tried: • SSRIs → anxiety better, mental noise unchanged • Pristiq → no clear benefit • Bupropion 300 mg → no improvement in energy or motivation • Currently starting Paxil (paroxetine) 20 mg; thinking about adding Intuniv (guanfacine) 1 mg as it may help with the rumination.

I don’t feel constantly sad — I feel mentally overloaded, exhausted, and stuck in my head. Therapy helps a bit but doesn’t reduce the constant mental noise.

I’m wondering if this resonates more with inattentive ADHD, Pure-O OCD, executive dysfunction, or an overlap. Not looking for diagnoses or prescriptions — just experiences.

If SSRIs helped your anxiety but not racing thoughts or motivation, I’d really appreciate hearing what helped you.

Thanks for reading 🤍