One out of every four adults with ADD/ADHD also suffers from symptoms of depression. When there are co-existing conditions, it can be harder to diagnose and treat ADHD. The symptoms may overlap and one of the conditions may not be accurately diagnosed. Or medication may not be as effective.
Previously, depression in patients with ADHD was thought to be situational and it was assumed that the depression was a result of constant failure or the inability to compensate for symptoms of ADHD in daily life. Because of this, depression was often ignored and ADHD was treated, assuming that the depression would disappear when the ADHD was controlled and treated. Research has now shown that ADHD and depression are separate diagnoses and both should be treated.
Medication for ADHD can interfere with the diagnosis and treatment of depression. Medications for ADHD sometimes mimic the symptoms of depression and sometimes exacerbate symptoms of depression (and bipolar disorder). This can make it hard to distinguish which symptoms are caused by clinical depression and which symptoms are caused by the medication. Often doctors will treat the depression first and once those symptoms are under control, they will treat the ADHD. Depression, therefore, becomes the primary diagnosis and ADHD the secondary. Some doctors, however, believe that in order for treatment to be effective, both conditions must be treated simultaneously. Arguments for this method believe that in order for either condition to be under control, both must be under control.
Co-existing conditions increase the risk, especially when they are undiagnosed and/or untreated. Some of these risks include:
- Substance Abuse
- Development of Conduct Disorders
- Aggressive or Anti-Social Behaviors
Some experts believe that the risk of undiagnosed co-existing conditions warrant a complete and thorough psychological evaluation for anyone with a diagnosis of ADHD, to determine if depression or any other related mental illness is present. Once completed, a team of medical professionals, including your primary physician, psychologist, therapist and psychiatrist can work together to develop a treatment plan specific to the individual.
Depression can have different symptoms depending on the age of the individual. The following behaviors and symptoms do not necessarily indicate the presence of depression, however, they may indicate a need for further evaluation and treatment.
Signs of Depression in Children:
- Frequent sadness, tearfulness, crying
- Decreased interest in activities; or inability to enjoy previously favorite activities
- Persistent boredom; low energy
- Social isolation, poor communication
- Low self esteem and guilt
- Extreme sensitivity to rejection or failure
- Increased irritability, anger, or hostility
- Difficulty with relationships
- Frequent complaints of physical illnesses such as headaches and stomachaches
- Frequent absences from school or poor performance in school
- Poor concentration
- A major change in eating and/or sleeping patterns
- Talk of or efforts to run away from home
- Thoughts or expressions of suicide or self destructive behavior
Signs of Depression in Teenagers:
- Sadness or hopelessness
- Irritability, anger, or hostility
- Tearfulness or frequent crying
- Withdrawal from friends and family
- Loss of interest or enjoyment in activities
- Changes in eating and sleeping habits
- Restlessness and agitation
- Feelings of worthlessness and guilt
- Lack of enthusiasm and motivation
- Fatigue or lack of energy
- Difficulty concentrating and making decisions
- Thoughts of death or suicide
- Irritable or angry moods
- Unexplained aches and pains
- Extreme sensitivity to criticism
- Withdrawing from some, but not all people
Signs of Depression in Adults:
- Noticeable change of appetite, with either significant weight loss not attributable to dieting or weight gain.
- Noticeable change in sleeping patterns, such as fitful sleep, inability to sleep, early morning awakening, or sleeping too much.
- Loss of interest and pleasure in activities formerly enjoyed.
- Loss of energy, fatigue.
- Feelings of worthlessness.
- Persistent feelings of hopelessness.
- Feelings of inappropriate guilt.
- Inability to concentrate or think, indecisiveness.
- Recurring thoughts of death or suicide, wishing to die, or attempting suicide. (Note: People suffering this symptom should receive treatment immediately!)
- Melancholia (defined as overwhelming feelings of sadness and grief), accompanied by waking at least two hours earlier than normal in the morning, feeling more depressed in the morning, and moving significantly more slowly.
- Disturbed thinking, a symptom developed by some severely depressed persons. For example, severely depressed people sometimes have beliefs not based in reality about physical disease, sinfulness, or poverty.
- Physical symptoms, such as headaches or stomachaches.
Common Treatments for Depression
Medications help the majority of patients with depression. There are three major types of medication used to treat depression.
- These work by blocking neurotransmitters. These medications often have side effects.
SSRIs or Selective Serotonin Reuptake Inhibitors
- These medications are often safer than the Tricyclics Antidepressants and often have fewer side effects.
MAOIs or Monoamine Oxidase Inhibitors
- These medications have been used for a number of years and are quite effective. They do have interactions with certain foods and other medications. These are not often used unless other treatment has failed. If you do take these, let your doctor know of all other medications you are taking, including over-the-counter medications and ask for a list of food products that may interfere with the effectiveness of the medication.
Psychotherapy or Counseling
Psychotherapy or Counseling can help a patient to develop life skills and provide strategies to compensate for symptoms of depression that may be interfering with daily life. Counseling can provide assistance in learning to cope with the stress that comes along with depression. Often, a combination of medication and therapy can be an effective treatment strategy for individuals with depression.
This type of treatment is surrounded by controversy. The treatment consists of placing electrodes on the patient and passing an electric current through them. This causes a seizure that lasts less than a minute. This treatment must be done in a controlled environment and performed by medical professionals trained in this area. Some studies have shown a high response rate to this treatment.
There can be side effects that include headache and temporary memory dysfunction. Normally complete memory will return within a few weeks.
If you, or someone you know is experiencing suicidal thoughts, you should contact 911 or call a suicide hotline:
Healthcentral also offers a screening test for depression to determine whether you should seek medical help;
Fact Sheet: Attention Deficit Hyperactivity Disorder, Russell A. Barkley, The Official Site, 2006
The Depressed Child, American Academy of Child & Adolescent Psychiatry, 2004
Teen Depression, Helpguide.org, 2007
An Overview of Depression, HealthyPlace.com, 2006
Eileen Bailey is a freelance health writer. She is the author of What Went Right: Reframe Your Thinking for a Happier Now, Idiot’s Guide to Adult ADHD, Idiot’s Guide to Cognitive Behavioral Therapy, Essential Guide to Overcoming Obsessive Love, and Essential Guide to Asperger’s Syndrome. She can be found on Twitter @eileenmbailey and on Facebook at eileenmbailey.