Primary vs. Secondary Depression in Adults with ADHDby Eileen Bailey Health Writer
Depression is common among both children and adults with ADHD. Almost one-half of adults with ADHD also suffer from depression according to the Chesapeake ADHD Center. Because these conditions share some symptoms, such as inability to focus, insomnia, loss of appetite, feeling tired and mood swings, either depression or ADHD is sometimes overlooked during the diagnostic process. Unfortunately, unless both conditions are addressed, the symptoms might worsen.
The Difference Between Primary and Secondary Depression
Primary depression is a separate condition than ADHD, although both conditions can live alongside one another. This type of depression can occur for no apparent reason, that is, there isn't any internal or external events that trigger feelings of sadness or despair. In primary depression, symptoms are often more severe and more persistent. This type of depression tends to run in families.
Secondary depression occurs because of something. For adults with ADHD, it can develop after years of low-self esteem. For many adults with ADHD, especially those who did not receive treatment until adulthood or haven't yet received treatment, their childhood was filled with academic and social struggles. During their adult years they may have gone through job after job and relationship after relationship. They may berate themselves for never accomplishing anything, despite putting forth great effort. They might belittle themselves for not trying hard enough, being stupid or being lazy. After years of despair and feelings of hopelessness, they become depressed.
According to Dr. David Feifel, Professor of Psychiatry at the University of California San Diego, depression is "often secondary to the underlying adult ADHD." He believes, in these cases, the ADHD needs to be addressed first. If depression is treated, without treating ADHD, symptoms will continue to cause despair and therefore the depression will continue despite treatment.
Differentiating Depression and ADHD
Although symptoms in both conditions can overlap, the reasons for the symptoms are different. It is those reasons that provide clues as to whether the depression is primary or secondary.
Motivation - A lack of motivation is a hallmark symptom of depression but it can also be a symptoms of ADHD. When you are depressed, you might feel fatigued and have no desire to do anything. With ADHD, however, a lack of motivation might be a sign of being overwhelmed and not knowing where to start on a project.
Inattention and Lack of Focus - These symptoms are found in both depression and ADHD. Inattention in ADHD is usually caused by an inability to tune out stimuli and therefore difficulties in paying attention to a single focus. Depression can also include a lack of attention and focus because of a preoccupation with despairing thoughts.
Insomnia - Many people with ADHD also fight insomnia on a daily basis. It is as if their minds are whirling and can't shut off. They have trouble falling asleep. With depression, however, you might fall asleep right away but wake up throughout the night. Your thoughts are filled with despair.
Mood Swings - For those with ADHD, mood swings, including dark moods, are often temporary and caused by setbacks or the perception of failure. Dark moods are more persistent and chronic with depression and can occur for no apparent reason.
Differentiating Primary and Secondary Depression
For those with ADHD and secondary depression, the sense of failure and the inability to control ADHD symptoms often is an underlying reason for the depressive symptoms. For example, Dr. Feifel explains that when asked the reason for feeling depressed, those with ADHD might state they are "frustrated with their inability to accomplish things." Those with primary depression aren't usually depressed over specifics but have more of an overall feeling of sadness or despair and might not even be able to explain what is causing their sadness.
Signs of depression in those with ADHD can also come and go. If it is a difficult time in their life or they have recently had a setback, such as losing a job, the depression might be in high-gear. During better times, the depression symptoms disappear. With primary depression, however, because the symptoms aren't driven by the ADHD symptoms, there is more a general feeling of despair all the time.
Treatment of Depression When You Have ADHD
Once your doctor determines whether your depression is primary or secondary, he can work with you to create a treatment plan. If you have secondary depression, your doctor might suggest treating your ADHD first. Since your depressive symptoms might be driven by your ADHD symptoms, he might want to wait to see if the symptoms of depression decrease or disappear as you learn to manage your ADHD symptoms and begin to feel better about yourself.
If you have both primary depression and ADHD, your doctor might want to treat both simultaneously since one is not caused by the other. Treatments for depression, such as antidepressants, can be taken with ADHD medications. Non-medication treatment for depression includes cognitive behavioral therapy, which has also been found to be beneficial for people with ADHD.