ADHD and Depression: New Understanding--Better Treatment
By Dr. Drew W. Edwards
Attention-deficit/hyperactivity disorder (ADHD) and depression are chronic debilitating conditions, affecting both children and adults. Recently, science has established a solid link between ADHD and depression. As a result, new, novel, evidenced based treatments have emerged, giving new hope to millions of children, teens, and adults who suffer from these debilitating brain disorders.
Children with ADHD often have at least one other psychiatric illness, such as anxiety, conduct disorder and the most common—-depression. In fact, children and teens with ADHD are at least three times more likely to become depressed than those without ADHD. Specifically, the research revealed that at the time of diagnosis, approximately 30 percent of children and teens with ADHD, were also depressed. At 4-year follow-up, that number swelled to 40 percent. We now believe that ADHD and depression share a common underlying genetic predisposition, which manifests as a deficit in the neurotransmitter, dopamine. Known as Reward Deficiency Syndrome, this genetic aberration affects approximately 30 percent of the US population.
Frequent, but minor accidents and mishaps associated with ADHD conspire to keep many children social isolated and lonely
It”s not difficult to see why so many children and teens with ADHD feel demoralized. Social isolation and rejection, along with academic failure are heart-wrenching problems. As a group, ADHD kids are less likely to be invited to play at other children’s homes or to participate in sleepovers or other normal social activities. Minor accidents and mishaps associated with hyperactive children conspire to keep them isolated. In addition, these kids are less likely to be involved in organized sports and other healthy recreational activities. Rejection of this magnitude exacts a heavy toll on a child’s self-esteem. As a result, children with ADHD often are discouraged, angry and sad— as a result, many become depressed.
Signs of depression in children
While all children have days when they feel sad, depressed children are sad, irritable, angry, or all of the above, on more days than not.
Symptoms of ADHD and depression among children include:
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withdraw from others
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stop participating in activities they once enjoyed
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increased sleep difficulties
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intense self-loathing
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intrusive negative thoughts
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erratic mood e.g., anger, then crying
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increased thoughts about dying or wishing they had never been born
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during adolescents, hurt and sadness are expressed as anger and rebellion against
a world that they now perceive as rejecting.
Diagnosis
Diagnosis of depression in this population can be very difficult. Stimulant medications commonly used to treat ADHD can cause extreme mood swings, sleep problems and other side effects that mimic depression. Among adults, ADHD is woefully underdiagnosed. These individuals often spend their lives struggling to understand their own erratic behavior and lack of success. In fact, many adults don't realize they have ADHD until they have experienced a serious life crisis or sought help for depression. They also have a higher incidence of substance abuse, which further complicates diagnosis and treatment.
ADHD and depression are highly treatable
Because most experts long assumed that the social and interpersonal problems associated with ADHD were a normal part of the disease, treatment remained singular in focus. Here’s the logic. Aggressive treatment of ADHD with stimulants would lessen symptoms, improve academic performance and presto, these kids would “fit in” and thus, be less unhappy.
If only it were that easy.
In order to manage either condition, we must treat both conditions
Due to recent advances in the understanding of both disorders, physicians are now beginning to diagnose and treat both problems simultaneously and aggressively. With better diagnosis and newer and novel medications, individuals with ADHD and depression have even more reason to feel hopeful. New and longer-acting stimulant preparations are more tolerable with fewer undesirable side effects. Selecting an anti-depressant medication for concurrent use in ADHD patients takes advanced training and excellent clinical skills. In the hands of a skilled doctor, treatment adherence among patients has been greatly improved, and thus, outcomes are also improved.
A novel, new non-prescription dopamine agonist, Synaptamlne, has proven effective in reducing symptoms of depression and improving focus, with or without the use of stimulant medication. In contrast to commonly prescribed stimulant medications like methylphenidate Ritalin) and Adderall (amphetamine / dextroamphetamine), which temporarily increase dopamine activity in the brain Synaptamine works by providing the brain with the amino acids and proteins necessary to increase the brain’s reservoir of dopamine. The initial clinical studies reveal that Synaptamine produces clinically significant increase in Dopamine in the midbrain and prefrontal cortex.
ADHD and Depression are chronic debilitating disorders that affect millions of children and teens. With proper treatment persons with these disorders can live healthy, happy and productive lives.
* Learn more about Reward Deficiency Syndrome or Synaptamine
References
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Children and Behavioural Problems: Anxiety, Aggression, Depression ADHD - A Biopsychological Model with Guidelines for Diagnostics and Treatment by Martine F. Delfos. Jessica Kingsley Publishers, 2004.
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Clinical Depression: The Overlooked and Insidious Nemesis Plaguing ADHD Children by Paul Lavin. University Press of America, 2008.
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Blum K, Chen AL., et al. Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatry Disease Treatment. 2008 Oct;4(5): 893-918
- Barkley RA: “Comorbid disorders, social relations, and subtyping,” Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. Guilford, 1998, pp 139–163
- Biederman J. (1998). “Attention-deficit/ hyperactivity disorder: A life-span perspective.” Journal of Clinical Psychiatry, 59(Supplement 7):4-16
- Biederman J. “An overview of comorbid conditions in ADHD.” Program and abstracts of the 154th Annual Meeting of the American Psychiatric Association; May 5-10, 2001; New Orleans, Louisiana. Industry Symposium 46A
- Milberger S, Biederman J, Faraone SV, Murphy J, Tsuang MT. (1995) “Attention deficit hyperactivity disorder and comorbid disorders: issues of overlapping symptoms.” American Journal of Psychiatry. 152:1793-1799.
