ADHD and depression - part two
Experienced psychiatrist Dr. Jennie Byrne answers common questions around ADHD and Depression. In Part Two, we discuss if an ADHD diagnosis later in life can increase the risk of depression, and how treatment can help those with both conditions.
Q. Is it common that patients can become (more) depressed after receiving an ADHD diagnosis?
A: Yes, it is. For patients diagnosed with adult ADHD there tends to be a "honeymoon period", where they are really happy with treatment. They are excited and like ‘wow I feel great’ / ‘this is so much better’. But then there is often a period, 3-6 months down the road, when they realize the medicine isn't going to fix everything in their life. And they need to do other work to get out of their depression and change some things in their life.
At this time, there is sometimes a worsening of their depression, where they realize how long they were left untreated for ADHD. And they start thinking things like “if I had known this back when I was 12 years old, my life would be totally different right now”. They essentially have a mourning period of what could have been, had they been diagnosed earlier and properly treated. It is a really fascinating pattern I have seen, especially in people who get a diagnosis in their thirties and forties.
And this is where it really helps to work with a psychiatrist who is used to seeing this pattern. If you are in primary care, and once you are stable on your ADHD medicine, you may sometimes only have to come in every six months or so. But that first 3-6 month period is really important to monitor. It is. therefore, good to work with somebody who might catch that depression early and to have that reassurance of knowing someone who has seen this before..
Q. How do you typically treat adults with both ADHD and depression?
A: For me, it depends on the severity of the depression. If I have somebody come in and they are very depressed and I think they may have ADHD, then normally I will treat the depression first – usually with medication or therapy. My aim is to get them to a place where their depression is very low level and then we can see what the ADHD looks like.
Q. Why is that?
A: Classically with depression, sufferers have cognitive dysfunction affecting their levels of concentration, which can look like ADHD. If someone is really depressed, they can't concentrate. In these cases, it may not be ADHD but depression. If the depression is moderate to severe, I would typically treat the depression, evaluate their cognitive function and then assess and treat ADHD.
In cases where someone has ADHD and mild to moderate depression, I might choose an antidepressant that I think will help ADHD as well. However, if the person comes in to me and they have mild depression, i.e. they are still functioning really well but they have a low mood, and I think they also have ADHD, then I treat differently. I would typically focus on the ADHD first and I would try to treat that and see how much progress we make. Sometimes, in cases like these, what I see is that once you treat the ADHD, their depression starts to resolve with therapy.
This is mainly because they realize this is the ADHD and "it is not something wrong with me". Once they realize this, they start to see things differently and their mood improves. Then, I would normally recommend psychotherapy to help them get through the rest of the depression and to re-frame their problems. We would try to re-frame the issues in their life through the context of ADHD and what is going to help them and what not.
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