Treatment Options For Adhd And Depression
ADHD and depression are both treatable disorders. Treatment for ADHD typically involves the use of stimulant and non stimulant medications, usually with behavioral therapy.
Treatment for depression involves the use of prescription medications called antidepressants, either on their own or in combination with psychotherapy and lifestyle changes.
If you think you may have ADHD, depression or both disorders together, your first step should be to talk to a licensed mental health provider.
You can do this by asking your primary care provider for a mental health referral, scheduling an appointment with a psychiatrist in your area or from home with our online psychiatric evaluation service.
Your mental health provider may ask you about your symptoms, mental health history and other health conditions you have that could contribute to ADHD and/or depression. Make sure to give your mental health provider all of the information they need for an accurate diagnosis.
Adhd Medications For Adults With Anxiety
ADHD medications treat symptoms and behaviors that relate to ADHD, such as inattention, impulse control difficulties, and hyperactivity. These drugs target brain chemicals called neurotransmitters.
Most drugs increase the levels of norepinephrine and dopamine in the body. Other medications only increase the levels of norepinephrine.
ADHD drugs fall into two categories: stimulants and nonstimulants.
Stimulant drugs are fast-acting, effective, and the first-line treatment for ADHD. However, these drugs may increase anxiety symptoms, making nonstimulants a suitable option for people with ADHD and anxiety.
Examples of stimulants include amphetamines and methylphenidate.
Articles On Adult Adhd Treatment
A lot of adults with ADHD take stimulant drugs to manage their symptoms. But if you don’t get better with those medicines, or you donât like how they make you feel, your doctor may suggest you try an antidepressant.
Stimulants like dextroamphetamine and amphetamine or methylphenidate don’t work perfectly for everyone. Your symptoms might not improve or you may get side effects like an upset stomach, problems with sleeping, or nervousness.
Are There Tips And Precautions For Nonstimulant Medications In Adhd Treatment
When taking one of these drugs for ADHD, be sure to tell your healthcare provider:
- If you are nursing, pregnant or plan to become pregnant.
- Consult your provider before discontinuing therapy Kapvay and Intuniv should not be abruptly discontinued.
- If you are taking or plan to take any prescription drugs, dietary supplements, herbal medicines or nonprescription medications.
- If you have any past or present medical problems, including low blood pressure, seizures, heart rhythm disturbances and urinary problems.
- If you develop irregular heartbeats or fainting spells.
The following are useful guidelines to keep in mind when taking clonidine or guanfacine or giving them to your child for ADHD:
Last reviewed by a Cleveland Clinic medical professional on 01/07/2021.
Acceptance And Commitment Therapy
ACT teaches some CBT principles, but rather than try to restructure negative thinking as CBT does, ACT directs patients toward passive acknowledgement instead. If a patient has a negative thought, ACT tells them they need not accept it as truth or put energy into changing it.
ACT also focuses on values. Particularly with depression, patients can feel worthless like they dont contribute much or have a place in the world. Many patients with whom I work feel they must be perfect in order to be acceptable, for example. ACT targets this way of thinking by asking patients to recognize and articulate their value systems and to execute their values through relationships, not accomplishments.
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Atypical Antidepressants And Antipsychotic Medication
Atypical antidepressants include:
These medications target things that are very different than all of those other classes of depression medication, and are the result of our ever-growing understanding that depression is nuanced and not the same for every patient.
Antipsychotics can help patients with depression by helping to loosen up the sort of concrete, rigid thinking that is common in patients with psychosis, and also with depression. Sometimes, a patients thoughts are so fixed that its very difficult to get out of that depressed way of thinking.
Antipsychotic medications can also be very useful for patients with particularly severe depression or TRD in augmentation therapy. Aripiprazole , Brexipipzole , and Quetiapine are all antipsychotics that are FDA approved as add-on therapies for TRD.
While not FDA-approved, off-label lithium is used by some psychiatrists to augment depression treatment as well.
Adhd And Depression: Treating Comorbid Conditions
ADHD and mood disorders are separate and distinct conditions that need to be treated separately. The one that gets treated first is typically the one causing the greatest impairment or concern, as determined by the patient or parent in consultation with a doctor.
The response to antidepressants is slow it may take 8-10 weeks to experience the full benefits of a given medication. For these reasons and others, some clinicians prefer to start treatment with a stimulant medication because the response is so much faster. All of the antidepressant medications have a robust response rate of about 70% of people. One-third of people get complete symptomatic remission with the first agent that is tried. About one-third of people get a good response to medications but not full symptomatic relief. These people will require a second medication, called an augmenter, in order to achieve full remission. The remaining one-third of people do not respond to the first medication tried and need to be switched to one of the other five classes of antidepressant medications.
Despite manufacturer statements to the contrary, atomoxetine does not have antidepressant abilities. Though it was developed by the same lab that produced fluoxetine, there is no study that shows that atomoxetine has significant benefits for mood disorders. It is moderately effective for about half of people with ADHD.
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What Is Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder is a neurodevelopmental disorder. Its usually diagnosed in childhood and can persist throughout a persons life, causing symptoms that affect learning, attention and behavior even when a person is an adolescent or adult.
Children and adolescents with ADHD may experience the following symptoms:
Difficulty paying attention
Losing things and/or forgetting information easily
Taking needless risks and/or making careless mistakes
Finding it difficult to wait
Struggling to get along with other people
Fidgeting, squirming and moving excessively
Talking often and excessively
Some of these symptoms are common in children without ADHD. For example, its common and normal for kids and teenagers to occasionally daydream or have difficulty focusing on homework or other repetitive tasks.
In people with ADHD, these symptoms can be severe and persistent. Often, people with ADHD will continue to experience symptoms as they get older, long after most people would grow out of certain behaviors.
To diagnose ADHD, mental health providers use a set of criteria. Children and adolescents are required to display a variety of symptoms, with settings present in multiple settings and from an early age, in order to be clinically diagnosed with ADHD.
Mental health professionals typically divide ADHD into three different types. A persons type of ADHD depends on the specific symptoms they display.
Treatment For Overlapping Adhd And Depression
What types of treatment are offered if you have overlapping ADHD and depression? It really depends on your particular situation.
In general, the approach is to work on the condition that is most impairing first. While therapy can address both issues at once, often medication is prescribed for one condition and then the other.
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How Antidepressants Can Help With Adhd Symptoms
Like stimulants, antidepressant drugs raise your brain’s levels of chemicals such as dopamine and norepinephrine. Doctors have found that these drugs can help people with ADHD improve their attention span. They also help keep a lid on behavior like being impulsive, hyperactive, or aggressive.
Suicidal Behavior And Thoughts
Teenagers with ADHD are likely to develop suicidal thoughts. They may not try to commit suicide at the teenage stage, but the suicidal thoughts and behavior gradually grow in them. And eventually, they may make suicide attempts.
Children and teens with ADHD and depression are more impulsive than those with depression only. A report by the JAMA Psychiatry shows that girls with ADHD and depression aged 6-18 years are at higher risk of experiencing suicidal thoughts than their peers.
What Can You Do?
Act fast when you notice that your family member is having suicidal thoughts. For instance, you may see them trying to hurt themselves or engaging in activities that might harm them.
Here is what to do:
- Contact local emergency
- Keep a close watch on the patient
- Safely hide any sharp objects and weapons
- You can call the National Suicide Prevention Lifeline if the person is at a point of committing suicide
- Book an appointment with the mental health professional to seek advice on a suitable treatment plan
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Other Forms Of Treatment
In some cases, your mental health provider may suggest making certain changes to your habits and lifestyle to reduce the severity of your ADHD and/or depression symptoms.
The symptoms of ADHD can often be managed by creating routines, lists and calendars to stop yourself from becoming disorganized. Simple steps, such as breaking down large, difficult tasks into smaller, more manageable steps may help to improve motivation and focus.
Many depression symptoms can improve with small changes to your habits, such as exercising regularly, setting realistic goals and spending more time with friends, family and people close to you who can provide emotional support.
Pharmacological Treatment Of Md With Adhd
Although seriousness of the combination of MD and ADHD was recognized by many clinicians for many years, there has not been any major focus on the systematic, randomized, clinical medication trials for treatment. No studies have compared stimulant responsiveness in ADHD and ADHD/MD subgroups, nor have there been any studies of differential response of these groups to psychotherapy. It is widely assumed that antidepressants might have a particular role in treating ADHD/MD subgroup, given the ability of these drugs to treat the symptoms of both ADHD and MD.23 Desipramine, however, was found to treat ADHD alone and ADHD with depression equally well, at least in terms of ADHD symptoms.24 It has been shown that fluoxetine and tricyclic antidepressants can be safely combined with stimulants. No unusual side effects were observed in any of these studies.25,26
Canadian ADHD Practice Guidelines27 recommend that both psychostimulants and atomoxetine are first-line medications and suggest that when possible, long-acting medications should be preferred to short-acting medications. Recent studies indicated that treatment outcome, remission rates, and patient, family, and teacher preference show that long-acting medications are superior to short-acting medications.27
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Adhd And Depression: High Prevalence Of Comorbidity
A recent decade-long study1 followed 388,00 young adults with ADHD and an equal number of neurotypical young adults. It found that approximately half of the ADHD group had a diagnosed depressive episode during that 10 years, more than twice the frequency seen in the non-ADHD group. Overall, 13% of people with ADHD attempted suicide 4 times the rate seen in the neurotypical control.
The rates of both depression and suicidality were much higher for women in all groups. The longest study of its kind2 found that 68% of women with ADHD were diagnosed with major depression as compared to 34% of women without ADHD. Disturbingly, the rate of suicide among women with ADHD was found to be 3 times higher than it was for the neurotypical group.
What Are The Side Effects Of Strattera
The most common side effects in children and adolescents are:
- Upset stomach .
These side effects can be significant and may require stopping the medication.
However in most cases, these side effects are generally not severe. Only a very small percentage of patients needed to stop Strattera due to side effects experienced during clinical trials.
Allergic reactions to Strattera are rare but do occur, usually as swelling or hives. Tell your provider right away if you or your family member taking Strattera develops a skin rash, swelling, hives or other allergic symptoms.
There have been reports of slightly decreased growth in children and teens taking Strattera. It’s recommended that children and adolescents be observed, measured and weighed periodically while on Strattera.
Strattera should be stopped if you have signs of jaundice yellowing of the skin or whites of the eyes. Jaundice is a sign of liver damage. Itching, right upper belly pain, dark urine and unexplained flu-like symptoms may also be signs of liver injury. If blood tests show evidence of liver damage, stop taking Strattera.
Strattera can increase suicidal thinking in teens who take the drug. Patients should be monitored for suicidal thoughts and actions while taking Strattera®.
Strattera should be discontinued if symptoms of psychosis or mania occur.
Aggressive or hostile behavior may occur. Therefore, monitoring for this type of behavior during Strattera therapy is recommended.
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What Other Nonstimulant Therapies Are Used To Treat Adhd
Two drugs, Kapvay® and Intuniv® , have been approved by the FDA for use alone or with stimulant drugs for the treatment of ADHD. These drugs can improve mental functioning as well as behavior in people with ADHD. However, they are usually reserved for those who respond poorly to and cannot tolerate stimulants or Strattera.
Clonidine is also available as a short-acting tablet and as a transdermal patch. Guanfacine is also available as a short-acting tablet. These dosage forms have also been used to treat ADHD, however they are not specifically approved by the FDA for this indication.
Adhd In Children And Adolescents
Clinicians who treat children and adolescents with depression and comorbid ADHD must be familiar with the numerous target symptoms across both disorders and the associated comorbid disorders in order to accurately monitor and treat their patients.
ADHD is a common disorder in children, adolescents, and adults with good treatment responses . Approximately 8 to 10 percent of boys and 3 to 4 percent of girls under the age of 18 have ADHD, and about 80 percent of children with ADHD continue meeting the diagnostic criteria for ADHD into adolescence approximately 60 percent will maintain some core symptoms of ADHD into adulthood. The nature of the presentation and symptomatology is different for the various age groups. Although there are some differences in symptomatology and comorbidity between male and female subjects, the impact of the disorder on patients and their families is similar.4
The symptoms and subtypes of ADHD and associated comorbid disorders change significantly throughout the life cycle. Hyperactivity and impulsivity often decrease as patients get older however, the demands on attention and other cognitive skills may increase. The ratios of ADHD/ADD cases will get smaller as ADHD predominantly inattentive type is the most common subtype in adulthood.4
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Stimulants As Treatment Of Treatment
The stimulants most commonly used for treatment-resistant depression include:
Lamotrigine is an anticonvulsant medication used to treat epilepsy. It can also be prescribed as a mood stabilizer in those with bipolar disorder as a replacement for Lithium, which has been relatively under-prescribed in recent years.
Studies have shown that the mood-stabilizing component of Lamotrigine is effective in treating treatment-resistant depression. The drug works by accelerating the onset of antidepressant action.
Ritalin is a trade name for methylphenidate. Some doctors prescribe Ritalin for treatment-resistant depression, but it is typically a stimulant used to treat attention deficit hyperactivity disorder and narcolepsy.
Although the adjunctive use of psychostimulants like Ritalin is still being investigated for the treatment of treatment-resistant depression, there is no clear evidence that methylphenidate is effective at easing the symptoms. Although some promising results were seen in case studies, controlled studies have not demonstrated significant improvement in patient outcomes. As such, most doctors do not recommend Ritalin as a first-line treatment for depression. You should never take methylphenidate medications without guidance from your doctor.
The Final Word on Stimulants for Treatment-Resistant Depression
Stimulant Drugs For Adhd
These drugs can cause possible side effects, such as stomachache, headache, irritability, decreased appetite, and insomnia. Some stimulants may increase the risk of developing heart or psychiatric problems. And particularly in teens and adults, there is a risk of misuse of these medications, including taking too much, inappropriately using them, or sharing them with friends.
Some common stimulants used to treat ADHD include:
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Risk Factors For Comorbid Adhd And Depression
What are the risk factors for having comorbid ADHD and depression? Below are some of the risk factors that have been identified.
- Being female: Although ADHD is more common in males, females are more likely to have comorbid ADHD and depression.
- Inattentive type: Those diagnosed as inattentive type are more likely to also have a diagnosis of depression.
- Mother’s mental health: When a mother has depression during pregnancy, this is linked to a higher likelihood of giving birth to a child who is later diagnosed with ADHD, depression, or both.
- Early-onset: Being diagnosed with ADHD during childhood is related to an increased risk of depression and suicidal thoughts later in life.
- Not receiving treatment: People who have untreated ADHD are at higher risk for depression due to secondary issues such as low self esteem.