July 5th, 2012
By Leslie Rouder, LCSW
Over the years I have worked with numerous adults who were being treated for depression for many years prior to being diagnosed with ADHD. In addition, these individuals complained that the depression rarely or only temporarily lifted until the ADHD diagnosis was identified and treated. Many of these individuals spent years of their adult life being treated for depression, while the primary diagnosis was actually ADHD. Because of the pervasiveness of the co-existence of these 2 diagnoses, it is vital to understand the differences between the two and to also treat both the ADHD and the depression, when appropriate, in order to develop the most effective treatment plan and outcome. The following article addresses the question of how to determine if it’s ADHD, depression or both? And why it’s important to treat the primary diagnosis first, in order to achieve the best treatment outcome.
Depression is one of the most common disorders to occur with ADHD. In fact, it has been determined that close to 50% of all adults with ADHD also suffer with depression (or have suffered with depression) at one time or another. Very often, the depression results from the struggles of having ADHD, but in some cases, depression can be the primary diagnosis, while the ADHD is secondary. It is essential for a practitioner to make this distinction to properly develop an effective treatment protocol, since primary depression can not only be debilitating, but also dangerous, if not treated. In addition, if the ADHD is not detected, treating the depression (which may be secondary to the ADHD) will not be an effective treatment option, since the primary reason for the depression is not being addressed. So, what are the 3 major distinctions one must look for in making this determination?
1. Depressed Moods
A person with ADHD may have dark moods in which he feels hopeless, frustrated, sad, angry, and unmotivated. These dark moods are usually experienced as a consequence of an outside negative trigger or disappointing event and are relatively short lived. In comparison, when a person is suffering from depression, they may experience these dark moods for weeks or even months and the mood cannot be linked to any precipitating event. They may feel that a dark cloud has just come over them for no particular reason and it is just lingering there.
If however, there is a mood fluctuation in which one feels elevated for periods of time, only to be followed by episodes of depression for no apparent reason, this may indicate that the person may be suffering with bipolar disorder. This is a vital distinction that needs to be made, since up to 20 percent of adults with ADHD also suffer with a bipolar disorder. In this circumstance, the mood disorder (bipolar) must be treated before the ADHD with medication. However, if it is determined that the person is experiencing depression as a result of having ADHD, the exact opposite is true. One would want to address the ADHD and see if the depression does not lift on its own (or with other natural remedies such as exercise, diet and proper rest) before considering a medication regiment to treat the depression.
2. Motivation versus disorganization
When a person is depressed they very often loss interest in those activities they once enjoyed and may lack motivation to do much of anything. When a person has ADHD, they may find it difficult to start a project or task or may feel that they don’t know where to start. If the task seems very large, they may even feel a sense of being overwhelmed, procrastinate and eventually give up and do something else more enjoyable, while not even starting the activity or project at all. This can sometimes be confused for laziness or lack of motivation, but is coming from difficulty in organizing oneself, rather than a lack of interest or motivation.
3. Sleep patterns
People who are depressed will usually fall asleep easily enough, but will often wake several times during the night or early morning and have difficulty falling back to sleep. Their thoughts upon waking may be negative or sad or may create some anxiety. People with ADHD, will have difficulty falling asleep, due to racing thoughts and/a general sense of restlessness. Once they are asleep, however, they generally remain sleeping.
When thinking about treatment protocol one must always consider treating the primary diagnosis first, since this is the one that is causing the greatest impairment. Here is why the ability to ferret out the ADHD is so vital in that, treating the depression without considering what may in fact be causing the depression is not particularly effective. In addition, treating someone for ADHD that has a severe mood disorder may actually make the mood disorder worse. Therefore, it is vital to work with someone who is strong in the area of diagnosing depression (or mood disorders) as well as ADHD and understands the subtleties of how they present in order to achieve the most effective therapy outcome.
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