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ADHD Insights: Depression and ADHD

Depresson and ADHD

Treatment Changes With Connected Conditions

Depression and ADHD Often Occur Together

Details are in from the CHADD National Resource Center on ADHD:

– nearly two thirds of these children with ADHD suffer from another condition such as depression or anxiety disorders in addition to their ADHD.1

The only problem with that impressive two-thirds number: too many don’t understand the clinical relevance of serotonin treatment in the context of a dopamine challenge with ADHD. Antidepressants treat serotonin related issues, and stimulants treat dopamine issues. Basic.

But you can’t treat dopamine problems with serotonin reuptake inhibitors – nor can you treat serotonin related conditions with dopamine reuptake inhibitors. One neurotransmitter modifier will not globally improve all unbalanced neurotransmitters. That observation may at first seem  profoundly commonsensical, but a casual glance at psychiatric second opinions will confirm that far too many don’t connect with that simple observation.

[On the accurate treatment theme: See this ADHD Medication Tutorial for an overview on ADHD diagnosis and stimulant dosage strategies – then take a look at this video playlist on How the PM Medication Drop can prove instructive about other diagnoses: http://corepsych.com/drop ]

Imprecise Clinical Objectives Create Serious Problems

What if you came in to see me, for example, as a family practice physician with a known heart problem, and I told you I was going to treat you with insulin? :-( Scary.  Mixed, imprecise treatments don’t work in general medicine, and they don’t work in mind medicine either. These are some causes and potential outcomes to overlooking these important dopamine and serotonin details.

  1. Drug interactions with Depression and ADHD – mainly 2D6.
  2. Basal Ganglia Seesaw Reactions [post from ’06] on both sides of the dopamine/serotonin continuum.
  3. Stimulants make depression worse.
  4. Antidepressants make ADHD worseSPECT brain scan evidence supported repeatedly.

Helpful Video Update Spells Out Details – 4:37min

Details On Cognitive Depression Coming

Stay tuned here for improved breakdowns on cognitive depression – so often missed in clinical practice and so relevant for using the correct medications. And pass this post along on your social networks, this report provides exceedingly relevant, indeed preventative, information.

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Dr Charles Parker
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1. J. Biederman, S.V. Faraone, & K. Lapey (1992). Comorbidity of diagnosis in attention-deficit hyperactivity disorder. In G. Weiss (Ed.), Attention-deficit hyperactivity disorder, child & adolescent clinics of North America. Philadelphia: Sanders.

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12 Comments
  1. Thank you so much for your input Dr Parker it is much appreciated. Just to confirm if I had ADHD + Depression (+Overmethylation) – would it be possible to utilise Vyvanse and Effexor carefully and augment with those nutrients for Overmethylation?

  2. Dr Firstly Merry Christmas – great blog but I wanted to ask a few questions. I have followed the advice in your book on immunity and metabolic issues before starting medication treatment with my doctor. I have been suffering with severe Depression.

    The Medication I am on (Effexor XR long acting) has elevated the depression (within the first day) – I am on 150mg and have been for 1 week now. I no longer have depression or anhedonia.

    The problem is that my motivation has plummeted. Whilst I am grateful that I don’t feel suicidal I am struggling to work – in my free time I am quite happy just sitting in front of the tv. I have a feeling of indifference.

    Please advise.

    Also wanted to ask about long term medications – is it safe to take SSRI’s or SNRI’s for 20 years etc?

    Seasons Greetings
    Adrian W

    • Adrian,
      Not a problem taking Effexor for 20 years – no evidence for long term negatives, much evidence for long term positives. It does appear that you might suffer with comorbid ADHD. Take a look at this video playlist to further assess the specifics if you were to take a stimulant medication – even with Effexor: http://corepsych.com/drop
      Best to you and yours, hope this is helpful,
      cp

  3. I was so excited to hear this presentation but you never said what medication DOES work.

    My son was diagnosed with ADHD in college and prescribed Vyvanse. He became very depressed. They tweaked his meds, trying different, shorter acting ones but he still had huge problems. Every semester was a struggle. He finally dropped out of college (after 2 years) to get a handle on things. He hasn’t taken his meds in a while but his depression is intermittently very scary. But after the Vyvanse I’m afraid of psychotropic drugs in general. He’s willing to try gluten free or other food modifications and I want to get an ALCAT test for that. But will that be enough? And if not, what medication options are left?

    He wants to return to a full class load but between the ADHD and depression it doesn’t even seem doable to him. I don’t even trust taking him to a psychiatrist anymore b/c I think they’ll just guilt me and talk him into trying another one.

    I’m desperate for answers. Completely desperate.

  4. Just as you would not send a depressed person to an AA meeting to relieve the depression, nor should you treat one mental disorder with the medication for another. At the same time, it does become complicated for the many people who suffer with multiple problems at the same time. This is where it becomes important to treat each case individually, rather than a one-size-fits-all approach. Careful diagnosis and an understanding of how treatments such as medications may interact should always be paramount.

  5. Hello Dr Parker,

    I am going over your old posts and wanted to get your take on Anhedonia. Previous to my diagnosis this year as having Adult ADHD and Depression this is my main symptom.

    I am stabilized on 30mg Vyvanse which regularly gives me a DOE of 14 hours and has immeasurably helped my organization and PFC.

    However my main symptoms remains despite trials on Sertraline and Effexor which is ANHEDONIA:
    – I have no other symptoms of Depression aside from feeling nothing.

    I have addressed metabolic challenges (Gluten, Dairy and Eggs), Sleep and B12, D3 and Trace Minerals.

    Anhedonia without sadness persists. Are there any medications which address this issue?

    All the best for 2014

    • Doug,
      Will be doing a vid this weekend on those troublesome to understand drops in the PM. On of those 5 important-to-differentiate drops is “no energy.” Anhedonia is often tied to no energy which most frequently resides downstream from adrenal fatigue. If you had food sensitivities for years, then have corrected them, the energy piece is most often the last to come back to normal.

      We have several tests at CorePsych that would provide information for you: 1. Saliva Hormone for Adrenals and Sex Hormones [related], 2. Neurotransmitters: if your short on Serotonin nothing works because you have insufficient serotonin chickens in your synaptic ranch, or 3. Your gut hasn’t yet healed from the previous corruption.

      Your anhedonia may arise from other biomedical challenges that could be measured and corrected.

      And best back for 2014 as well for you… you’re close, but no cigar yet! ;-)
      cp

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