ADHD Insights: Depression and ADHD

ADHD Insights: Start Stimulants Slowly
September 29, 2012
ADHD Insights: Cellular Energy
October 1, 2012

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

Depresson and ADHD

Treatment Changes With Connected Conditions

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.

cp
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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16 Comments

  1. Donald R. Hurst says:

    Dr. Charles Parker:

    I awake each morning to the depressive feeling of being in a psychic hole (with some suicidal feelings attached) from which I must daily extricate myself. The depth of the hole depends on how high/ inflated I become the day/night before. Recently I have decided to ‘label’ myself bipolar, but since this condition exists each a every morning I have doubts in labelling myself thus. My physician has me on Bupropion SR 100 mg. and today I increased it to Mylan-Bupropion XL 150 mg. I have attempted this reversal several times since 15Dec2014. but always fall back to the lower dose since the 150 mg dose makes me feel somewhat drugged.

    Four years ago I became addicted to cocaine. I came off of it cold turkey and have returned from what I can only describe as the “hell realms” of the psyche. I have been absolutely clean for 1.5 years. This ‘removal from’ also includes many years of marijuana use (late 1960’s), and from a more infrequent nicotine addiction. I turned 68 years old on Jan 11/16. I feel like a Jekel and hyde. Throughout the day I build to something which amounts to psychic homeostasis or ‘beyond’ and like Icarus fall to my death each and every night. I believe I’ve been depressed all my life but having come through the ‘grin and bear it’ era I have kept most of this phenomena hidden since I felt it incumbent upon myself to lift self up by his own bootstraps. Please forgive the duplicity of language, it sounds so weird. I know there is only one of me.

    Some days I awake with such anxiety that my psyche never truly comes into balance throughout that day, and so I drag this so called ‘self’ along and struggle through. I rather like to compare this event to the repetitive unfolding scenes from the movie ‘Groundhog Day’. It’s all so predictably repetitive.

    I also might add that when I was teaching ADHD to teacher assistants in education at the University of Calgary some years ago, and examining the symptoms, I was so thoroughly struck by them, that I felt I too suffered from the outrageous fortunes of this phenomenon.

    From what I understand of the literature my antidepressant treats serotonin issues and not what I should be treated for, dopamine imbalance./? I have raised this debate with my physician but his response is one that suggests the serotonin/dopamine perplexity has ‘not’ been thoroughly explored and so a ‘realistic’ judgment call has yet to be satisfactorily determined.

    As I enter my 69th year and live the scenario ‘one is the loneliest number you can ever do’, having become a recluse and one abhorrent to going out into the general community in the town I live in (even though I have three beautiful daughters and four grandkids and a dog and they talk to me, and we all love each other, and live in two other cities) I feel I have chosen to live ‘a less than satisfactory life’ due to several neurotic fears.

    To say that I am desperate would be an understatement, and since I live on a very restricted income I throw up my hands ‘almost’ in despair. Any direction you might suggest I will pass on to my physician in the hopes of pushing this complexity to some satisfactory conclusion. The life I currently live can be described as a ‘sad joke’. I have also heard that it can take upwards of 5 years to balance out over cocaine. However, that still leaves other questions unanswered. Thanks for listening.

    Respectfully,

    Dr. Donald R. Hurst – PhD ret’rd

    • Don, my friend, it’s time for a careful review. I strongly suggest you look at this video and playlist: 1. http://corepsych.com/balance and 2. http://corepsych.com/drop. Antidepressants over 80% of the time aggravate and amplify underlying Executive Function Disorder [EFD], dopamine, imbalances. You absolutely need a more careful review, as I strongly suspect with all your use depression mixed with EFD and enhanced by metabolic issues not yet considered. You can always set up a brief chat here and I could in just few minutes shine the light on some of these things: http://corepsych.com/appointments
      Let’s talk,
      cp

  2. Jenna says:

    During the festive season if one is on these medications (Depression and ADHD) is it suitable to have the odd alcoholic drink as long as one is careful?

    Or would alcohol usually cancel out the positive action of the depression medications?

    • Jenna,
      Occasional is not a problem with a drink with meds. The significant challenge is substance abuse, and uncontrolled use of any substances. They do compete at the same receptor sites, marijuana even more than alcohol. Consider the strong possibility that poor judgement will be encouraged by even small intake, so forewarned is forearmed.
      cp

  3. Adrian says:

    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?

  4. Adrian says:

    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

  5. Kay says:

    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.

  6. […] Problems [More Details In New ADHD Medicatioin Rules]: 126. Depression 127. Anxiety [ed. note: Do these sound familiar?] 128. Post Traumatic Stress Disorder 129. Bipolar […]

  7. Dr. Olivia says:

    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.

  8. Dougie says:

    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

  9. […] rightly pointed out, won’t respond well to dopaminergic, stimulant meds – for all the medical seesaw reasons outlined in my […]

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