Feeling down? You’re not alone. At any given time, more than 17 million American adults are battling the dark moods and general listlessness of depression. A disproportionate number of these individuals also have ADHD.
In fact, major depression is estimated to be 2.7 times more prevalent among adults with ADHD than among the general adult population. (That’s not surprising, since the same neurobiological systems that control attention also control mood.) A mild form of depression, known as dysthymia, is a whopping 7.5 times more common.
That’s the bad news. The good news is that effective remedies for depression are readily available, and that they work just as well for ADDers as they do for others. Of course, it can take a while to find the right types of medication, psychotherapy, and lifestyle strategies.
Primary vs. secondary depression
Some ADDers become depressed for no obvious reason—the condition strikes even in the absence of unpleasant life circumstances or events (difficulties at work or in school, job loss, relationship problems, chronic illness, and so on). Risk for this form of depression, known as primary depression, seems to be largely inherited.
“Major depression tends to run in families that have ADHD,” says Lenard Adler, M.D., director of the adult ADHD program at New York University Medical Center in New York City.
In other cases, depression arises as a direct consequence of the chronic frustration and disappointment of living with untreated or poorly controlled ADHD. Such cases of depression are said to be secondary to ADHD.
“I frequently see depression in adults whose ADHD wasn’t recognized and treated in their younger years,” says Yvonne Pennington, Ph.D., an Atlanta-based psychologist who specializes in adult ADHD. “Having endured so many blows to their self-esteem, they’ve accepted the idea that they’re lazy and stupid.”
Kathy, a fifth-grade teacher in St. Paul, Minnesota, would probably agree. “It was the stress of trying to cope with ADHD that got to me—always trying to compensate for shortcomings and falling short of expectations. I never could be the person I wanted to be.”
In other words, ADHD impairs what psychologists call the “core sense of identity”—the way an individual sees herself and her social interactions. ADDers—especially that 25 percent of adults with the disorder who have never gotten appropriate treatment—come to feel that they’ll never be “good enough” to succeed socially or professionally.
As Denver-based psychiatrist William Dodson, M.D., puts it, “People come in and say, ‘I’ve been depressed every moment of my life. I try so hard, and nothing works out. I feel like giving up.’ What they’re describing is frustration and demoralization stemming from real experiences.”
Telling ADHD and depression apart
To complicate matters, doctors sometimes mistake ADHD for depression. Liz, a 22-year-old teacher living in Dallas, was diagnosed with depression during her freshman year at college. Her doctor prescribed antidepressants, sleeping pills, and pills for anxiety—but she still didn’t feel right. “My mood improved,” she recalls, “but not enough to make me feel good.” She was restless and unable to focus on her course work.
The breakthrough didn’t come until the following year: “My doctor figured out I had ADHD. I started taking a stimulant, and, after 19 years, I finally felt I could live up to my potential.”
Liz still has days when she feels down and unable to accomplish much. “But,” she says, “it’s a complete 180 from what it used to be. I get out of bed and enjoy life.”
Differentiating ADHD from depression can be difficult because both disorders bring mood problems, forgetfulness, an inability to focus, and a lack of motivation. There are, however, subtle distinctions between ADHD-induced symptoms and those caused by depression.
One distinction involves emotions. ADHD can cause dark moods, but these are usually linked to a specific setback. The bad feelings tend to be transient. An ADDer may descend to the depths for an hour or two, but then moves on. In contrast, mood problems associated with depression are generally pervasive and chronic, often lasting weeks or months. And, unlike the bad feelings caused by ADHD (which often began showing up in childhood), depression typically doesn’t develop until adolescence or later.
With ADHD, it seems impossible to accomplish anything, because you’re “in a dither and can’t decide what to do first,” says Roberta Tsukahara, Ph.D., a psychologist in Austin, Texas. “With depression, it’s more that you’re lethargic and can’t initiate activity.”
Sleeplessness is another symptom common to both depression and ADHD. Yet the pattern of insomnia differs between the two disorders. With ADHD, the problem usually occurs while falling asleep; the mind refuses to “turn off,” and keeps adding things to the next day’s to-do list. In contrast, people who are depressed tend to fall asleep readily, but wake up repeatedly during the night (and early in the morning). At each awakening, the mind is filled with negative or anxious thoughts.
This article comes from the October/November 2006 issue of ADDitude.
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