How to Treat Depression in Children with ADHD

Depression is especially common among children with ADHD. Fortunately, medical treatments are more safe and effective than ever.

Symptoms of depression include irritability, anger, oppositional behavior, low self-esteem, fatigue, poor concentration, sadness and more. ADDitude Magazine

Sadness is only the most familiar symptom of depression.

   
 

Best Books on Childhood Depression

The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities
by Larry B. Silver, M.D.
(Three Rivers Press)

Straight Talk about Psychiatric Medications for Kids,
by Timothy E. Wilens, M.D.
(The Guilford Press)

More Than Moody: Recognizing and Treating Adolescent Depression
by Harold S. Koplewicz, M.D.
(Perigee Trade)

Do alternative remedies work for depression?

Bright-light therapy is effective against seasonal affective disorder, a form of depression associated with reduced exposure to daylight during winter months. Studies on omega fatty acids as a treatment for depression are inconclusive.

Symptoms of Depression

Sadness is only the most familiar symptom of depression. Other symptoms include irritability, anger, oppositional behavior, low self-esteem, fatigue, poor concentration, sleep disturbances, reduced appetite, and loss of interest in friends, sports, and other activities that once were enjoyable.

 
   

Clinical depression is more than just the blues. It's a serious illness, and it affects more young people than parents realize. Each year, four out of every 100 teens become severely depressed. By adulthood, one in five young people will have experienced depression.

Depression is especially common among teens and young adults who have attention deficit disorder (ADD ADHD).

In many cases, ADHD-related problems at school and with family and friends trigger depression by undermining a child's self-esteem. This is called "secondary" depression, because it arises as the aftermath of another problem - including ADHD.

Depression can also be secondary to learning difficulties or substance abuse. Secondary depression is typically triggered at a specific point in time and can be directly linked to specific life experiences.

"Primary" depression arises independently of life experiences. It typically occurs in children who have a family history of depression, and it tends to recur. About half of all children who have ADHD have trouble regulating their emotions, and this problem can also lie at the root of primary depression.

The good news is that effective help is available. As a parent, you must be aware of your child's feelings and behavior. If a teacher, friend, or anyone else suggests that your child is depressed, don't take offense. Take action. Consult your family doctor. If he or she cannot recommend a psychiatrist, psychologist, or clinical social worker who is trained to work with children and adolescents, seek referrals from friends, a school counselor, or your health insurance directory.

Tailoring the treatment

The best remedy for depression depends upon the cause of the problem. Let me introduce you to three children I've treated for depression (names have been changed) and show you how treatment differed in each case.

Jimmy was always in trouble at school. His teacher constantly had to tell the fourth-grader to sit still, pay attention, and raise his hand before speaking. Home was no better. "I hate my life," he told his mother. Once he said, "I'm so bad, maybe you should just send me away."

At my first evaluation of Jimmy, it was clear that he was depressed. It was also clear that he had untreated AD/HD. I sensed that his depression was secondary - resulting from years of experiencing negative reactions to his untreated hyperactivity, inattention, and impulsivity.

Once he began taking the stimulant I prescribed, Jimmy's behavior improved. He was happier. He stopped his negative talk and started playing with friends again. Treatment for the AD/HD was all he needed.

Another patient of mine, 13-year-old Louise, was already taking AD/HD medication. With the help of her 504 Plan and a tutor, she was getting good grades. But she seemed unhappy. She had been ignoring her friends and had given up activities she once loved, her mom told me.

I could see that Louise was depressed. Her parents had separated recently, and I suspected that that might be the cause of her trouble. I prescribed an antidepressant and initiated therapy. In our sessions, she spoke of her sadness over the breakup of her family - and the fact that her father had moved in with the woman with whom he had been having an affair.

Over time, as we talked about her family, Louise's depression lifted. She stopped therapy but stayed on the antidepressant for six months. When it was phased off, she showed no more signs of depression.


This article comes from the August/September 2006 issue of ADDitude.

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