Fighting Depression, Part 2
Antidepressants and ADHD meds
If you or someone you love has been feeling out of sorts for two weeks or longer, it’s important to find out what’s wrong. “I would not go after both ADHD and primary depression at the same time,” says Dr. Adler. “I’d first work on the condition that causes greater impairment. Although the problems raised by ADHD are very real, severe depression can be life-threatening.”
Antidepressants that aim to boost levels of the neurotransmitters serotonin and/or norepinephrine are the primary treatment for severe depression. Your doctor may also prescribe an antidepressant if mild to moderate depression persists despite lifestyle changes and effective treatment for your ADHD.
Most antidepressants work well alongside ADHD stimulant meds, as well as with the nonstimulant Strattera (atomoxetine), though minor adjustments may need to be made.
If you’re taking Paxil (paroxetine) or Prozac (fluoxetine) and starting Strattera, for example, your doctor may prescribe a lower dosage of both the antidepressant and the ADHD medication because the two will interact. Other antidepressants, like Effexor (venlafaxine) and Cymbalta (duloxetine), can magnify the effect of stimulants on blood pressure and pulse.
Wellbutrin (bupropion) is an antidepressant that can be useful for ADD, as well. “The effect of bupropion on ADD is modest, but it might be enough,” says Dr. Adler.
No matter what antidepressant you take, remember that it’s likely to take longer to “kick in” than ADHD medication—as long as 12 weeks for the full effect, although you should notice positive changes within two weeks.
Most of the time, depression improves substantially with the first antidepressant tried. If the first antidepressant doesn’t work, a second one probably will. About half of those who take antidepressants achieve full remission—that is, complete relief of depressive symptoms.
Do-it-yourself relief
When depression is secondary to ADHD, minor medication or lifesyle adjustments may be all it takes to get out of a funk. “Three-quarters of the time, when people come in and tell me they’re depressed, they’re not treating their ADD adequately,” says Dr. Dodson. “Half of those who get an ADD prescription don’t fill it the third time. Within nine months, 85 percent aren’t even taking it anymore.”
What if depression persists despite adherence to an ADHD drug regimen? Doctors recognize that a variety of lifestyle changes are likely help. Aerobic exercise, for example, “has a profound effect on the mood level of people with ADHD,” says Dr. Dodson. “If you’re finding it hard to motivate yourself, aerobic exercise can return your mood to normal.”
Working out can also calm a revved-up mind. “Exercise has made such a difference to me,” says Annie, a 40-something commercial artist living in Scituate, Massachusetts. “When I’m getting ‘dithery brain’ and I can’t decide what to do, I get out of the house and do something physical. After a bike ride, I can think straight.”
There’s another good reason to get outside. “Sunlight is a wonderful antidepressant,” says Dr. Pennington. “Humans need two hours of natural light every day. If you have attention problems, you need even more.” She recommends spending as much of your day outdoors as possible. “Take meals outside, do paperwork outside, bring your laptop,” she recommends.
Many ADDers, including Liz, find that their mood darkens when they have nothing to do. “My depression gets a lot worse when school’s in recess,” she says.
“The ADD nervous system feeds on interest and challenge,” says Dr. Dodson. To guard against idleness, he recommends setting up what he calls an “interest closet”: Whenever you come across something interesting—a good book, for instance, or a craft projec—stash it in a closet. The next time you find yourself looking for something to do, there will be something waiting for you.
Meditation and psychotherapy
Focused inactivity also has its place in treating depression, as Liz has found. “Meditation really works for me when I’m depressed,” she says. “I push everything out of my head and concentrate on breathing in and out. After five minutes, I feel better.”
Dr. Tsukahara is a fan of the “relaxation response.” To do this simple form of meditation, sit quietly, with your eyes closed, and focus on your breathing. Each time you exhale, silently repeat a one-syllable word—“one” or “peace” or “om.”
“Do this for a minute or two,” says Dr. Tsukahara, “or just try it for 10 or 20 seconds whenever your mind is in ‘dither mode’ or when you’re having trouble transitioning from one activity to another.”
Along with, or instead of, meditation and medication, a form of psychotherapy known as cognitive behavioral therapy (CBT) has proven to be highly effective against depression. In fact, this short-term therapy has been shown to work as well as antidepressants for mild to moderate depression.
The first goal of CBT is to enable the patient to identify and reduce frequent, intense negative thoughts that lead to depression. Says Dr. Tsukahara, “Certain themes keep coming up: ‘I’m a failure,’ ‘This is too much for me,’ ‘I’m just not good enough.’ The next step is to replace these self-destructive thoughts and beliefs with more realistic and constructive thoughts—“Yes, this is hard. How can I make it more manageable?” You’re acknowledging the difficulty, but not wallowing in it. You’re pointing yourself toward positive action.
According to Dr. Tsukahara, the goal is to reduce the frequency and intensity of symptoms. “Don’t expect to eliminate them,” she says.
No matter what the cause of your depression, there’s always a solution. There’s no need to suffer!
This article comes from the October/November 2006 issue of ADDitude.
To read this issue of ADDitude in full, purchase the back issue and SUBSCRIBE NOW to ensure you don't miss a single issue.
