Saturday, April 16, 2016

Treatment-Resistant Depression Might Be ADHD

Sometimes the simplest explanation is the best.

Here’s an example: if you have depression that’s not responding to treatment, the core issue you’re dealing with might not be depression at all.
Medscape is reporting on some interesting research just presented at the 2016 Anxiety and Depression Association of America (ADAA) Conference. It turns out a lot of people who seek help for depression but don’t respond well to antidepressants might in fact have undiagnosed ADHD.
The study looked at 105 people between the ages of 17 and 71 who were referred to a clinic for mood and anxiety disorders. Although none of the patients were referred for ADHD, an assessment found that 22.6% of them had undiagnosed ADHD.
The results also suggested that patients with less successful treatment histories were more likely to have undetected ADHD. Specifically, patients who had received more diagnoses, tried more medications, and tried more SSRIs were more likely to have ADHD.
Among people referred for treatment-resistant depression in particular, those who had received more diagnoses, tried more medications unsuccessfully, tried at least one SSRI unsuccessfully, and been diagnosed with social anxiety had the highest rates of undiagnosed ADHD.
This research highlights an important point: many people with undiagnosed ADHD initially seek help for depression and/or anxiety.
That’s how I first found out I had ADHD. I was lucky to have a doctor who was able to start untangling what was really going on, that depression and anxiety weren’t the whole story.
Unfortunately, many people with ADHD seek treatment for depression or anxiety, and that’s what they get. They try failed med after failed med. They don’t get the answers they’re looking for, just a bunch of SSRIs that don’t work, because SSRIs don’t treat ADHD.
It’s easy to misdiagnose ADHD as depression not just because adult ADHD is a newer and somewhat complicated diagnosis but also because ADHD and depression can look similar.
First, there’s the fact that undiagnosed ADHD often leads to depression. It’s pretty damn depressing to feel like you can’t get your life together, like you’re destined for failure for reasons you don’t understand. It can feel downright hopeless to think you’re too lazy to create the kind of life you want but at the same time there’s no amount of work you can do to make yourself not lazy.
Then there’s the overlap in actual symptoms between ADHD and depression. People with ADHD and depression both struggle with motivation. The understimulation and boredom-proneness of ADHD can look similar to the anhedonia of depression. And inattention can be associated with depression, not just ADHD.
Despite these similarities, though, ADHD and depression are very different in terms of brain chemistry. No amount of antidepressants are going to treat ADHD. Treating ADHD like depression leads to doctors prescribing failed med after failed med until the patient just gives up on treatment altogether.
There are also big differences in terms of symptoms. Maybe most importantly, ADHD is a chronic condition that begins in childhood. It might make itself known in different ways, but a doctor and patient working together should be able to find a running thread of symptoms through the patient’s life. ADHD is like the worst kind of house guest – it shows up early, makes your life hard, and never leaves. The showing up early and never leaving parts in particular are aspects of the disorder a good doctor can use to distinguish ADHD from depression.
But many people with ADHD never do get past a misdiagnosis of depression. The fact that almost a quarter of the patients in this study had undiagnosed ADHD despite the fact that none of them were referred for ADHD shows that there’s still a lot of work to be done in raising awareness about adult ADHD, and that doing this work will help a lot of people.
How did you get diagnosed with ADHD? Did you seek help for depression or anxiety, or did you know you had ADHD? Please share in the comments!


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