When someone tells me they are depressed but every type of treatment in the book, including medications and several trials of different therapies haven’t worked, I start wondering if something else is going on. Many times, symptoms of ADHD can masquerade as other diagnoses. People with ADHD often have “mood swings” and difficulty with mood regulation. This isn’t in the DSM V criteria, but if you have worked with hundreds of patients with ADHD, you know that ADHD causes mood swings. When someone with ADHD is sad or in a funk, they have a hard time shaking it. And when they are excited, they are really excited. This is one of the gifts and wonderful traits about people with ADHD. They are passionate people, passionate about life and passionate about letting other people know about it. If one doesn’t spend the time getting to know the person, might think the person has bipolar disorder. Yes, bipolar disorder and ADHD do have a higher rate of occurring together; however, more often that not, people with ADHD who say they have mood swings really mean “adhd child swings” not manic swings.
Many clinicians were taught that if someone presents with depression and ADHD, first treat the depression and THEN treat the ADHD. In my opinion this is just backward thinking. Very often, the patient feels depressed, frustrated, and has lost interest in work and other activities, but this can be because he has experienced one failure after another or has gone from one job to the next. In our experience at the Hallowell Center, when you treat the ADHD, the person begins to acquire the ability to achieve their goals, improve relationships, meet deadlines, remember to pick up the children, avoid accidents on the road, remember their tickets before driving to the airport and feel a lot more competent, confident and happy.
Unfortunately, when patients are treated for depression with antidepressants, or worse, treated with atypical antipsychotics for bipolar disorder and kept on these medications for months or years, their symptoms often do not improve and might worsen. I have never seen this data in the literature, but during my training at Massachusetts General Hospital, I was taught a VERY IMPORTANT PEARL. Never, never, never take away someone’s dopamine. Dopamine gives us zest for life, motivation, and enables us to pay attention. It is the piece of the puzzle people with ADHD may be missing that inhibits and blocks them from reaching their potential. Guess what antidepressants and antipsychotics do? Through a feedback loop, these medications can decrease the function of dopamine in the frontal lobes and limbic system.
Treatment for ADHD must be individualized, as each person is unique. But there are some general guidelines that are helpful to remember. People are complex and their lives are complex. Treatment isn’t about writing a prescription and seeing the patient once a year. Treatment is about helping people develop a comprehensive strategy to move on with their lives and achieve full potential.
Here are five ways that we can help our patients:
Many patients are often not diagnosed as children. Thus, by using a simple 5 minute screening tool in the office or waiting room, we can help our patients that may have been misdiagnosed as borderline, chronically depressed, anxious or bipolar disorder.