How Untreated ADD/ADHD Can Cause or Worsen Depression
Here’s a sad statistic: Having attention-deficit disorder (ADD), more commonly referred to as attention-deficit hyperactivity disorder (ADHD), increases the risk for mood disorders such as depression. Even worse, when a child or an adult has these co-existing disorders, both conditions are intensified. When ADD/ADHD goes untreated, young people who struggle with co-occurring depression, especially girls, are at higher risk of suicide. And adults with undiagnosed or untreated ADD/ADHD and depression may lose jobs, struggle in relationships, and are at greater risk for substance abuse and addiction.
For those who currently struggle with ADHD, there’s positive news. Research indicates that when ADD/ADHD is properly diagnosed and successfully treated, the risk of depression significantly decreases.
Having ADD/ADHD increases the risk for mood disorders such as depression. And when a child or an adult has these co-existing disorders, both conditions are intensified.
BASICS ABOUT ADD/ADHD
Currently, it is estimated that 9.4% of children and 4.4% of adults in the U.S. have ADD/ADHD, according to Centers for Disease Control and Prevention data. However, experts believe there are millions more that remain undiagnosed. ADD/ADHD is a neurodevelopmental disorder characterized by issues with attention, and in many cases, impulsive and hyperactive behavior as well. Although the disorder affects millions of people, it continues to be highly misunderstood and is often incorrectly treated, if it is treated at all. Research estimates that roughly 40% of kids with ADD/ADHD symptoms don’t receive proper diagnosis or treatment, and a review study on ADD/ADHD underdiagnosis estimates that 80% of adults with symptoms of the condition do not get the treatment they need. The implications are far-reaching.THE ADD/ADHD-DEPRESSION CONNECTION
The link between ADD/ADHD and major depressive disorder in medical research is strong. Studies indicate that among youths with ADD/ADHD, rates of concurrent depression range from 12% to 50%, and additional research suggests the rate in adults to be from 16% to 31%. ADD/ADHD and depression “travel together” in several ways. The most obvious connection is that the consequences of living with the core symptoms of ADD/ADHD—which include short attention span for common everyday tasks; poor organization; being easily distracted; procrastination; lack of follow-through; and poor impulse control—lead to depression. These symptoms can and do create a lot of problems in children and adults. They can adversely affect school or work performance, leading to a poor self-image and low self-esteem, which can contribute to depression, studies have shown. Relationships, finances, and even driving are negatively impacted by ADD/ADHD, which may contribute to low mood. Those with ADD/ADHD have more difficulty regulating emotions. They often experience emotions more intensely than others without the condition, and they can struggle to soothe themselves and transition out of difficult emotions, which factors into a low mood. Further, research in the Journal of Abnormal Psychology shows that for inattentive ADD/ADHD types, social problems with peers and dysfunctional parent-child relationships can trigger depression. One study that controlled for poor academic performance and social problems with peers found that adolescents with ADD/ADHD remained at high risk for depression, suggesting that additional factors are at play. Indeed, there are other factors involved, including what’s happening in the brain. The combined symptoms of ADD/ADHD and depression include inattentiveness, being easily distracted, disorganization, chronic low mood or negativity, a “glass half empty” perspective, low energy, a tendency to be more isolated socially, and general feelings of hopelessness and worthlessness a majority of the time. Those with ADD/ADHD and depression may or may not be hyperactive.ADD/ADHD, DEPRESSION, AND THE BRAIN
ADD/ADHD brains work differently. Brain SPECT imaging scans have revealed that ADD/ADHD is associated with biological changes in the brain. When neurotypical people (those without ADD/ADHD) concentrate, blood flow increases to the prefrontal cortex, the area of the brain that controls focus, planning, judgment, empathy, and impulse control. However, in those with ADD/ADHD, scans reveal decreased activity in the prefrontal cortex during concentration. This physiological difference may explain why it is difficult for people with ADD/ADHD to focus. In fact, the harder they try to focus, the worse it gets. Similarly, when people are depressed, SPECT scans reveal decreased activity in the prefrontal cortex (especially on the left side) at rest, although it improves with concentration—and increased deep limbic activity at rest and during concentration. The limbic system is the brain’s emotional center. What’s more, a 2021 neuroimaging study has shown that both conditions are associated with dysregulation of the brain’s reward system. Dopamine, the neurochemical that drives motivation and plays a role in reward systems and moods is typically in short supply in people with ADD/ADHD. It’s not surprising then that research indicates those with the condition have a harder time realizing rewards and staying motivated. One study in the Journal of Clinical Psychology on college students with ADD/ADHD revealed that this dysfunction in reward responsivity is evident in both ADD/ADHD and depression (although not for hyperactive types).UNTREATED ADD/ADHD AND DEPRESSION
There are reasons ADD/ADHD often goes undiagnosed and untreated. Unfortunately, the stereotype of ADD/ADHD to be a childhood affliction limited to hyperactive boys with poor impulse control causes other less obvious symptomology to fly under the radar. According to a 2016 paper in The ADHD Report the condition is likely underdiagnosed in girls because they more frequently exhibit inattentive symptoms, which are internalized rather than externalized and more difficult to catch. Additionally, symptoms are misinterpreted in childhood, especially the ones having to do with focus and attention, distractibility, procrastination, and disorganization. Kids (and their parents) may simply believe they are not smart, lazy, or not trying hard enough. Many of those undiagnosed in childhood continue to struggle as adults. And adults are more prone to overlook these symptoms. In fact, the condition is so unrecognized in adults that research in the Journal of Psychiatric Research shows it’s usually the accompanying depression that gets people to seek treatment, not the ADD/ADHD.UNDERSTAND THE SIGNS OF ADD/ADHD AND DEPRESSION
It’s important for parents and adults to understand the signs of both ADD/ADHD and depression and what the risk factors are for them occurring together. Getting the correct treatment for both conditions is essential. Here are some risk factors to keep in mind:- Being female: Girls and women are more likely to have co-occurring ADD/ADHD and depression.
- Inattentive ADD/ADHD type: Of the 7 types of ADHD, those with inattentive ADD/ADHD more frequently have depression.
- The mental health of the mother: When a mother is depressed during pregnancy, she’s more likely to give birth to a child who will develop ADD/ADHD, depression, or both.
- ADD/ADHD diagnosis in childhood: A childhood diagnosis of ADD/ADHD is associated with a greater risk of depression and suicidal ideation later in life.
- Untreated ADD/ADHD: When people don’t get treatment for ADD/ADHD, they are more likely to suffer from depression due to issues such as a negative self-concept.
