Depression and ADD/EFD – one or both?
Monday, October 3, 2016 39 Comments
Increased Risk for Depression –
and for being diagnosed with depression in error
© Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
An ADD Awareness Month Post
Because of the pervasiveness of the co-existence of these 2 diagnoses, it is vital to understand the differences between the two and to also treat both . . . when appropriate . . . to develop the most effective treatment plan and outcome.
[It’s] important to treat the primary diagnosis first, in order to achieve the best treatment outcome. ~ from Attention Research Update by Duke University’s David Rabiner, Ph.D. (whose article on ADD and Depression was the genesis of this article)
ADD/EFD, depression or both?
Everybody has shuffled through a down day or a down week. Most of us occasionally experience feelings of sadness, grief or depression as the result of a difficult life event.
We don’t qualify for a diagnosis of depressive disorder, however, unless these feelings are so overwhelming that we cannot function normally — generally characterized by the presence of sad, empty or irritable moods that interfere with the ability to engage in everyday activities over a period of time.
It’s not Unusual
Depression is one of the most common disorders to occur in tandem with ADD/EFD. In fact, it has been determined that, at one time or another, close to 50% of all ADD/EFD adults have also suffered with depression. Studies indicate that between 10-30% of children with ADD may have an additional mood disorder like major depression.
The overlap of the symptoms of ADD/EFD and depression, however, can make one or both disorders more difficult to diagnose — poor concentration and physical agitation (or hyperactivity) are symptoms of both ADD and depression, for example. That increases the potential for a missed differential diagnosis – as well as missing the manner in which each relates to the other.
The chicken and egg component
Many too many doctors don’t seem to understand that serious depression can result from the ongoing “never enough” demoralization of ADD/EFD struggles. In those cases depression is considered a secondary diagnosis.
In other cases, depression can be the primary diagnosis, with ADD/EFD the secondary.
Treatment protocol must always consider the primary diagnosis first, since this is the one that is causing the greatest impairment, and may, in fact, present as another diagnosis.
It is essential for a diagnostician to make this distinction correctly to develop an effective treatment protocol.
- Untreated primary depression can be debilitating, and suicidal thoughts might be acted upon.
- If primary ADD is not detected, it is highly likely that treating the depression will not be effective, since its genesis is not being addressed.
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Depression Risks & Misdiagnoses
Depression is estimated to be 2.7 times more prevalent among adults with ADD/EFD than among the general adult population – almost three times as often. Although effective treatment for depression works just as well for adults with ADD/EFD as for those without, the appropriate diagnoses needs to be made FIRST – accent on appropriate.
Some estimates say that one quarter of the adult ADD/EFD population – 25% – has NOT received appropriate treatment, sometimes for decades.
They can’t diagnose what they don’t know
In order to achieve an effective treatment outcome, a depth of expertise allowing them to recognize the symptom mix that identifies ADD/EFD is essential — in addition to the more common depth of experience with depression (or mood disorders) — as well as a clinician who is well versed in the subtleties of how each disorders presents.
- Treating depression without considering what may be causing the symptoms of depression will rarely be particularly effective.
- Treating someone for ADD who has a mood disorder like BiPolar Disorder may actually make the mood disorder worse.
It’s more than a shame it is not widely known in the medical profession, but there are many ADD/EFDers who are unsuccessfully treated for depression for many years before they finally locate an ADD-knowledgeable doctor who appropriately diagnoses the primary problem as ADD/EFD.
- Executive Functioning Disorders field experts are well aware that, in a great many cases of so-called treatment-resistant depression, the depression rarely or only temporarily lifts until the ADD/EFD diagnosis is identified and treated.
- Far too many doctors believe that mood disorders always get treated before cognitive disorders, despite the reality that, in many cases, the depression lifts without medication once the ADD is treated.
Perhaps those doctors are ignorant of the difference between primary and secondary diagnoses and/or primary and secondary depression?
Primary vs. Secondary Depression
Some adults with ADD/EFD (and/or other diagnoses) become depressed for no obvious reason. Their relationships are satisfying, there are no difficulties on the job or at school, they are physically healthy, and so on. This form of depression, known as primary depression, seems to be largely inherited and may be tied to hypersensitivity.
In other cases, depression arises as a direct consequence of the chronic frustration and disappointment of living with untreated or poorly managed ADD/EFD (or chronic pain, or any of ADD’s comorbid conditions). Such cases of depression are said to be secondary.
Secondary depression can certainly be the result of the dejection and demoralization that can result from sometimes many years of ongoing struggles due to “working twice as hard for half as much,” as pioneering ADD expert Dr. Edward Hallowell frequently says. However, ADD also has a high risk factor for primary depression as an additional diagnosis.
- Since the symptoms of depression can be incorrectly diagnosed as ADD/EFD, it is certainly important to find a doctor highly familiar with both: qualified to rule out depression as an explanation for the some of the symptoms in common.
- Struggles with concentration, tasks completion, and anxious/agitated behavior that can resemble hyperactivity aren’t rare with depression
- However, it is important to remember that they can also occur together (co-occur).
You have to treat everything that’s present
Kids and adults may not present the same
The depression-like symptoms caused by ADD/EFD often begin showing up in childhood, while uncomplicated depression typically doesn’t develop until adolescence or later.
The results of one study indicated that the strongest predictor of persistent major depression in children with ADD/EFD was an inability to get along well with others, especially peers. Interestingly, learning difficulties and severity of ADD/EFD symptoms were not highly associated with persistent major depression in kids in that study.
In addition, successful treatment of ADD/EFD symptoms in children did not necessarily predict a lessening of their depressive symptoms. In other words, as Rabiner points out, the course of ADD/EFD symptoms and the course of depressive symptoms in that particular study sample of children appeared to be relatively distinct.
In adults, major depression predictors have been inadequately studied: in the 20 or more years since it became clear that ADD/EFD does not go away at puberty, science has discovered little about the potential cognitive and behavioral mechanisms of risk that could shape treatment.
They can’t find what they don’t look for.
Related Post: ADD – What’s in a NAME?
Telling ADD and Depression Apart
Too many doctors mistake ADD/EFD for depression. Differentiating the two can be difficult because, in addition to problems with mood management, both disorders can feature lack of motivation, an inability to focus and forgetfulness. There are, however, subtle distinctions between ADHD-induced symptoms and those caused by depression.
STAY TUNED for some tips on telling the two apart, as well as a few things that help.
Technically, the term ADD is no longer used. Instead, [individuals] who have the inattentive symptoms of ADHD but who do not show hyperactive/impulsive symptoms are now diagnosed with ADHD, Predominantly Inattentive Type rather than with ADD . . . no longer technically correct. ~ from Attention Research Update by David Rabiner, Duke University
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