ADHD and depression – part three
In Part Three, Dr Jennie Byrne explains about the challenges within and beyond the treatment of those with ADHD and depression.
Q. Is it more difficult to treat depression in patients with ADHD?
A: I would say this is a definite yes. Part of the challenge is that patients may forget their medication, but what I also see in some cases in those with ADHD is an increase in the emotional reactivity component.
By this I mean they tend to be more reactive emotionally to both good or bad things. So, they can be overly positive or overly negative about things compared to other people. When they get depressed, they are trapped in that moment. And it is very hard for them to remember how they felt when they were doing well and vice versa. They tend to be trapped in whatever emotional state they are in, even if they are being successfully treated for their ADHD.
Additionally, if they are low and they say things like ‘oh I am so depressed, I have never felt good, everything has always been terrible’, they can stop caring for themselves or stop doing all the good work they have been doing. They can slip into a real depressive episode, which can be like an emotional windmill of impulsivity. At these times, it is hard for them to see outside of their current emotional state, which can complicate the course of treatment.
Q. What other type of support can be helpful for those with depression and ADHD?
A: It is really important to have someone, either their care provider or a family member or friend, who can help them reflect and understand: ‘Ok, today you are having a bad day’ or ‘you are depressed but you know two weeks ago you were doing fine’. It can be very hard for them to believe others, so this person has to be a trusted source or a trusted family member to communicate this effectively. Otherwise they can remain stuck in that moment for a long time.
The challenge, however, is that I see a lot of people with ADHD who are very impulsive in their relationships. They tend to be impulsive in their speech and behavior in their close relationships, and say or do things that hurt their partners, friends and family. Which makes it hard to have the same support network that they would have otherwise.