Undiagnosed ADHD could be the reason your antidepressants aren’t working
2 adult ADHD patients spent their lives in a revolving door of antidepressants
The New York Times recently published an important article on attention-deficit/hyperactivity disorder (ADHD): Doctors Are Still Figuring Out Adult A.D.H.D. The NYT article says, “A.D.H.D. is one of the most common psychiatric disorders in adults. Yet many health care providers have uneven training on how to evaluate it. Plus, the U.S. has no clinical practice guidelines for diagnosing and treating adult patients.”
The tragedy is they’ve spent most of their lives in a revolving door of antidepressants, when their main condition was ADHD . . .
Our mental health providers often see patients who are diagnosed with depression and anxiety and started on antidepressants, but who actually have undiagnosed and untreated ADHD.
ADHD is a medical condition that results in insufficient dopamine and norepinephrine levels in the brain. Untreated, this deficiency can contribute to the development of depression and anxiety. However, treating the underlying deficit with a stimulant medication can be much more effective than using traditional antidepressants. Most antidepressants impact serotonin, an entirely different neurotransmitter.
Many patients we see with undiagnosed ADHD have spent nearly their whole lives trying different antidepressant medications. However, their their condition could have been easily treated if it had been diagnosed correctly. Health officials should make childhood screenings mandatory across the country. These screenings should be part of annual physicals to help identify ADHD in kids.
ADHD is particularly underdiagnosed in women. According to Lisa MacLean, M.D., a psychiatrist at Henry Ford Health, “Girls (and women) are more likely to have inattentive behaviors,” says Dr. MacLean. “But that doesn’t mean that’s their only symptom. The hyperactivity side of ADHD is often also present in girls—it may just look different . . . girls with ADHD may just seem energetic, talkative and social. Since girls often display fewer behavioral problems and less noticeable symptoms, their difficulties are often overlooked.”
One complicating factor is that ADHD has three types – hyperactive, inattentive and combined. We can easily identify the hyperactive and combined types through externalized behaviors, while the inattentive type may go unnoticed for years.
Undiagnosed ADHD causes problems in adulthood.
Many adults who have untreated and undiagnosed ADHD often hear that they are underperforming, not paying attention, or simply not trying hard enough. They wonder why some things seem so difficult for them, yet come easily to others. If it is left untreated, ADHD can have a lasting negative impact on self esteem. As they grow up, they continually feel like they aren’t good enough.
They may end up divorced multiple times, changing jobs repeatedly and frequently drop out of college. Many people with ADHD also develop addiction problems. They might turn to food, sex, caffeine, alcohol, or drugs to boost dopamine levels.
ADHD runs in the family.
ADHD is heritable. When one family member is diagnosed ADHD, other close relatives often have it too. It is not uncommon for us to treat three generations of a single family.
Fortunately, ADHD treatment can take effect immediately with stimulants, such as methylphenidate or amphetamines. At Manlove Brain and Body Health, we provide genetic testing which may help identify which medication is likely to work best for you. Some people respond better to amphetamine based medications, such as Adderall, Dexedrine and Vyvanse. Methylphenidate based options are also available, including Ritalin, Concerta and Focalin.
Patients who receive ADHD treatment often remark how life changing it is. They can suddenly function at work, home and school in an entirely different capacity than ever before.
Once they find the right treatment, patients often experience a grieving process. They wonder how their lives would look if their invisible disability had been found and treated sooner.
Many patients with depression and anxiety who are also diagnosed with ADHD are able to stop or decrease all other mental health medications after their ADHD is addressed.
The NYT article focuses primarily on what some experts deem as incomplete guidelines for adult ADHD and a new effort to provide practitioners with something better. And while universal screening guidelines should be implemented, primary care practitioners and mental health generalists should partner with a psychiatrist experienced in treatment-resistant depression in the meantime to ensure that patients with ADHD aren’t misdiagnosed.
Signs of ADHD in Adults.
ADHD signs to watch for in your patients:
- Tried multiple antidepressant medications without benefit.
- Fails to pay close attention to details or makes careless mistakes.
- Difficulty staying focused.
- Does not seem to listen when spoken to directly.
- Does not follow through. Often emerging as relationship or workplace problems in adults, they may report that they don’t ‘live up to expectations’ or that they get bored easily.
- Struggles with organization
- Avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time. This may emerge as difficulty with prioritization or time management.
- Loses things necessary for tasks and activities (e.g. keys, wallet, phone, files, eyeglasses).
- Is easily distracted.
- Is forgetful in daily activities.
Adult ADHD Case Studies
Steve’s Story: After 30 years trying depression and anxiety treatments, Steve’s symptoms finally resolved after one of our psychiatrists discovered that ADHD was the true cause.
Steve is a married man in his 60s with autism spectrum disorder who runs his own firm. He has declared bankruptcy three times and has a lifelong long history of depression and anxiety. Over 30 years, he tried to find relief for his depression and anxiety symptoms with no luck. He tried transcranial magnetic stimulation (TMS), ketamine infusions and several antidepressants including Prozac, Wellbutrin, Auvelity, Paxil, Buspar, Ativan, and many others.
Steve received a total of 49 ketamine infusions, finding these helpful for mood. Over time, he developed sedating side effects to ketamine and stopped taking it. Shortly thereafter, one of our psychiatrists diagnosed him with ADHD, inattentive type.
He started Adderall and felt that it was more effective for his mood than any other medication he had taken in the past. He was able to function much better at work and decided to sell his now successful business so that he could retire.
After increasing Adderall to the maximum recommended FDA dose of 60mg a day, Steve was able to stop all depression and anxiety medications. His symptoms resolved simply by treating their primary cause; his ADHD.
Jean’s Story: Abused for decades and married multiple times, Jean wonders how different her life could have been.
Jean is a retired executive in her 70s. She suffered lifelong depression, anxiety and PTSD after being physically abused by her father plus two subsequent husbands, as well as childhood sexual abuse. She took clonazepam for 20 years and bupropion for 10 years. Plus, she completed six-month trials of duloxetine and fluoxetine.
Even though Jean had been under the care of psychiatrists, psychologists, and primary care providers for decades, it wasn’t until several of her children and grandchildren had been diagnosed with ADHD that she decided to ask a doctor if she had ADHD. That’s when she came to see one of our providers. She stated, “I can never relax. Never. Why can’t I have a good time? I can’t enjoy anything.”
After Jean was diagnosed with ADHD, she started Adderall and found it incredibly effective to improve her ability to function with no side effects. “For the first time in years, I could read the newspaper and get things done around the house. I could even socialize at a party without worrying…my daughter and her children visited and said it was the most relaxing time we have ever spent together.” Sleep improved with Adderall, and she was able to stop bupropion entirely as it was ineffective for her mood.
Over the years, Jean married multiple times. She wonders how different her life and career could have been if her invisible disability of ADHD had been identified and treated at a young age.
Resources:
- National Institute of Health Attention-deficit/hyperactivity disorder (ADHD) – Prevalence of ADHD in Adults, https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd#part_255
- Henry Ford Health, Why ADHD Is Often Underdiagnosed In Women September 7, 2023.
Stephen Manlove, MD is one of the most entrepreneurial psychiatrists in the upper Midwest. Dr. Manlove graduated from the University of Minnesota Medical School and completed residencies in Psychiatry and Internal Medicine through the University of Virginia Medical School. He holds multiple board certifications in psychiatry/neurology, internal medicine and forensic psychiatry. This deep understanding of medicine gives him a unique ability to practice truly holistic psychiatry—fusing lifestyle changes and brain health best practices with genetic testing and a detailed laboratory workup to develop a personalized plan for each patient. As an early adopter of transcranial magnetic stimulation (TMS) and ketamine/Spravato, he and the Manlove Brain + Body team have helped thousands of patients suffering from treatment resistant depression, anxiety and PTSD.
