Adult ADHD and comorbid depression: A consensus-derived diagnostic algorithm for ADHD

Abstract

Objective: Many patients present to their physician with depression as their primary symptom. However, depression may mask other comorbid disorders. This article presents diagnostic criteria and treatment recommendations (and monitoring) pertaining to the diagnosis of adult attention defi cit hyperactivity disorder (ADHD), which may be missed in patients who present with depressive symptoms, or major depressive disorder (MDD). Other co-occurring conditions such as anxiety, substance use, and bipolar disorder are briefl y discussed. Methods: A panel of psychiatrist-clinicians with expertise in the area of child and adolescent ADHD and mood disorders, adult mood disorders, and adult ADHD was convened. A literature search for recommendations on the diagnosis and treatment of co-occurring conditions (MDD, anxiety symptoms, and substance use) with adult ADHD was performed. Based on this, and the panel's clinical expertise, the authors developed a diagnostic algorithm and recommendations for the treatment of adult ADHD with co-occurring MDD. Results: Little information exists to assist clinicians in diagnosing ADHD co-occurring with other disorders such as MDD. A three-step process was developed by the panel to aid in the screening and diagnosis of adult ADHD. In addition, comorbid MDD, bipolar disorder, anxiety symptoms, substance use and cardiovascular concerns regarding stimulant use are discussed. Conclusion:This article provides clinicians with a clinically relevant overview of the literature on comorbid ADHD and depression and offers a clinically useful diagnostic algorithm and treatment suggestions.

Mediating Effect of Depressive Symptoms on the Relationship between Adult Attention Deficit Hyperactivity Disorder and Quality of Life

“… 8 , 21 When ADHD was accompanied by depression, the patients were afflicted with worsened conditions, which subsequently impinged on their QOL. 22 The results of this study are consistent with previous studies that determined ADHD symptoms significantly increased the severity of depression.…”

Neurobiology of hedonic tone: the relationship between treatment-resistant depression, attention-deficit hyperactivity disorder, and substance abuse

“…For example, most individuals with depression experience psychiatric comorbidity, according to the National Comorbidity Survey Replication. 145 , 146 It has been reported that depression occurs in 9%–50% of patients with ADHD, 147 and STAR*D study has reported that approximately a third of patients with MDD also have a substance use disorder. When MDD is comorbid with ADHD, it is associated with a much more severe course, an earlier age of illness onset, more complex psychiatric comorbidities, decreased quality of life, greater burden of illness, greater illness complexity, lower social functioning, lower work productivity, and lower employment rates than patients with MDD alone.…”

Genetic Epidemiology of Attention Deficit Hyperactivity Disorder (ADHD Index) in Adults

“…Attention Deficit Hyperactivity Disorder (ADHD) is a common neurobehavioral disorder that is characterized by inattention, hyperactivity and impulsivity. It is associated with considerable social, family, behavioral and cognitive dysfunction and is comorbid with depression, bipolar disorder, anxiety, and substance use [1] . ADHD in adults is often left untreated and significantly correlates with previous married status, unemployment, and European ancestry [2] .…”