The ADHD-Depression Link in Adults: Symptoms & Treatments (with Roberto Olivardia, Ph.D.)

30% of individuals with ADHD have had a depressive episode, and if you have ADHD, your risk of developing depression is four times greater than it is for those without the disorder. Researchers have traced back this elevated rate of depression to four ADHD-specific risk factors: emotional dysregulation, executive function deficits, social problems, above-average impulsivity, and physical and sexual abuse.
In this hour-long webinar with Roberto Olivardia, Ph.D., learn about the treatment options that exist today for managing depression, ranging from psychotherapy to pharmacological interventions. In addition, doctors are using promising new treatments for depression, including electroconvulsive therapy, transcranial magnetic stimulation, and the chemical ketamine, when conventional approaches fall short. Learning about these newer approaches and discussing them with your doctor may lead to treatment breakthroughs.
Download the slides associated with this webinar here:
www.additudemag.com/webinar/a...
4:19 ADHD and Depression
7:07 ADHD-Specific Risk Factors for Depression
13:48 Suicide and ADHD
15:38 Psychological Treatments for Depression
20:21 Psychopharmacological Treatments for Depression
25:32 Electroconvulsive Therapy
30:00 Transcranial Magnetic Stimulation (TMS) or Repetitive TMS (rTMS)
33:51 Ketamine
37:22 Esketamine (Spravato)
38:33 Cautions
41:29 Q&A
Additional Resources:
Self-Test: Depression in Adults
www.additudemag.com/quiz-depr...
Understand: What Does Depression Look Like in Adults?
www.additudemag.com/depressio...
Read: Treatment for Depression and ADHD: Treating Comorbid Mood Disorders Safely
www.additudemag.com/treatment...
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[@AdamDavisEE]

I'm a little disappointed that the majority of the talk was just general depression treatments, with only a little mention of ADHD. Here are the notes I took with timestamps: 14:28 Ljung et al (2014) found Non-ADHD 1.3% attempted suicide 0.02% died by suicide ADHD 9.4% attempted suicide 0.2% died by suicide Hinshaw et al (2012) (looking at a sample of people with ADHD vs a control group of non-ADHD) Reported at least one suicide attempt at the 10 years follow-up 22% of ADHD-Combined 8% of the ADHD-Inattentive 6% of Non-ADHD Girls who reported self-injury: 51% of ADHD-Combined 29% of ADHD-Inattentive 19% of Non-ADHD 15:45 Psychological treatments for depression You can’t treat depression alone - whether they are diagnosed with ADHD or not, if they have it you’ll be treating them for it even if it’s not intentional. Many treatments for depression also treat ADHD Cognitive-Behavioral Therapy (CBT) Things they shouldn’t be doing Things they should be doing Anxiety management Skills to help them execute expected behaviors Acceptance and Commitment Therapy (ACT) Offshoot of CBT Goes in a different direction Rather than restructuring negative thinking, don’t put energy into changing it, but don’t put energy into accepting it Focus on values - what is my value system For instance, focus on feelings of worthlessness We have a place in the world, we have worth, we have health, we have good relationships Dialectical Behavior Therapy (DBT) Skills based - very practical Four modules Mindfulness Distress tolerance Emotional regulation Interpersonal effectiveness and assertiveness skills Concrete, strategy based, works very well with ADHD and depression Interpersonal Therapy (IPT) Similar to traditional therapy/psychotherapy Focus on relationships If we have good relationships, we can relieve a lot of depression Health Hygiene 20:27 Psychopharmacological treatments for depression SSRIs (Selective Serotonin Reuptake Inhibitors) Citalopram (celexa) Escitalopram (lexapro) Fluoxetine (prozac) (classic SSRI) Fluvoxamine (luvox) (also anxiety) Paroxetine (paxil) Sertraline (zoloft) (also anxiety) Tricyclic Antidepressants (older classes of antidepressants Often have a lot of side effects - nausia Target serotonin and norepinephrine Amitriptyline Amoxapine Desipramine (norpramin) Doxepin Imipramine (tofranil) Monoamine Oxidase Inhibitors (MAOIs) Target more than serotonin receptors Doesn’t go well with cheese, alcohol, and Phenelzine (nardil) Tranylcypromine (parnate) Atypical Antidepressants Bupropion (welbutrin, forfivo XL, aplenzin) Mirtazapine (remeron Trazodone (also insomnia) Vortioxetine (trintellix) Antispychotics may be used with other medications particularly for treatment-resistant depression Helps loosen up concrete, rigid thinking - common in psychosis, but also found in depression Aripiprazole (abilify) Brexipipzole (rexulti) Quetiapine (seroquel XR) Olanzapine-Fluoxetine (symbyax Lithium 25:38 Cutting edge therapies. May sound a bit drastic, but treatment resistant depression may require drastic measures. Electroconvulsive Triggers brief seizure by passing electrical currents through the brain using electrode pads on the head General anesthesia Unilateral or bilateral 5-10 minutes 2-3x week for 3-4 weeks: 6-12 treatments Side effects: confusion, memory loss (retrograde amnesia), nausea, headache, muscle pain Particularly useful for catatonic depression - so paralyzed by depression they don’t move, talk, etc Useful for high risk situations - pregnancy, anorexia(which, due to lack of nutrition, can be extremely hard to break), psychosis, catatonia, suicidal See an improvement after 6 treatments Transcranial Magnetic Stimulation (TMS) or repetitive TMS (rTMS) Magnetic fields stimulate nerve cells in brain, typically prefrontal cortex Mechanism of action not clearly understood Noninvasive Magnetic coil against scalp - pulsing, painless while awake 25-30 sessions 20-40 minutes each, 5x week for 5-6 weeks $10k FDA approved in 2008, typically covered if four different antidepressant trials have failed Safer, nosurgery or anesthesia Can drive & resume normal activities Side effects include headache, scalp discomfort, twitching, spasms No cognitive functioning changes Studies show significant improvement in 30% to 50% adults Results can last 6 months to 1 year Ketamine infusion (drug club special k) Affect Glutamate and GABA neurotransmitter system Promotes synaptic connections Block NMDA receptors - rapid antidepressant action Administered through IV over 40 minutes Dose determined by weight Patients remain awake Odd perception and/or dissociative experiences may occur that go away after infusion ends 6 infusions over 2-4 weeks Firt is most intense 30 minutes or more wait time before leaving office Reduce or eliminate acute symptoms of depression Can induce neurogenesis - creation of nerve cells in hippocampus $300-$800/treatment 60% report relief Short acting, 1-3 weeks f treatment Reserved for severe cases of treatment resistant depression Experimental - FDA has only approved it as an anesthetic Risk of addiction? More studies needed. Esketamine FDA approved March 5, 2019 Nasal spray, in conjunction with oral antidepressant Only for treatment resistant depression Administered in Doctors office with 2 hours monitoring No driving or heavy machinery for the remainder of the day Newer treatments do not have long term studies Educate, speak to others who’ve experienced it, ask lots of questions, only use certified providers, ask providers about training and experience, success rate, etc. Lots of pop-up clinics that don’t even have therapists. 41:45 What are the more standard approaches to depression in individuals with ADHD? What treatments help with both? Often take a stimulant and SSRI - generally no contradiction Stimulant doesn’t affect SSRI MAOIs can have side effects of blood pressure, appetite that may interact with stimulant Therapy - Drawing from CBT, DBT, ACT, Interpersonal therapies. Acute distress - DBT right away, often with medication - applicable skills Cognitive therapy is very difficult in those with severe depression As depression lifts they can process their thoughts better Four components of DBT - may be useful for ADHD Mindfulness is great for ADHD Emotional regulation Identify first Skills to manage or express in a healthy way Distress tolerance How do I soothe myself Skills in interpersonal relationships Assertive - not aggressive or passive, but respecting own and others’ boundaries Diet and nutrition for ADHD and depression Eating well is helpful all around, just like sleep ADHD - impulsive eating Depression - over/under eating Nutrient thoughts - the jury is out whether anything is specifically anti-depressant (ie, omega 3, etc) Depression meds in adolescents? Any ADHD meds that work well for depression? (answer wasn't adolescent or ADHD specific, and I stopped watching after this point)

[@kuyaroonline]

Oh my gos thank u so much

[@leilap2495]

I am curious why SNRI and NRI meds are not covered in this presentation.

[@GrannyGooseOnYouTube]

Viewers: Please IGNORE spam comments under this video. They are unrelated to the content.

[@Saritabanana]

Thank you for timestamps!!!

[@markwolfe503]

Its not that hard to figure out.ADHD makes it SO much harder to attain what the average adult does in a fraction of the time. I have dealt with both a.d.d. and depression for 30 years. Looking back im the difficulty in achieving certain goals due to attention problems causes poor self confidence and a sense of accomplishment.

[@JRR100]

This Harvard psychologist is a perfect example of the ludicrous, myopic approach the current system has re sick brains. News flash, a broken leg is associated with limping disorder, under cast heat rash, difficulty driving and sitting, and we often find these people to have a lateness disorder. It is important to find a drug to treat all of these issues when a person presents like this which can be very challenging. Sometimes we give them large doses of stronglegpazine which is FDA approved and has been shown to be safe and effective in large placibo controlled trials conducted by the drug company Mizer, but many patients remain treatment resistant and many stop taking the medication because the side effect is bi lateral leg fracture in 43% ot the patients who use it. Kapish????

[@JRR100]

Re TMS they dont know the mechanism of action, it is intensely painful and if you go to any tms chat board you will hear the tragic stories of permanent serious side effects that this guy just failed to mention.

[@lisawhitehall1870]

🥺

[@user-ux6wm3jo9b]

ADHD/ neuro divergence is an inflammatory issue, not a mental illness. Same with depression