How do severe depression and (inattentive)ADHD mix?
June 25, 2014 6:50 AM   Subscribe

I know that ADHD and depression often occur together, understandably. But how does each change the way that the other displays?

I am mostly asking out of curiosity. I do plan on getting assessed for inattentive ADHD soon however this question is not necessarily about my diagnosis per se, though I appreciate comments on my situation as well. I have read that one of the features of severe depression is a slowing down of activity and movement. On the other hand, while inattentive ADHD does not have significant hyperactivity as a marker, there is usually restlessness involved is there not (due to lack of ability for sustained and directed attention)? So how do these two things end up going together?

When I was a kid I was severely depressed due to a very insecure and unsafe life. While I still speak noticeably slowly now when I was this depressed I spoke so slowly that all the kids would make fun of me for it. It was a thing to mimic something I said extra slowly and moronically and then get everyone to laugh about it. At this time I spent ALL my time laying in bed reading. I had a very undemanding childhood in the sense that we never had homework, I was in no extracurricular activities, no family or social events, I wasn't required to do any chores, etc. I was left alone to read ALL the time. I always thought that was why my (possible) inattentive ADHD was not "problematic" or didn't display during childhood ( I'll probably do a post soon on this but I don't want to go into my symptoms here). Because I had an utterly undemanding, unstructured life. Now it occurred to me that this might be something that sometimes happens with severe depression and ADHD. That the slowing down effect of the depression masks what is the more active or restless features of ADHD.

I know this is a subtle and nuanced question but I'm curious nonetheless.
posted by anonymous to Health & Fitness (4 answers total) 16 users marked this as a favorite
There are two different sides of your question: 1) how do ADHD and depressive disorders present as comorbid, and 2) how have they presented as comorbid in me*?

The second question in some ways obviates the first, insofar as psychological disorders present in personal ways informed by our personal histories, our historical cohort, our culture, the expectations placed on us by our families, and a myriad of other details about your particular life. These two psychological disorders can present at the same time in almost any way imaginable based on all of those factors. ADHD is an externalizing disorder, depressive disorders are internalizing disorders. You could literally see a presentation here from one kid where they were jumping off roofs for "fun," and from another kid where they never left their bed and read all the time. Neither is "right," both are personal. The larger, research-based, answer to the first question literally doesn't matter in the face of the specificity of your situation, just as it doesn't matter how unlikely it is to get ALS (2:100,000), if you are among those who have it. Basically, the second question falls into the "no one can diagnose you over the internet" box, although I have no doubt people will be along to try.

The first question is easier to answer because there are data and case studies to answer it. See A Review of Co-Morbid Depression in Pediatric ADHD: Etiologies, Phenomenology, and Treatment available at PubMed. It should get you started on avenues to explore.

*You seem to have diagnosed yourself with this, and for the purposes of this question, I am taking that at face value. I have no idea if you have one or both of these disorders, and neither does anyone else on the internet.
posted by OmieWise at 8:57 AM on June 25, 2014

I was closer to hyper as a kid, I think most adults tend to lose that as they get older anyway. My official dx now is inattentive. What I've noticed of my periods of depression is that my attention span was frustratingly short, but it wasn't in a high-energy sort of way, if that makes sense? Things just became "meh" very quickly. I don't think depression improves things in the least, if anything it makes it harder to sustain attention for even previously pleasurable activities. Inattentive type is not hyperactive and thus I can't see how it would possibly benefit from "slowing things down". It's more a matter of drifting focus, not restlessness in that bouncy sort of way.

But kind of hard to see how things might be interacting for you when you haven't described anything here that seems even vaguely ADDish. If there were literally no expectations on you as a child, yeah, that would make it hard to pick up on inattentive ADD, but it could also be that as an adult you haven't yet learned how to do sustained things like work and studying, because those are definitely skills that require practice. Everybody's different, but for me the ADD isn't just "I don't like to clean and my place is kind of a mess", it's "I have started doing dishes six times so far this week and somehow have yet to finish a full sink". It isn't "I have a hard time studying for four hours at a stretch", it's "I've been trying to read this chapter for two hours and I'm two pages in". But I didn't get diagnosed as a kid, personally, because I could keep up with schoolwork as long as it took negligible effort, and my parents put my constant flakiness and bedroom-from-hell down to other factors. So that's a thing.

If you've got any questions about the whole adult diagnosis thing, you can MeMail me.
posted by Sequence at 9:24 AM on June 25, 2014 [1 favorite]

IANAD, but I do not believe that Inattentive ADHD has to show any "restless" or energetic manifestations. After my own diagnosis I did a lot of reading on ADHD, and I don't recall there being any requirement to show both sides of the disorder. Symptoms are different in children than in adults, and different in children between genders.

If you are being treated for depression, seek out a professional who can also test you for ADHD. If you are treated for both, consider getting coordinated treatment (ie, see a professional who can treat you for both, instead of having separate doctors).
posted by Cardinal Fang! at 12:14 PM on June 25, 2014

One nice thing about how they combine is that Adderall is a treatment for both ADD and for treatment-resistant major depression. So if you end up being prescribed Adderall for your ADD then you should see some improvement in your depression, too.
posted by Jacqueline at 4:15 PM on June 25, 2014 [1 favorite]

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