The ADHD-Depression Link in Adults: Symptoms & Treatments (with Roberto Olivardia, Ph.D.)
ฝัง
- เผยแพร่เมื่อ 20 ต.ค. 2022
- 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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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)
Oh my gos thank u so much
I am curious why SNRI and NRI meds are not covered in this presentation.
Norepinephrine is raised both by stimulants and SNRI leading usually to stronger anxiety, that's why it's avoided
@@meoao8829 I suppose that’s why I take them together. They’re very relaxing for me. As a perimenopausal woman and a prescriber, I find that my experience is very common.
I actually had to split my SNRI to twice a day from once a day to reduce the sedating effect.
Just like Adderall slows down my brain, my SNRI slows my anxiety. I must add that SNRIs are prescribed for anxiety.
Thank you for timestamps!!!
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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.
🥺
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????
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.
ADHD/ neuro divergence is an inflammatory issue, not a mental illness. Same with depression
Link?