Research Spotlights highlight scientific research focused on girls and women with ADHD and inform non-scientists about the research process. This Spotlight breaks down “ADHD in adults with recurrent depression,” published in December 2021.
Study Goals
- To examine the frequency of ADHD in middle-aged women with histories of recurrent depression
- To investigate whether certain features of depression are associated with co-occurring ADHD
- To study whether co-occurring depression and ADHD symptoms were linked to worse treatment response or more complex clinical presentations
What is already known about the topic?
- Children and adolescents with ADHD may be at higher risk for early-onset, recurrent depression.
- ADHD in childhood and adolescence has been linked to more severe depressive symptoms in adulthood.
- Depressive symptoms may mask ADHD symptoms in adulthood, potentially making it harder to identify ADHD at that stage of life.
- Individuals with depression and ADHD may have greater clinical challenges, such as not responding to antidepressant medication and higher rates of hospitalization and suicide.
How was this study done?
- 148 women (average age = 53 years) from the Early Prediction of Adolescent Depression (EPAD) study—a longitudinal study of recurrently depressed parents and their children in the United Kingdom—completed interviews and questionnaires at 4 time points between 2007 and 2020.
- During interviews, women reported on an array of different features regarding depression including the age they experienced their first major depressive episode and the number of subsequent episodes; depression symptom severity; history of suicide attempts and self-harm; number of psychiatric hospitalizations; and use and type of depression medication.
- ADHD symptoms and diagnosis were measured by self-reports on the Adult ADHD Investigator Symptom Rating Scale (AISRS) and by asking about DSM-5 criteria.
What were the study’s findings?
- 12.8% of frequently depressed women had increased ADHD symptoms; 3.4% met diagnostic criteria for ADHD. None of the participants reported being previously diagnosed with or treated for ADHD.
- A history of recurrent depression and co-occurring ADHD symptoms were associated with a more complex clinical picture. These women had earlier depression onset, more depressive episodes, more impairment and irritability, increased risk of self-harm and suicide attempts, and a higher likelihood of having been hospitalized.
- Women with depression and ADHD symptoms were more likely to have been treated with a non-first-line antidepressant medication, which suggested poor response to first-line (i.e., more commonly prescribed) medication.
Actionable Items
If further research confirms these preliminary findings, middle-age women and their clinicians might consider the tips below.
Women in mid-life should:
- Explore whether ADHD is present alongside recurrent depression—especially for those whose depression started early in life.
- Be aware that individuals who are diagnosed with ADHD during childhood and adolescence are more likely to experience depression in adulthood.
- Learn about how depression may affect women differently than men. Check out this resource from the National Institute of Mental Health for more information.
Clinicians who assess and treat psychiatric conditions in adult women should:
- Recognize that co-occurring depression and ADHD symptoms in adult women are associated with greater clinical impairment.
- Realize that recurrent adult depression may be masking “lurking disorders” such as ADHD that were not previously identified.
- Consider assessing for other conditions, including ADHD, if a patient is not responding to first-line depression treatments.
- Understand that having co-occurring ADHD and depression may require a different care plan—such as more frequent follow-up appointments or different medications—than if treating one of those conditions alone.
Terms to Know
- Recurrent depression: Having more than one depressive episode that lasts over an extended period.
- Longitudinal study: Consistent investigations of the same variables over time.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5): The American Psychiatric Association’s professional reference book on mental health and brain-related disorders.
We are grateful for Ikenna Iloabachie’s contributions to the development of this Research Spotlight.