Treatment for Depression and ADHD

Patients with both depression and ADHD may exhibit more severe signs of each condition, necessitating customised treatment approaches that take possible side effects, drug interactions, and lifestyle factors into account. This article provides a thorough overview of all available therapies, including cutting-edge ones like ECT, TMS, and ketamine that are still being actively researched for the treatment of depression and ADHD.

The risks and difficulties that come with co-existing depression and attention deficit hyperactivity disorder (ADHD) are distinct. The symptoms of the illnesses manifest more strongly when they co-occur than they would if they didn’t. Secondary depression is the term for when depression appears as a result of ADHD symptoms. Other times, ADHD does not play a role in the development of depression, but it can still have an effect on its symptoms.

Therefore, it is essential to manage and treat both ADHD and depression appropriately. Today’s patients have a variety of psychiatric and psychopharmacological options, as well as more recent, cutting-edge techniques. For patients with comorbid ADHD and depression, psychologists, therapists, and psychiatrists should think about the following therapy and medicines.

Psychological Treatments for Depression and ADHD

The most effective strategy for treating depression and ADHD relies on the specific requirements of the patient, as with any form of therapy. These four behavioural therapies are frequently used by psychologists and therapists to treat depression.

Cognitive Behavioral Therapy (CBT)

Strong empirical investigations demonstrate the efficacy of this therapy in treating depressed people. CBT is typically the first line of defense for psychological therapy in my practice.

CBT targets cognitive distortions by helping patients be mindful of their negative thoughts, and by challenging them to find evidence for them. The behavioural component, in turn, addresses self-destructive, avoidant, and otherwise unproductive behaviours. Patients may be given tools, like anxiety management skills, to help them execute positive behaviours.

However, it can be challenging to execute CBT when a patient is suffering from severe depression, which impairs their ability to think properly and prevents the therapy from having the intended impact. Once the patient’s depression has subsided to the point that they are better able to process thoughts, psychologists and/or therapists can always go back to CBT.

Acceptance and Commitment Therapy (ACT)

Some CBT ideas are taught by ACT, but instead of attempting to reconstruct negative thinking as CBT does, ACT encourages patients to practise passive acknowledgement. When a patient gets a bad idea, ACT advises them not to accept it as true or exert any effort to change it.

ACT emphasises values as well. Patients, especially those with depression, may experience feelings of worthlessness, such as not having much to offer or having no place in the world. For instance, many of the patients believe they must be flawless to be accepted. ACT asks patients to identify and define their value systems and to live out their values through connections rather than accomplishments in order to combat this way of thinking.

Interpersonal Therapy (IPT)

IPT, which is classified as traditional psychotherapy or talk therapy and resembles ACT in some ways, places a strong emphasis on the functions that relationships and interpersonal connections play.

IPT patients will think about the idea that having healthy relationships might lessen depression. They might be encouraged to evaluate their relationships and consider whether some strained bonds could be contributing factors to their sadness.

IPT may not be beneficial in people with severe depression or depression that is resistant to treatment, just like cognitive therapy sometimes is (TRD). Patients with severe illnesses may be hesitant to process their interactions in this way because they may genuinely feel like they are not going to make it through the day.

Dialectical Behavior Therapy (DBT)

DBT has been used to treat a wide range of brain illnesses and disorders, including depression, since it was first developed for people with borderline personality disorder.

DBT is a practical approach and skill-based therapy. It focuses on four modules: emotional control, distress tolerance, interpersonal effectiveness, and assertiveness. For those with ADHD, mindfulness can be very beneficial. Being aware of potential distractions and where one’s thoughts may travel, for instance, can be helpful for ADHD patients.

DBT is another first-line strategy for me, similar to CBT. In my own clinical experience, I’ve discovered that individuals with depression and ADHD respond favourably to DBT since the treatment places such a strong emphasis on immediately actionable skills and tactics. DBT is, in my experience, the ideal therapy to utilise right away, along with medication, if I have a patient who is experiencing severe distress. In general, behaviorally oriented therapies, such as DBT, are preferable for treating severe distress.

Psychopharmacological Therapies for Depression and ADHD

Psychiatrists should take treatment resistant depression, or TRD, into account when prescribing any drugs, whether they contain stimulants or not. An individual with TRD might not have responded well to one, two, or more antidepressants or other treatments, but they might be a good fit for drugs and treatments that are less common.

Psychologists and psychiatrists ought to consult with one another and collaborate on a patient’s care. The burden of establishing contact between a patient’s healthcare providers shouldn’t lie on the patient.

Selective Serotonin Reuptake Inhibitors (SSRIs)

The most frequently given drugs for depressed people are those that increase serotonin levels in the brain. SSRIs consist of:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Setraline (Zoloft)

While some of the more recent antidepressants, such as Luvox and Zoloft, are antidepressants with anti-anxiety properties. The most frequently reported adverse effects of SSRIs in adults are sexual side effects, such as erectile dysfunction or inability to orgasm. Teenagers may experience nausea and/or a small amount of weight gain.

Since stimulants and non-stimulants do not interact negatively with SSRIs, individuals with ADHD and depression can typically take these drugs concurrently without any negative effects.

Tricyclic Antidepressants

Tricyclics are an older type of antidepressant that may perform best for some patients because they target more serotonin and norepinephrine. Tricyclics consist of:

• Amitriptyline
• Amoxapine
• Desipramine (Norpramin)
• Doxepin
• Imipramine (Tofranil)

However, because of the numerous side effects, which include nausea, vertigo, and anxiety, most patients do not begin taking tricyclics. However, dealing with chronic depression can be so taxing that some patients may be ready to put up with some unpleasant tricyclic side effects. People with ADHD should be aware that some tricyclics can interact negatively with stimulant medicines.

Monoamine Oxidase Inhibitors (MAOIs)

Serotonin, dopamine, and norepinephrine are just a few of the neurotransmitters that can be targeted by the MAOI class of antidepressants. MAOIs phenelzine (Nardil) and tranylcypromine are frequently administered (Parnate). Some MAOIs may interact with drugs for ADHD that contain stimulants.

Some individuals are unable to eat or drink while taking MAOIs particular cheeses can have major side effects. However, some of my patients are more than happy to give up cheese altogether if one of the MAOIs helps them when no other treatments have.

Atypical Antidepressants and Antipsychotic Medication

 Atypical antidepressants include:

• Bupropion (Wellbutrin, Forfivo XL, Aplenzin)
• Mirtazapine (Remeron)
• Trazodone (also for insomnia)
• Vortioxetine (Trintellix)

These drugs are the consequence of our expanding awareness that depression is complex and different for each patient, and they focus on issues that are extremely different from all of the other types of antidepressants.

Antipsychotics can benefit individuals with depression by easing the type of concrete, rigid thinking that is typical of both psychosis and depression sufferers. 

Patients receiving augmentation therapy who have extremely severe depression or TRD may benefit greatly from antipsychotic drugs. The FDA has approved the antipsychotic medications aripiprazole (Abilify), brexipipzole (Rexulti), and quetiapine (Seroquel XR) as additional treatments for TRD.

Modern Therapies for Depression and ADHD

Electroshock Treatment (ECT)

Although the general public has a negative opinion of ECT, some people may benefit from this treatment more than others.

The treatment includes putting patients to sleep and using electropads to send electrical currents across the brain. This is especially beneficial for those with catatonic depression and/or TRD.

According to the study, ECT can be a secure and beneficial solution for TRD patients in high-risk circumstances. For instance, one of the pregnant patients was suffering from bipolar disorder and was at a high risk of committing suicide. But she was unable to take medication since it would have negatively impacted her unborn child. Instead, she had electroconvulsive therapy, which was incredibly beneficial for her.

At most, ECT sessions last 10 minutes. Patients typically require six to twelve ECT treatments, or two to three sessions spread out over roughly a month. After around six treatments, improvement is evident.

ECT side effects include confusion, retrograde amnesia, nausea, headaches, and muscle soreness while being safer than procedures used decades ago.

Ketamine Infusions for Depression

A hallucinogen with qualities that can be highly helpful in treating depression is ketamine. Ketamine encourages the formation of synaptic connections in the brain that are necessary for memory and learning, but it can also block other receptors and have an immediate antidepressant effect. Studies have demonstrated that medication lessens or completely eliminates very severe or upsetting depressive symptoms, such as suicidal thoughts. According to other research, these infusions provide depressive symptom alleviation for 60% or more of patients. Ketamine infusions may be necessary when other antidepressant drugs haven’t worked and/or if there is acute suicidality.

Infusions take place when the patient is awake. During the operation, some people may suffer strange perceptions or dissociative episodes, but these usually disappear afterwards. Although the first session is the most demanding, patients can resume their regular activities about 30 to 45 minutes after the infusion. Among the documented negative effects include tiredness, nausea, and a peculiar feeling. In comparison to the majority of antidepressants, relief normally lasts one to three weeks.

Ketamine infusions cost money, much like TMS. Six infusions over the course of two to four weeks make up the average treatment. Insurance may or may not pay for infusions, which range in price from $300 to $800 per session.

However, there are many positive findings from the drug’s use in clinics, and the research is looking extremely hopeful. Although preliminary studies indicate that this is not widespread, the risk of misuse and dependency, for instance, is unknown.

Spravato Treatment for Depression

The nasal spray esketamine, also known as Spravato which is spravato treatment that combines ketamine-like effects with an oral antidepressant, received FDA approval in 2019. Only those with TRD are eligible to use this medication, which was approved after preliminary tests showed that it was highly successful in easing TRD symptoms. Sedation, dissociative experiences, nausea, anxiety, vertigo, and vomiting are some of the side effects of this therapy. After the dose is given, patients are observed by healthcare professionals for at least two hours. Along with other restrictions, the prescription is only offered as part of the Risk Evaluation and Mitigation Strategy program. So patients aren’t allowed to drive or operate heavy equipment for the remainder of the day after receiving them.

Transcranial Magnetic Stimulation (TMS)

Uses magnetic fields to stimulate nerve cells in the brain, namely the prefrontal cortex. Which may have unusually low activity in depressed patients. During the operation, patients are conscious and perceive a tapping sensation that corresponds to the coil pulses. In 2008, the FDA approved the marketing of TMS as a therapy for severe depression.

TMS patients can resume normal activities immediately following their sessions. However, certain adverse effects may include scalp soreness, lightheadedness, mild twitching, and, in rare cases, seizures. There are no cognitive functioning side effects associated with the procedure, such as memory loss or confusion. 

TMS is particularly beneficial for TRD, according to research. In a 2012 study involving 307 patients from 42 different practises, nearly 60% reported considerably fewer depression symptoms after TMS. Another 2014 study of over 250 adults discovered a 30% reduction in depressive symptoms after TMS even after a year of follow-up, which is quite significant. The effects can last for six months, a year, or longer.

TMS has helped several of my own patients with TRD. The treatment’s disadvantage is that it requires a large time and financial investment. Each session lasts approximately 20 to 40 minutes and may take up to 25 to 30 daily treatments for a patient to observe the effects. The overall cost of treatment is approximately $10,000. If at least four different antidepressant trials have failed, insurance companies typically cover a portion of the cost for patients.