ADHD & Depression
- Children with ADHD are 5x as likely to have depression as children who don’t have ADHD.
- Around 14% of children with ADHD also have depression.
- In children with ADHD and Oppositional Defiant Disorder or Conduct Disorder (ODD/CD) depression rates are substantially higher.
- Children diagnosed with depression are at a higher risk for also having ADHD.
What is Depression?
Depression is far more serious than ordinary sadness. It is a mood disorder that causes feelings of sadness, hopelessness and a loss of interest in activities that used to be pleasurable. It affects the way you think, feel or behave and causes a range of emotional and physical symptoms.
Because it can manifest as increased irritability, decreased ability to concentrate, indecisiveness, agitation, slow thought processing, decreased ability to think clearly, fatigue or loss of energy, loss of appetite, sleep disturbances and feelings of worthlessness it may cause a sense of being unable to deal with everyday tasks and/or that life isn’t worth living.
Some people with depression also have suicidal thoughts and may act on them if they don’t get appropriate treatment.
Signs of Depression in Children with ADHD
Symptoms might include:
- Low mood or feeling ‘down’
- Losing interest in previously enjoyable activities
- Withdrawing from friends & family
- Feeling extra tired
- Decreased/increased appetite
- Falling grades
- Not wishing to do homework/attend school
- Talking about feeling hopeless, worthless, helpless or suicidal
Depression may also exacerbate existing ADHD behaviours so children may start to:
- Become more inattentive than usual
- Feel completely overwhelmed by organisation and everyday tasks
- Become angrier, more aggressive or disruptive in class – lashing out at people, property or blowing up over small issues
- Some children may want to discontinue with medication
- Some older children may attempt to improve their mood with drugs/alcohol
Why is there a link between ADHD and Depression?
ADHD creates many challenges for children. In a typical day an ADHD child may struggle with time-keeping, organisation, focussing in class, impulsive behaviour, learning difficulties, how to study for a test or problems with friends.
Their issues with working memory, organisation and time management may make it hard to follow daily routines leading to chronic stress.
Kids with ADHD often have more trouble managing stress than other kids due to their emotional regulation difficulties, so it’s no wonder anxiety can become a problem for children with ADHD.
Anxiety and depression often go hand-in-hand – with chronic anxiety often leading to depression. Therefore, anxiety needs to be controlled to avoid it progressing to depression.
Children with ADHD may feel discouraged and as though they lack control over their environment because of their symptoms or because of experiencing repeated failures or negative interactions in their lives, leading to depression.
Children can also experience true depressive illness that is not connected with their feelings about their life with ADHD.
ADHD and Depression can occur at the same time and can be misdiagnosed for each other too.
There is an overlap of symptoms, which makes depression difficult to diagnose. For example, symptoms of poor concentration and physical agitation are both symptoms of ADHD and depression but the addition of feeling hopeless, suicidal or sad means it is true depression.
Depression misdiagnosed as ADHD
Here are some ways in which depression and ADHD can be confused with each other:
- Low self-esteem – children with ADHD often have low self-esteem because of their difficulties. A child who is depressed has low self-esteem for no apparent reason.
- Low motivation – children with ADHD may have low motivation because they feel their efforts don’t make a difference to what they do. A child who is depressed may not make an effort because he feels hopeless about life and sees no point in making an effort.
- Difficulty with school work – children with ADHD find it hard to focus at school and so may fall behind. A child who is depressed may not be focussing due to negative thoughts and/or lack of sleep.
- Resistant to school – children with ADHD often hate going to school but a child who is depressed just doesn’t have the emotional capacity to manage at school.
- Becoming withdrawn socially – children with ADHD may feel isolated from their peers but still crave the chance to socialise, whereas children with depression do not want to socialise at all.
In order to minimise the occurrence of depression in children with ADHD, it is important to help them to minimise any loss of self-esteem and challenges in life.
Therapy for the child should include strategies for helping him to express and cope with his feelings and teach appropriate coping skills.
Cognitive behavioural therapy is useful to assist in reframing negative thoughts allowing for a more positive outlook.
Family counselling or parenting classes which can provide parents with a greater understanding of their child’s difficulties, allow for greater empathy and can result in improved outcomes for the child’s mental well-being.
ADHD & Suicide
Teens, and occasionally younger children, have suicidal thoughts, which is extremely worrying for parents. However, it’s rare for them to act on these thoughts. Having said that, children with ADHD have a slightly higher risk of acting on those thoughts due to their impulsive nature and lack of consideration for consequences.
Research in 2010 found teens diagnosed with ADHD were twice as likely to attempt suicide than those who did not have ADHD. So parents of children with ADHD must be vigilant to their moods and take seriously any talk or indications of hopelessness, despair or suicide extremely seriously.
Bear in mind that some ADHD medications carry a slight risk of suicidal ideation, so please monitor your child’s mood carefully when starting, changing or increasing the dose of any medications.
If you’re worried your child may be thinking about causing him/herself harm, don’t leave them alone. Call your child’s doctor or mental health professional or contact one of the helplines listed below.
What to look out for
Keep a close eye on changes in your child’s mood and behaviour. Look at the checklist of symptoms above, and take notes on what you notice. This can help you to see any patterns and help you when working with a mental health professional.
Check with your child’s teacher as to whether they’ve noticed any symptoms. If so, you can request a meeting with the school psychologist/counsellor.
What causes symptoms of depression?
The causes for depression are many and varied, so it’s wise to look for any root causes that can be corrected.
Some root causes for depression could be:
- Traumatic Life Experiences
- Current Life Situations e.g. bullying
- Stress & Other Psychiatric Conditions
- Chemically-induced (recreational/prescription drugs, alcohol)
- Genetic Susceptibility
- Chronic Inflammation
- Poor diet – including blood sugar imbalances
- Digestive disorders
- Biochemical imbalances of neurotransmitters
- Environmental toxins – heavy metals, plastics, pesticides
- Hormonal imbalances
- Seasonal Affective Disorder (SAD) – lack of sun exposure
We need to consider the whole body’s ecosystem when considering depression – after all, the brain is connected to the rest of the body. Food can be our best medicine as all your cells, tissues, bones, neurotransmitters and so on are all built from the food you eat, so a nourishing diet is the best strategy against depression.
It is becoming more widely accepted now that inflammation is a cause of depression and studies are showing that using anti-inflammatories is a treatment for depression. So following an anti-inflammatory diet, which includes healthy fats, high quality protein, vitamins and antioxidants is beneficial and conversely a poor diet which creates chronic inflammation is unhelpful.
Gluten is considered an inflammatory food and its consumption has been linked to depression, seizures, headaches, anxiety, nerve damage and ADHD-like symptoms.
Another cause of inflammation is high blood sugar so balancing blood sugar is beneficial in treating depression and anxiety.
The appropriate levels of certain micronutrients are required for good mental health. These nutrients influence neurotransmitter activity and allow methylation processes to be optimised for effective nerve cell functioning.
The most essential micronutrients for optimal brain health include zinc, vitamin B6, calcium and magnesium. If methyl concentrations are either elevated or depleted, mood disorders, anxiety and depression can occur.
For example, magnesium is required to produce serotonin and a deficiency, which is extremely common in the general population, has been linked with anxiety and depression and high copper levels are associated with aggression, anger and other mood disorders.
Omega 3 fatty acids (DHA/EPA) are both also needed for optimal brain function, including a relaxed mood.
Vitamin D activates genes that regulate the immune system and release neurotransmitters that affect brain function and development, such as dopamine, norepinephrine and acetylcholine, as well as encouraging the growth of nerve cells for improved memory storage and executive function.
Vitamin D deficiency is linked with depression and mood as it is involved in the release of serotonin.
More people than you would imagine are Vitamin D deficient (even in sunny countries like Australia), particularly in winter.
Symptoms of iron deficiency are fatigue, irritability and brain fog – symptoms similar to depression – so checking iron levels is a good idea to rule that out as a cause for symptoms.
Sleep & Blue Light
A lack of or poor quality sleep is a risk factor for depression as well as exacerbating symptoms of ADHD. Get more natural daylight and avoid blue and/or artificial light at night to optimise your sleep. See Sleep Problems for more information.
The Gut-Brain Connection
Much evidence and research now suggests depression can be caused by issues originating from the micro biome (gut). This is an in-depth topic and an emerging area of science, but when you understand that approximately 90% of serotonin and 50% of dopamine (the “feel good” chemicals that help to regulate and boost your mood) are produced by the bacteria in your gut, it makes perfect sense that if this system is disrupted in some way then neurotransmitter production, and therefore brain function, mood and behaviour, will be impacted as a result.
A healthy gut micro biome is full of beneficial bacteria that break down, absorb, and assimilate nutrients from the foods you eat, which fuel every process in your body.
While a healthy micro biome contributes to good mood, an unhealthy one full of ‘bad’ bacteria or yeast, and all the toxins associated with it, may contribute to mood disorders. The presence of yeast, for example, alters the ability to absorb nutrients and the toxic by-products cause reactions, which cause inflammation in the body, which in turn greatly contributes to depression, anxiety and poor mental function.
Genetic susceptibility means you may have certain genetic mutations that pre-dispose you to particular health issues such as mood problems. For example, studies show an association between the MTHFR C677T mutation and depression, schizophrenia, and bipolar disorder!
Whilst you can’t change your genes, you can support your body with lifestyle, diet and specific nutrients to allow the methylation cycle to function more efficiently.
When the methylation cycle is not working efficiently, it can also effect the bodies ability to detoxify heavy metals and chemicals, it can effect the immune system, hormones, energy, histamine levels, controls inflammation and can be responsible for imbalances in the liver, thyroid, adrenal, digestion and hormonal systems.
Medication Side Effects
If your child is taking ADHD or other prescription medications, including ironically, anti-depressants, you should be aware that side-effects can sometimes include anxiety, depression or suicidal ideation. It is therefore crucial that if your child is taking medications you keep a careful eye on them and be alert to any changes in their mood when first taking medication or over the longer term. Any new symptoms should be reported to your prescribing doctor immediately. Also bear in mind any drug interactions where multiple medications have been prescribed. You can check these at Drugs.com.
How You Can Help
- Ask your child if something is worrying him or making him feel uneasy and see if you can find a pattern to their behaviour.
- Always acknowledge and validate your child’s feelings. Rather than telling them not to be silly– work with them to figure out the next steps to take.
- Seek psychological counselling for your child.
- Keep a check on anxiety levels, as chronic anxiety can lead to depression.
- Support them at home. Acknowledge their feelings and help them to brainstorm ways you can help with tasks.
- Make time for them and get outside – encourage them to go for a walk, get lunch or do something they enjoy with you.
Because mental health issues are seen so often in association with ADHD, children with ADHD should be checked for anxiety and depression and getting a thorough evaluation is key in understanding whether your child has ADHD, depression or both.
As explained above, there are numerous causes of depression, so you might find it useful to seek help from any of the following:
- Naturopath/Integrative GP
- School counsellor
- GP or paediatrician for a referral to a child psychologist or psychiatrist
- Check your gut health
- Identify food sensitivities/allergies
- Correct nutritional deficiencies
- Check for environmental toxins
- Balance hormones
- Ensure optimal thyroid function
- Balance blood sugar by eating small, regular low GI meals
- Implement dietary interventions e.g. gluten/dairy-free/grain-free
- Eat adequate protein
- Consume high magnesium foods e.g. green vegetables, nuts & seeds
- Avoid excessive alcohol consumption
- Eat wild oily fish 2-3 x week and supplement with high quality Omega 3
- Consume flax and linseeds
- Avoid known food allergens
- Epsom Salt baths
- Essential Oils
- Optimise your sleep
- Regular exercise
- Spend time with friends & family
- Yoga, Tai Chi or other relaxing activities
- Practice deep breathing techniques
- Spend time in nature – preferably barefoot
- Get adequate sunlight
- Avoid overuse of screens & excessive exposure to artificial/blue light
- Avoid recreational drugs
- Kinesiology/Neuro-emotional techniques
- Keep a gratitude diary
Where can I find professional help?
The Good Therapy website explores various types of therapy on offer to assist with mental health issues. There is a great variety on offer to take a look and decide which one may best fit you and your individual situation.
Check out the ADHD Directory to find a suitable practitioner for your circumstances.
If you live in and around Sydney’s Northern Beaches please come along to one of our monthly ADHD speaker evenings to increase your knowledge on the co-morbidities of ADHD such as Anxiety.
You can find more information or book one of our events here.