Treating ADHD in Adults With Comorbid Mood Disorders: What the Evidence Shows

Craig BH Surman, MD


May 31, 2007

In This Article


The recent National Comorbidity Survey Replication (NCSR) suggests that attention deficit-hyperactivity disorder (ADHD) affects 4.4% of adults in the United States.[1] Although ADHD is associated with significant distress and hardship, its impact is often compounded by comorbid mental health conditions, including mood disorders. The NCSR found that in the year before the survey, adults 18 to 44 years of age with ADHD experienced higher rates of major depression (18.6% vs 7.8% in non-ADHD adults), bipolar disorder (19.4% vs 3.1% in non-ADHD adults), and dysthymia (12.8% vs 1.9% in non-ADHD adults). The odds ratio for the presence of an association between ADHD and a mood disorder in the past year was 5.0.[1] High rates of lifetime depression, dysthymia, or bipolar disorder have also been reported in several studies of adults with ADHD.[2,3,4,5]

These findings suggest that many individuals presenting to clinicians with affective disorders may also have ADHD. Because affective distress may be functionally impairing and can manifest with symptoms of inattention or restlessness, identifying ADHD in individuals with depression may be challenging. When screening for ADHD in such patients, it may be helpful to inquire about periods when individuals were most free of mood distress. For patients without a clear history of recent ADHD symptoms who have severe affective distress, current ADHD may only be identifiable after the affective disorder is treated. The presence of mood symptoms, in the case of depressive disorders, and grandiosity, hypersexuality, or decreased sleep in the case of bipolar disorder, may help differentiate affective conditions from ADHD clinically. Because ADHD itself may be demoralizing, mild depressive or dysthymic states may also be a result of ADHD. (See Diagnosis and Management of ADHD From Adolescence Through Adulthood for an in-depth discussion of identification and treatment of adult ADHD)


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