ADHD in adults with recurrent depression

Abstract

Background: Depression is highly heterogeneous in its clinical presentation. Those with attention deficit/hyperactivity disorder (ADHD) may be at risk of a more chronic and impairing depression compared to those with depression alone according to studies of young people. However, no studies to date have examined ADHD in recurrently depressed adults in mid-life.

Method: In a sample of women in mid-life (n=148) taken from a UK based prospective cohort of adults with a history of recurrent depression, we investigated the prevalence of ADHD and the association of ADHD with clinical features of depression.

Results: 12.8% of the recurrently depressed women had elevated ADHD symptoms and 3.4% met DSM-5 diagnostic criteria for ADHD. None of the women reported having a diagnosis of ADHD from a medical professional. ADHD symptoms were associated with earlier age of depression onset, higher depression associated impairment, a greater recurrence of depressive episodes and increased persistence of subthreshold depression symptoms over the study period, higher levels of irritability and increased risk of self-harm or suicide attempt. ADHD symptoms were associated with increased risk of hospitalisation and receiving non-first-line antidepressant medication.

Limitations: ADHD was measured using a questionnaire measure. We focussed on mothers in a longitudinal study of recurrent depression, so the findings may not apply to males or other groups.

Conclusions: Higher ADHD symptoms appear to index a worse clinical presentation for depression. Clinical implications include that in women with early onset, impairing and recurrent depression, the possibility of underlying ADHD masked by depression needs to be considered.

Keywords: ADHD; Attention deficit/hyperactivity disorder; Clinical management; Clinical presentation; Depression; Women.

Fig 1

Study design and participation rates across assessment waves of the EPAD study. The Early Prediction of Adolescent Depression (EPAD) study took place over four assessment waves between April 2007 and September 2020 via interview and questionnaire. Numbers of participants reported are those participating at each wave via questionnaire, interview or both. Only 262 adults were contactable at wave 4. Reasons for this include loss of up to date contact details, withdrawal from the study, death and declining to participate due to ill health, bereavement or other commitments such as work (n=75). Of the 262 contactable participants at wave 4, 68 were unresponsive despite multiple communication attempts.