ADHD Depression

and

Adolescent Girls

Douglas Cowan, Psy.D.

ADHD Information Library

Several studies in recent years have loo ed into the im!act of ADHD on the lives of teenage girls. "#I studies re!ort that teenager$s brains are ra!idly maturing, but that they are not fully mature until the early %&$s in females, and !erha!s the early '&$s in males. Long(term studies on behavior and emotional health re!ort that girls with ADHD may struggle through the teen years. And other studies re!ort that de!ression is common among teens with ADHD, and is so common among adolescents that the use of medications for ADHD, antide!ressants, anti( !sychotics, and even slee! medications, is u! shar!ly with adolescent girls. )hile many children and teens with ADHD also suffer from some degree of sadness, discouragement, or frustration, as many as %*+ are clinically de!ressed. Children and teens with ADHD are as much as '&&+ more li ely to also suffer from de!ression than are children or teens without ADHD. ,he co(morbid de!ression seems little associated with the ADHD sym!toms such as inattention, im!ulsivity, hy!eractivity, or academic !roblems. ,hese !roblems might result in discouragement, sadness, or frustration, but not clinical de!ression. #ather, the de!ression seems to be most correlated to social aw wardness or inter!ersonal difficulties that are often a !art of having ADHD. ,he lac of friendshi!s, the sense of loneliness, or the sense of being a -social outcast. seemed to be behind the de!ression. And these feelings are, of course, much stronger in the teenage years. In girls who were diagnosed with ADHD, and were followed by long(term studies through the years, it was observed that as they moved from childhood to adolescence their -outward. sym!toms of ADHD, such as hy!eractivity and im!ulsivity, tended to decrease. )e do want to note that most girls with ADHD do not have the sym!toms of hy!eractivity or im!ulsivity. "ost girls with ADHD are inattentive, distracted, disorgani/ed, or -s!ace cadets,. which is why girls are so under(diagnosed for ADHD. 0irls tend to 1ust sit in the classroom, get distracted, and do !oorly on the tests. 2ut they don$t cause trouble in the classroom so they don$t get the attention that might lead to a diagnosis and treatment. 2ut for those girls were did have the sym!toms of hy!eractivity or im!ulsivity, and had been diagnosed as children, their -outward. sym!toms tended to decrease as they reached the teenage years. However, as these girls reached the teenage years, it was noted that their academic !erformance continued to be a !roblem, and that the academic ga! between them and their non(ADHD !eers continued to widen with each !assing year. ,hese researchers also noted that, while some girls with ADHD actually -out(grew it. as they reached adolescence, for the most !art the girls not only continued to suffer from it but many began to get into serious trouble. 2oth behavioral and emotional !roblems began to emerge in many of these girls, and the need for s!eciali/ed treatment greatly increased.

,here were increased !roblems with friends, which led to increased levels of de!ression. ,here were increased levels of substance abuse 3both alcohol and drug abuse4. School delin5uency increased as the academic !roblems got worse. And, sur!risingly, eating disorders became a serious !roblem among many of these girls. All of these !roblems were at higher levels among these ADHD girls than among their non( ADHD !eers. As we have noted elsewhere, twice as many teens with ADHD will run away from home than teens without ADHD. About 67+ of teens run away from home at some !oint, versus '%+ of teens untreated for Attention Deficit Hy!eractivity Disorder ( ADD ADHD. And as many as *&+ of all teenagers in 1uvenile facilities have Attention Deficit Hy!eractivity Disorder but were untreated for ADHD. ,eenagers untreated for ADHD are ten times more li ely to get !regnant, or cause a !regnancy, than those without ADHD, and teenagers untreated for Attention Deficit Hy!eractivity Disorder are 8&&+ more li ely to contract a se9ually transmitted disease than teens without ADHD: 67+ to 8+.

ADHD, and Depression )ith as many as %*+ of teenagers with ADHD being clinically de!ressed, it is im!ortant to understand what de!ression loo s li e, why it is im!ortant to treat it and manage it, and the treatment o!tions available. )hen we thin of someone who is de!ressed, we usually !icture a sad, tearful, lonesome !erson. 2ut teenagers with de!ression don;t loo li e adults with de!ression. Current studies show that there are about as many teenagers who are de!ressed as there are adults that are de!ressed, about 6&+ of the general !o!ulation. And as we have noted, as many as %*+ of teens with ADHD are de!ressed. However, de!ression in teenagers doesn$t always loo li e de!ression in adults. ,eenagers do not commonly dis!lay gloom, self(de!reciation, or tal about feeling ho!eless li e adults do. ,eenagers with "a1or De!ression are described as often becoming negative and antisocial. <eelings of wanting to leave home or wanting to run away will increase. ,here may be a strong sense of not being understood and a!!roved of by !arents, siblings, or !eers. ,he teen often changes, and becomes more restless, grouchy, or aggressive. A reluctance to coo!erate in family ventures, and withdrawing from the family by retreating into their room is !retty common. School difficulties are li ely even in those few ADHD teens who were doing !retty well in school, as concentration is even more affected than from the ADHD alone. Sometimes the teen will sto! !aying attention to !ersonal a!!earance, and sometimes they will ado!t the -uniform. of social grou!s that !rofess de!ression or des!ondency as a way of life.

,hey often become much more emotional -at every little thing.. =ften there is an increased sensitivity to re1ection in love relationshi!s as well. )hich reminds me of a Cornell >niversity study that re!orted that the leading cause of teenage de!ression was brea ing u! with a boyfriend or girlfriend. And that the younger the teen was in this relationshi!, the more li ely the brea u! would lead to de!ression. ,eenage boys will often become aggressive with their !arents or !eers, seem more agitated around the house, and get into more trouble at home, at school, or with the law. ,eenage girls will sometimes become !reoccu!ied with themes of death or dying, and become decreasing concerned about how they loo . ,hin blac ? blac hair, nails, clothes, li!s. Suicidal thoughts are common in de!ressed teens. Some studies suggest that *&&,&&& teens attem!t suicide each year, and *,&&& are successful. ,hat would be 6&+ of de!ressed teens. =ther studies suggest that the number is 6*+ of de!ressed teens ending their life via suicide. 2y the way, another study notes that of all the teenagers that commit suicide each year, only seven !ercent were receiving mental health treatment at the time of their death. Poor self(esteem is common with teenagers, but es!ecially with those who are de!ressed, and there is often an increase in -self(destructive behaviors. such as alcohol abuse, drug abuse, and se9ual !romiscuity. Parents are often confused and frustrated when their teens begin to act li e this. Sometimes !arents become stern disci!linarians, or even !ut the teen down, which only serves to increase feelings of guilt and de!ression. =ther times, !arents feel hel!less, and stand by waiting for adulthood to arrive. =f course neither course is the right one to ta e. <rom %&&6 to %&&7, the use of ADHD medicines !rescribed to girls was u! by nearly @*+, and the use of antide!ressant medications was u! by nearly 6&+ in girls. Black Box Warning Label Ao doubt you have seen recent news headlines about a federal !anel that recommended to the <DA that anti(de!ressant medications carry the strongest !ossible warning label for use in children and teenagers. ,his recommendation to the <DA shoo the medical community, es!ecially those who wor with de!ressed young !eo!le, and now the <DA does mandate that antide!ressants used to treat adolescent de!ression carry the -blac bo9. warning label. ,he warning label reads:
Suicidality in Children and Adolescents Antidepressants increase the risk of suicidal thinking and behavior suicidality! in children and adolescents "ith #a$or depressive disorder %DD! and other psychiatric disorders& Anyone considering the use of 'Drug (a#e) or any other antidepressant in a child or adolescent #ust balance this risk "ith the clinical need& *atients "ho are started on therapy should be observed closely for clinical "orsening, suicidality, or unusual changes in behavior& +a#ilies and caregivers should be advised of the need for close observation

and co##unication "ith the prescriber& 'Drug (a#e) is not approved for use in pediatric patients except for patients "ith 'Any approved pediatric clai#s here)& See Warnings and *recautions, *ediatric -se! *ooled analyses of short.ter# / to 01 "eeks! placebo.controlled trials of nine antidepressant drugs SS23s and others! in children and adolescents "ith %DD, obsessive co#pulsive disorder 4CD!, or other psychiatric disorders a total of 5/ trials involving over //66 patients! have revealed a greater risk of adverse events representing suicidal thinking or behavior suicidality! during the first fe" #onths of treat#ent in those receiving antidepressants& 7he average risk of such events on drug "as /8, t"ice the placebo risk of 58& (o suicides occurred in these trials&

,he biggest !roblem from the treatment community;s !oint of view was not the recommendation for the warning label, but the way that the media !ortrayed the !anel;s recommendation. ,he !anel re!orted that %+ to 8+ of children and teens that were given anti(de!ressants for the treatment of de!ression had suicidal thoughts, or made suicidal attem!ts of one ind or another. Aone of the 8,&&& children and teens studied committed suicide. )hat the media did not re!ort well is the fact that 6&+ to 6*+ of children and teens with de!ression that receive no treatment will commit suicide. ,hese 6&+ to 6*+ will not 1ust thin about it, but will actually ill themselves. So what are we to doB If the media had their way it seems that no teens with de!ression would receive anti(de!ressants. As a result the suicide rate for those who could be using the medication would rise from nearly /ero !ercent to about fifteen !ercent, which is the suicide rate for de!ressed teens who are untreated. )hile there actually are young !eo!le, and adults, who have become suicidal only after beginning treatment with an anti(de!ressant, and some have in fact gone on to ta e their own lives, which is absolutely tragic and heart(brea ing, so is the fact that untreated de!ression is !otentially a fatal disease. As many as fifteen out of one hundred young !eo!le with de!ression ta e their own lives unless they receive treatment. ,hese young !eo!le should receive a treatment that will lower the suicide rate dramatically, without any stigma attached to it by the media. )ith !ro!er diagnosis and treatment a de!ressed teen, or adult, can be greatly hel!ed. If someone close to you is suffering from de!ression, first !lease understand that de!ression is a very emotionally !ainful condition. Please ta e the situation seriously. If you now of a teen whose behaviors have changed to loo li e what has been described above, let the !arents now that there is hel! available, and encourage the family to see hel! from a !rofessional.