28% Of Referrals To A Mood & Anxiety Clinic Had Undiagnosed ADHD


Do you know someone whose has been treated for years for depression but they don’t get better? Are their antidepressant medications not working? Do they really have treatment resistant depression? Or do they have undiagnosed and untreated ADHD that the medical system often ignores and neglects?

In this post, I will show that a very large percentage of children, teenagers, and adults with ADHD have been misdiagnosed thanks to ignorance and malpractice with major depression and dysthymia (chronic low-level depression).

This study shows what we adult ADHD coaches have known for a long time. Only 5% of adults have ADHD. But,

28.4% of referrals to a tertiary-care mood and anxiety clinic had undetected ADHD.

ADHD was also diagnosed in 22.6% of patients referred to the clinic for treatment-resistant depression.

ADHD vs Undiagnosed ADHD vs Undiagnosed ADHD in Treatment Resistent Depression

Chart of study SSRI Treatment Response may Predict Undetected Attention Deficit Hyperactivity Disorder in Depressed Patients.

Adults who fail to respond to antidepressant therapy may have underlying attention-deficit/hyperactivity disorder (ADHD) and not treatment-resistant depression, as is often assumed, new research suggests.

 Many people with ADHD are getting misdiagnosed with depression and ADHD is getting ignored because medical professionals are STILL often not properly trained on ADHD. The antidepressant medications they’re taking (usually SSRI’s) are not working because they have been misdiagnosed with just depression, vs ADHD and depression.

While you can have depression for standalone reasons, job loss, divorce, death in the family etc, if you have ADHD and do not have it diagnosed and properly treated they ADHD symptoms will often lead to becoming depressed, anxiety disorders or both.

A study on ADHD and Depression by T. Sternat et al. at the START Clinic for Mood and Anxiety Disorders, Toronto, Canada was presented at the Anxiety and Depression Association of America (ADAA) Conference 2016: Abstract S2-10, April 2, 2016. 

Despite evidence that adolescents with a history of ADHD are significantly more likely to develop MDD (Major Depressive Disorder), many clinicians fail to screen adult patients for ADHD during psychiatric assessment.

The aim of this study was to determine the percentage of patients with undetected ADHD referred for treatment of MDD and identify predictive correlates for the presence of treatment-resistance depression (TRD).

Sadly many doctors, psychiatrists and psychologists are not properly trained in medical school/psychology departments on ADHD in adults and children. And their professional bodies and governments refuse to demand they be properly educated on ADHD to give an accurate diagnosis, let alone treatment.

People will present with symptoms of depression, and physicians won’t ask any further questions about their history. They’ll just give them a selective serotonin reuptake inhibitor [SSRI]

So physicians need to screen for premorbid conditions, including ADHD, before making the diagnosis of treatment-resistant depression. 

Tia Sternat, Mood and Anxiety Disorders Program, University of Toronto.

What were some of the predictors that it might be ADHD if the doctor, psychiatrist or psychologist did not bother to properly screen for ADHD like they should because research has conclusively shown so many of us ADDERs have depression and anxiety disorders?

Significant factors that were predictive of the presence of previously undiagnosed ADHD for patients referred to the clinic for treatment-resistant depression again included:

  • the number of diagnosis the patient had received (P = .006)
  • the number of failed medications at intake (P = .005)
  • past SSRI failure (P = .003)
  • the presence of social anxiety disorder (P = .006).

What were the study’s conclusions?

These results support previous findings that ADHD is a significant risk factor for the development of MDD.

This study demonstrated that ADHD is often undetected in adult patients referred for MDD treatment and suggests that SSRI failure is a predictor of patients being diagnosed as TRD.

This signifies the importance of accurate screening for premorbid conditions, and the need for further studies of behavioral and neurobiological markers to direct treatment selection.

It is not new information that children, teens and adults with ADHD have higher rates of depression and dysthymia.

If you fail to properly diagnose ADHD and treat it properly  with multiple methods, those ADHD symptoms will quite often naturally lead to higher rates of anxiety and depression let alone other ADHD-related comorbid conditions.

I’ve been coaching people like me, adults with ADHD since 2003 and I knew about that year’s before I started coaching.

ADHD rarely travels alone, having coexisting or comorbid conditions are the norm with ADHD, not the exception.

Sometimes I coach people who have ADHD and depression IF they are not too depressed to take some action between the ADHD coaching calls.

I help them learn how to manage their ADHD  more effectively, and their doctor or psychiatrist manages their ADHD and Depression medications, their psychologist does cognitive behavioural therapy for depression.

I did a post on this topic 9 years ago. 9 years! Is it depression or ADHD?  I personally know more than 15 people with ADHD who spent a decade or more misdiagnosed with depression or depression and anxiety disorders and were treated with antidepressants and therapy.

When they brought up that they might have ADHD, their doctors, psychologists and psychiatrists rudely dismissed them.

“You can’t have ADHD, you did well in school.” There is a MENSA ADHD special interest group with 600+ members.

“You can’t have ADHD, you’re doing well at work.” There are 3 billionaires who have gone public with ADHD. 

They eventually found someone who was properly trained on ADHD, many are not, got diagnosed and treated for ADHD by people properly trained on ADHD, and then no more depression.

But they had a decade+ of needless suffering due to medical malpractice.

Why should we ADHD adults and children be condemned to such second class treatment?

Go read some of the comments by people on that post.

Clinically, it is necessary to consider the possibility of comorbid depression in individuals diagnosed with ADHD and vice versa.

However, it is important to carefully differentiate between the presence of a depressive syndrome and the presence of depressive symptoms that may arise secondarily to the demoralization or other negative emotional effects experienced by individuals as a consequence of ADHD.

This distinction has important therapeutic considerations.

It sure does. If you’re depressed and or have an anxiety disorder, your doctor will usually prescribe antidepressants. They will boost your serotonin, which will boost your mood, but boosting your serotonin will reduce your level of dopamine, which will reduce your ability to focus which will make your ADHD symptoms worse.

You make your ADHD symptoms worse, they will often lead to more depression and or anxiety. More depression and anxiety will, of course, make your ADHD symptoms worse and you have a vicious cycle than many of us ADDers are doomed to suffer needlessly for years.

Permanently depressed because misdiagnosis. Ignoring ADHD can be costly.

It’s not just depression, adults and children with ADHD have a very high rate of anxiety disorders as well.

of 264 consecutive patients referred to the Anxiety Disorders Clinic in Hamilton, Canada, the prevalence of lifetime ADHD was 37.5% (48.5% male, 51.5% female, p<0.05). “The prevalence of lifetime ADHD was higher in our anxiety disorders clinic than that found in the general population.”

Despite meeting DSM-IV criteria for lifetime ADHD, Van Ameringen noted that most patients in the study had never been given a diagnosis or treatment. 76% (75/99) of those diagnosed with adult ADHD on the MINI had never received a prior diagnosis and only 17.2% had received ADHD treatment before the study.

When will ADHD adults and their families finally start demanding medical professionals become properly trained on ADHD and stop:

  • Underdiagnosing us (biggest problem) 90% of adults with ADHD are undiagnosed.
  • Misdiagnosing us (2nd biggest problem)
  • Overdiagnosing us ( the smallest problem if you read research vs media ADHD stigma click-baiting).

ALL three of those things should imply there is a huge need for governments to mandate and fund the proper training of medical professionals on ADHD in adults and children. Yet that conclusion, which should be screamingly obvious, is almost never mentioned in the lazy ADHD hating media OMG! ADHD is overdiagnosed! Moral panic! Hide the women and children! stigmatization clickbait pieces.

Children and teens had much higher rates of Major Depression and Dysthymia.

A ten-year-old study showed 32.4% of children and teens with Major Depression had ADHD. So not only ADHD was the most common comorbid condition of major depression, more had ADHD and Major Depression than just Major Depression alone!

More people with Major Depression and Dysthymia had ADHD than Generalized Anxiety Disorder!

Why do these medical professionals not automatically screen for ADHD if depression or anxiety disorder are suspected with these numbers?

Of the 188 patients screened, 104 patients (28.4%) had a diagnosis of MD alone, while the remaining had comorbid disorders. ADHD was the most common comorbidity; 125 (34.24%) patients were diagnosed as ADHD (65% were combined type) as well.

Here’s more data from Dr. Atilla Turgay’s research article, I met him at a CADDRA conference many years ago, cool guy, RIP. The data shows the huge rates of ADHD in both major depression and dysthymia.

Major Depression with ADHD In Children and Adolescents Atilla Turgay, MD, and Rubaba Ansari. Psychiatry (Edgmont). 2006 Apr; 3(4): 20–32.

So 34.24% of children and teens with major depression had ADHD.

62.9% of children and teens with dysthymia had ADHD.

Only 8-10% of children and teens have ADHD. With such massive numbers of people with ADHD having both major depression and dysthymia and the costs of depression let alone ADHD, this should cause governments and health care bureaucracies to stop ignoring us and start treating us.

It also shows that if anyone is diagnosed with depression or dysthymia, they should be mandatory that they are automatically screened for ADHD and this should be part of medical professionals protocol.

Here’s a chart of the comorbidity differences in major depression and dysthymic disorder in children and adolescents

Comorbidity Differences In Major Depression In Children And Adolescence Turgay, et al.

Comorbidity Differences In Dysthymia In Children And Adolescence Turgay, et al.

Notice the number one disorder in both cases? ADHD. Is ADHD being taken as seriously as those numbers justify the others by the medical and mental health system? Absolutely not.

Chart of ADHD Comorbidity, age and gender relations, teens 13-18 year olds

Age: 13 to 18 years

Males

Females

Tota

ODD

61.97%

60.54%

61.62%

CD

30.87%

27.89%

30.13%

AD

14.32%

15.65%

14.65%

MD

10.29%

25.17%

13.97%

DD

12.53%

17.01%

13.64%

PDDs

2.46%

2.04%

2.36%

ADHD only

17.23%

12.24%

15.99%

Total

447

147

594

Did you notice how very rare it was for children and teens with ADHD to only have ADHD?

Only 17.23% of male teens with ADHD only had ADHD.

82.77% of male teens with ADHD had at least one other comorbid or co-existing condition.

And even less female teens only had ADHD, 12.24%.

87.76% of female teens with ADHD had at least one other comorbid or co-existing condition.

With such huge numbers of teens with ADHD also having depression, dysthymia, and anxiety disorders, why aren’t doctors and mental health professionals automatically screening people with those conditions for ADHD?

Why aren’t doctors and mental health professionals properly diagnosing ADHD earlier, before teens add on other conditions like depression, dysthymia, and anxiety disorders?

Adults with ADHD had much higher rates of Major Depression and Dysthymia.

Chart of ADHD Comorbidity, age and gender relations, adults

Age: >18 years

Males

Females

Total

MD

35.71%

54.02%

41.08%

AD

14.76%

27.59%

18.52%

DD

12.86%

16.09%

13.80%

ODD

5.24%

3.45%

4.71%

CD

0.48%

3.45%

1.35%

PDDs

0.00%

0.00%

0.00%

ADHD only

36.19%

22.99%

32.32%

Total

210

87

297

KEY—

OCD: obsessive-compulsive disorder. CD: conduct disorder. AD: anxiety disorders. MD: major depression. DD: dysthymic disorder. PDDs: pervasive developmental disorders. ADHD: attention deficit hyperactivity disorder.

Also, just like children and teens with ADHD, it is rare for adults with ADHD to only have ADHD. Most have one or more co-morbid conditions, although a bit less than children and teens.

Only 36.19% of male adults with ADHD only had ADHD.

63.81% of male adults with ADHD had at least one other comorbid or co-existing condition.

Even less female adults with ADHD only had ADHD, 22.9%.

77.1% of female teens with ADHD had at least one other comorbid or co-existing condition.

Both girls and women with ADHD had higher rates of comorbid or co-existing conditions than boys and men with ADHD.

  • 35.71% of ADHD males over 18 had major depression
  • 54.02% of ADHD females over 18 had major depression
  • 12.86% of ADHD males over 18 had dysthymic disorder
  • 17.01% of ADHD females over 18 had dysthymic disorder

It is not just ADHD and depression. ADHD has many other comorbidities and risk factors.

Functional impairment in patient with ADHD compared to those without ADHD.

Functional impairment in patient with ADHD compared to those without ADHD

And those are just some, there are others, girls and women with ADHD have higher rates of all 3 eating disorders.

Society and our medical/mental health system’s neglect of ADHD can be fatal to some ADHD children, teens, and adults.

The rate of self-injurious behavior and suicide is 2 to 3 times higher in children and adolescents with ADHD. The presence of impulsivity and aggression in patients with ADHD may significantly increase the rates of suicide in children and adolescents with MD and ADHD.

So medical professional’s negligence to properly diagnose and treat ADHD could mean increased numbers of children and teens with ADHD killing themselves. (other studies show adults with ADHD also have higher rates of suicidal thoughts and suicide attempts).

It’s not just that medical professionals are often not properly trained to diagnose and treat adults and children with ADHD.

Their professional bodies and healthcare bureaucracies in government refuse to demand that they all get properly trained in diagnosing ADHD in adults and children. Politicians stigmatize us but refuse to ensure we are properly diagnosed and treated. To them, we ADDers are second-class citizens, not worthy of a proper diagnosis.

I and some of the others who work with people with ADHD have been mentioning this for a very long time. When will people start to care enough to do something about this?

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