Females are more likely than males to have complex presentations of ADHD, potentially leading to delayed diagnosis and treatment, according to new research published in the Journal of Attention Disorders. The study found that females with ADHD are more likely than males to have inattentive ADHD, are diagnosed at older ages, and have higher rates of anxiety and depression diagnoses both before and after their ADHD diagnoses. ¹

The retrospective observational study was conducted using data from four U.S. health databases. The researchers sought to explore the relationship between sex as well as ADHD subtype and diagnosis timing. They also hoped to assess whether receiving an ADHD diagnosis had an impact on pre-existing diagnoses of depression and anxiety in women and girls, who receive treatment for these comorbidities at higher numbers.

Age of ADHD Diagnosis Rates by Sex and Subtype

The study revealed:

• The average age of ADHD diagnosis by gender:
  • Females:16 to 29 years
  • Males: 11 to 23 years
• Across both sexes, the average age of diagnosis by ADHD type:
  • Inattentive Type: 17 years to 27 years
  • Hyperactive impulsive Type: 10 years to 20 years
• Females were substantially more likely than males to be diagnosed with inattentive ADHD

How Mood Disorders Fit Into the Diagnostic Picture

• Females were twice as likely as males to have depression or anxiety diagnoses and treatments in the year before their ADHD diagnosis.
• Females were more likely than males to receive new diagnoses or treatments for depression or anxiety in the year following an ADHD diagnosis.
• The number of females with pre-existing depression or anxiety diagnoses with symptoms that did not continue after their ADHD diagnosis was higher than the number of males. In these cases, ADHD may have been misdiagnosed as anxiety or depression.
• Patients with inattentive ADHD were more likely to receive a prior diagnosis of depression or anxiety:
  • Inattentive ADHD: 13% to 18% (depression) and 17% to 26% (anxiety)
  • Hyperactive impulsive ADHD: 5% to 12% (depression) and 9% to 20% (anxiety)

Repercussions of Delayed Diagnosis

The study’s finding that females are diagnosed five years later than males, on average, together with other key data points lead researchers to conclude that diagnoses in females tend to occur “only once ADHD symptoms become more severe,” and underscores the importance of addressing this gap in health equity.

The consequences of undiagnosed ADHD are dire, especially for women.

“Women who live undiagnosed until adulthood experience significant negative outcomes in the areas of self-esteem, social interaction, and psychosocial wellbeing beginning in childhood and continuing into adulthood,” concluded the authors of a systematic review of research published in March 2023. “Women in these studies engaged in less task-oriented coping and more emotion-oriented coping and often turned to recreational drugs, alcohol, nicotine, and sex to self-medicate for symptoms of undiagnosed ADHD.” ²

A female ADDitude reader explains the lived experience of late diagnosis this way: “I have lived with the misleading belief that I was a loser, lazy, incompetent. What are the long-term impacts of these self-defeating beliefs?”

The Complicating Presence of Mood Disorders

The connection between ADHD and mood disorders, including depression, is well-established. According to a recent study in BMJ Mental Health: ³

• People with ADHD are 9% more likely to have MDD
• An MDD diagnosis increases the risk for ADHD by 76%

These findings are echoed in the responses to a recent ADDitude survey of 6,810 adults, which found that 72% reported having anxiety and 62% having reported depression.

In addition to the over-representation of mood disorders among individuals with ADHD, previous research has documented that women in general are twice as likely as men to suffer from MDD and General Anxiety Disorder (GAD).

While rates of mood disorders are unequivocally higher among women with ADHD than either men with ADHD or women without the condition, the new study lends credence to what many women have reported anecdotally: They are also more likely than men to have ADHD initially misdiagnosed as depression or anxiety.

“Because of stigma and thoughts related to gender role presentations, when females do present with ADHD symptoms, it can be thought that it’s more likely due to anxiety or depression, because those are presentations that people are used to seeing in females early on,” explained Dave Anderson, Ph.D., in the ADDitude webinar “ADHD Then and Now: How Our Understanding Has Evolved.” “So, people say, ‘She’s distracted because she’s anxious or sad,’ not because she has ADHD. That’s something that we’re actively trying to fight, even in clinician bias.”

The new study, and research like it, helps shed light on the unique toll exacted on women by ADHD. More investigation is desperately needed, explains Dawn K. Brown, M.D., in the ADDitude article, We Demand Attention! A Call for Greater Research on Women with ADHD.

“Further research regarding these topics is indeed crucial,” Brown explains. “By conducting in-depth investigations into the gender-specific nuances of ADHD presentation and impact, healthcare professionals, policymakers, and advocates can promote greater awareness, understanding, and tailored support for women with ADHD.”

Read on to learn about the Top 10 research priorities detailed in ADDitude’s groundbreaking, cross-platform initiative : We Demand Attention! A Call to Action for Greater Research on Women with ADHD.

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

1. Sex Difference in ADHD
2. The Health Consequences of Delayed ADHD Diagnoses on Women
3. How Hormonal Changes Impact ADHD Symptoms in Women
4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
5. The Elevated Risk for PMDD and PPD Among Women with ADHD
6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

Sources

¹  Siddiqui, U., Conover, M. M., Voss, E. A., Kern, D. M., Litvak, M., & Antunes, J. (2024). Sex Differences in Diagnosis and Treatment Timing of Comorbid Depression/Anxiety and Disease Subtypes in Patients With ADHD: A Database Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547241251738

²  Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders, 27(7), 645-657. https://doi.org/10.1177/10870547231161533

³  Meisinger, C. & Freuer, D., (2023) Understanding the Causal Relationships of Attention Deficit/Hyperactivity Disorder with Mental Disorders and Suicide Attempt: A Network Mendelian Randomisation Study. BMJ Mental Health. doi.org/10.1136/bmjment-2022-300642

When administered at carefully selected dosages in clinical settings, and combined with therapy before and after treatment, psychedelics have been found to provide rapid relief from some of the most painful and difficult-to-treat mental health conditions. Ketamine is being used for depression and suicidality in clinical trials. MDMA is treating severe post-traumatic stress disorder (PTSD), and psilocybin is being used for treatment-resistant depression, alcohol use disorder, and more.

However, important questions remain about the long-term efficacy and safety of psychedelics, as well as patient suitability. Several large-scale studies are now under way to address these concerns, including the first-ever phase 3 clinical trial on psilocybin-assisted therapy — the largest randomized, controlled, double-blind study on the drug, with more than 800 participants. Initial results are expected this summer.

How Do Psychedelics Work?

Research shows that psychedelics improve many neuropsychiatric disorders, but the way they work is less clear. Functional MRIs and laboratory studies offer possible explanations:

• Ketamine binds to NMDA receptors in the brain, increasing levels of a mood-regulating neurotransmitter called glutamate.¹
• MDMA increases oxytocin, dopamine, and other chemical messengers related to positive emotions.²
• Psilocybin stimulates the brain’s serotonin 2A receptors, appearing to decrease activity across the default mode network.³

But these biochemical explanations don’t tell the full story, says Gül Dölen, M.D., Ph.D., professor of psychology and researcher at University of California Berkeley’s Center for the Science of Psychedelics. Psychedelics only reliably improve psychiatric conditions when administered with therapy. “Therapy is the context to get the cure,” Dölen explains. “You can’t take MDMA and go to a rave and expect it to cure your PTSD.”

Indeed, when taken on their own, psychedelics aren’t hugely effective, according to studies; therapy unlocks the drugs’ enduring benefits. Also, there are serious risks to taking the drugs without medical supervision.

[Read: The Truth About Lion’s Mane, Psychedelics & Caffeine]

A Brand-New Framework

Most psychiatric medications must be taken daily, often for a lifetime. By contrast, a single dose of certain psychedelics paired with therapy can result in full-blown remission. This claim appears too good to be true when viewed through the traditional “biochemical imbalance” model of neuropsychological disease that has dominated the field for the past 50 years. “The idea is that depression, for example, is a biochemical imbalance in serotonin,” Dölen says. “So, we’ll restore serotonin levels with a pill, and you’ll get better.”

But what if there were an approach that treated depression by restoring the fundamental ability to learn (and unlearn) behaviors and ways of thinking, and not by raising serotonin levels? It’s an entirely different framework for understanding neuropsychiatric disorders — the learning model — and Dölen says it’s the best way to comprehend how psychedelics work.

Psychedelics act like master keys unlocking what scientists call “critical periods” of learning—specific times when individuals have a heightened ability to soak in new information. During brain development, these are the critical windows in which we acquire vision, language, motor development, and more. And after these critical windows close, they remain locked.

Or so we thought.

Psychedelics Restore Child-Like Learning

In a study that involved giving mice MDMA, Dölen found that the drug unlocks a critical period for social reward learning, restoring adult mice to child-like levels of openness for social development.⁴ Dölen’s next study uncovered the potential of all psychedelics—including LSD, psilocybin, ketamine, and ibogaine—to open these critical periods.⁵

[Watch: “Psychedelic Therapy for Mood Disorders: Research & Potential”]

“This is a big deal,” says Dölen. “And if it’s true, it’s going to revolutionize things, but only if we understand what a critical period is. It’s not that you take a pill and you speak Japanese. It’s that you take a pill and you restore the ability to learn Japanese.”

The drugs open the mind to learning. The therapy provides the learning itself.

“Patients talk about how they had an epiphany, how the trip enabled them to see how they’d built their lives around a foundational myth that wasn’t true, whether about their relationship to other people, their personality, their deserving to be in the world,” Dölen says. The post-trip therapy, in turn, allowed them to identify how that myth led to maladaptive ways of interacting with the world, and understand how to integrate that knowledge into their daily lives.

The potential of psychedelics to re-open critical periods has far-reaching implications. Dölen’s lab is exploring the possibilities of treating conditions like stroke and blindness with psychedelics through a project called PHATHOM (Psychedelic Healing: Adjunct Therapy Harnessing Opened Malleability).

“Psychedelics are not going to be the magic bullet that fixes everything, but we’re excited about the possibilities,” Dölen says. “Being able to restore child-like learning is a major therapeutic opportunity.”

Psychedelics Therapy and Mental Health: Next Steps

• Self-Test: Symptoms of Depression in Adults
• Free Download: Signs of Depression That May Surprise You
• Read: Real Stories of Using Ketamine for Depression, Anxiety, PTSD

Nicole C. Kear is Consumer Health Editor at ADDitude.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Matveychuk D, Thomas RK, Swainson J, Khullar A, MacKay MA, Baker GB, Dursun SM. Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers. Ther Adv Psychopharmacol. 2020 May 11;10:2045125320916657. doi: 10.1177/2045125320916657. PMID: 32440333; PMCID: PMC7225830.

² Mitchell, J.M., Bogenschutz, M., Lilienstein, A. et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med 27, 1025–1033 (2021). https://doi.org/10.1038/s41591-021-01336-

³ Smausz R, Neill J, Gigg J. Neural mechanisms underlying psilocybin’s therapeutic potential – the need for preclinical in vivo electrophysiology. J Psychopharmacol. 2022 Jul;36(7):781-793. doi: 10.1177/02698811221092508. Epub 2022 May 30. PMID: 35638159; PMCID: PMC9247433.

⁴ Nardou, R., Lewis, E.M., Rothhaas, R. et al. Oxytocin-dependent reopening of a social reward learning critical period with MDMA. Nature 569, 116–120 (2019). https://doi.org/10.1038/s41586-019-1075-9

⁵ Nardou, R., Sawyer, E., Song, Y.J. et al. Psychedelics reopen the social reward learning critical period. Nature 618, 790–798 (2023). https://doi.org/10.1038/s41586-023-06204-3

Q: “What are the causes of postpartum depression? As an expectant parent with ADHD, what should I know about factors that increase risk for postpartum mood disorders? How can I protect myself after I have my baby?”

The causes of postpartum depression (PPD) and postpartum mood disorders are complex and combine differing sources for different people. These sources are not always fully understood. Genetic and biological factors, including dramatic hormonal fluctuations after birth, are thought to play a major role. However, hormones or biology alone do not fully explain why someone might develop a postpartum mood distress or disorder. While no parent is immune to developing PPD or other postpartum mood disorders, the following psychological and psychosocial factors are known to increase risk for these conditions: ^{1 2 3 4}

• a history of depression or anxiety
• experiencing depressive/anxious/high stress symptoms during pregnancy
• a history of trauma
• a history of significant mood changes during menstruation
• a history of significant reactions to sleep deprivation
• an unwanted pregnancy
• a lack of social supports, particularly stress in a primary parenting partner relationship
• social isolation
• a lack of access to basic needs
• low socioeconomic status

[Take This Self-Test: Signs of Postpartum Depression]

Black women and individuals of other ethnic and racial groups who have been historically under-resourced and overlooked also face higher risk for postpartum depression, largely because of expressed concerns not being adequately tended to by the helping professions. ^{5 6}

The ADHD-Postpartum Depression Link

Recent studies show that ADHD is a risk factor for PPD. A 2023 study found that mothers with ADHD, even those without a history of depression, are 24% more likely to be diagnosed with PPD than are mothers without ADHD.⁷ This link may be partly explained by increasing rates of first-time diagnosis of ADHD among adults, and among women in particular of childbearing age ⁸, which is likely contributing to better identification of individuals with ADHD who have developed postpartum depression.

Another 2023 study of more than 773,000 women who gave birth found that about 25% of women with ADHD were diagnosed with anxiety disorders postpartum compared to 4.6% of women without ADHD. In addition, about 17% of women with ADHD had PPD compared to 3.3% of women without ADHD.⁹ Researchers are still working to understand what underscores the disproportionate link between postpartum depression and ADHD. Both ADHD and postpartum depression and anxiety disorders represent challenges in self-regulation.

Frequent Screenings Are Key for Postpartum Parents

Though about one in eight women or birthing parents — and as many as one in 10 fathers or caregiving partners — develop a postpartum mood disorder, ^{6 10} these conditions are still largely overlooked. In a live ADDitude webinar poll, about 70% of respondents said their doctor missed their symptoms of postpartum depression. In a separate poll, about 45% of ADDitude readers said they wouldn’t be able or aren’t sure if they’d be able to identify postpartum depression in themselves or in others.

[Free Download: The Facts About Major Depressive Disorder in Women]

Frequent screenings are the most powerful tool for early detection of PPD and other postpartum mood disorders. Early detection is important to curb the development of severe forms of postpartum mood disorders. While postpartum mood disorders typically onset within three weeks of a child’s birth, they can develop through the first postpartum year. Screenings, therefore, should occur all through the first year after childbirth. Like most women and birthing parents, you likely won’t see your OB-GYN after your six-week postpartum appointment. In that case, your primary care provider and pediatrician should screen you.

At the same time, it’s critical that you know the signs of PPD and other postpartum mood disorders. Do not wait to talk to your doctor(s) if you think you show any of the signs. Insist on formal screeners, especially if you have a risk factor for PPD.

Postpartum Depression: Next Steps

• Free Download: Hormones & ADHD in Women
• Read: Postpartum Care for Mothers with ADHD
• Read: Healing Through Parenting — The Key to Postpartum Depression Recovery

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Unspoken Truths of Postpartum Depression: Help for Women With and Without ADHD” [Video Replay & Podcast #470] with Jayne Singer, Ph.D., IECMH-E®, which was broadcast on September 7, 2023.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Stewart, D. E., & Vigod, S. N. (2019). Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics. Annual Review of Medicine, 70, 183–196. https://doi.org/10.1146/annurev-med-041217-011106

² Beck C. T. (2002). Revision of the postpartum depression predictors inventory. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN, 31(4), 394–402. https://doi.org/10.1111/j.1552-6909.2002.tb00061.x

³ Buttner, M. M., Mott, S. L., Pearlstein, T., Stuart, S., Zlotnick, C., & O’Hara, M. W. (2013). Examination of premenstrual symptoms as a risk factor for depression in postpartum women. Archives of Women’s Mental Health, 16(3), 219–225. https://doi.org/10.1007/s00737-012-0323-x

⁴ Choi, K. W., Houts, R., Arseneault, L., Pariante, C., Sikkema, K. J., & Moffitt, T. E. (2019). Maternal depression in the intergenerational transmission of childhood maltreatment and its sequelae: Testing postpartum effects in a longitudinal birth cohort. Development and psychopathology, 31(1), 143–156. https://doi.org/10.1017/S0954579418000032

⁵ Onyewuenyi, T. L., Peterman, K., Zaritsky, E., Ritterman Weintraub, M. L., Pettway, B. L., Quesenberry, C. P., Nance, N., Surmava, A. M., & Avalos, L. A. (2023). Neighborhood Disadvantage, Race and Ethnicity, and Postpartum Depression. JAMA network open, 6(11), e2342398. https://doi.org/10.1001/jamanetworkopen.2023.42398

⁶ Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo Mph, D. V., Warner, L., Folger, S., Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression – United States, 2018. MMWR. Morbidity and mortality weekly report, 69(19), 575–581. https://doi.org/10.15585/mmwr.mm6919a2

⁷ Bartelt K, Piff A, Vitek G, Barkley E. Maternal ADHD Correlated with Increased Risk of Postpartum Depression. Epic Research. https://epicresearch.org/articles/maternal-adhd-correlated-with-increased-risk-of-postpartum-depression.

⁸ Russell J, Franklin B, Piff A, Allen S, Barkley E. Number of ADHD Patients Rising, Especially Among Women. Epic Research. https://epicresearch.org/articles/number-of-adhd-patients-rising-especially-among-women. Accessed on March 18, 2024.

⁹ Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069

¹⁰ Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA, 303(19), 1961–1969. https://doi.org/10.1001/jama.2010.605

Postpartum Depression: Key Takeaways

• Postpartum depression is characterized by significant emotional challenges that affect the parent-child bond.
• Hands-on parenting, not separation, is essential in powering recovery from postpartum depression and in repairing bonds.
• Self-care and other coping strategies are an important part of postpartum depression recovery.

The Fourth Trimester: What No One Talks About

The first few months after a baby is born — sometimes called the “fourth trimester” — is a critical time for the emerging parent-infant relationship. You and your newborn are rapidly adjusting to a new way of life, a reality that is often complex and unexpected.

• You may feel ambivalent. We’re told that pregnancy and parenthood should be happy and joyous, but experiencing mixed feelings after a baby arrives is common — and normal. You might well not feel the rush of falling in love that you might have expected.
• You may have held unrealistic expectations of your baby. There may be a disconnect between the baby you imagined or wished for and the baby in front of you.
• You may feel overwhelmed. Like many expectant parents, you might have imagined your new baby smiling and cooing all the time. But newborns more often cry and fuss and sleep as they learn to regulate (and do so with help from parents). The round-the-clock care babies require, which invariably disrupts sleep and daily routines, is a major adjustment for any parent.
• You may feel worried about your baby’s health and wellbeing, about your emotions about your baby, and your emerging parenting skills.
• You are likely sleep deprived. You are learning to care for a newborn during a period of acute disruption of your sleep.
• You may feel discouraged. Especially if your baby is fussy or requires special caregiving needs, you may struggle with feeling successful as a parent and emotionally attached to your baby.
• You may feel under pressure to return to work and make childcare decisions and arrangements.
• There may be friction in the parenting partnership or lack of partnership if you’re a single parent.

These common factors — combined with dramatic hormonal fluctuations following childbirth — can increase risk for postpartum depression (PPD) during this critical stage.

Characterized by persistent and acute feelings of sadness, guilt, irritability, anxiety, and lethargy — well beyond the baby blues — PPD is a condition that interferes with your wellbeing and how you bond with your baby. It is important for your health and wellbeing – and the healthy development and wellbeing of your baby – for you to seek and accept help. You deserve relief!

PPD is treatable, and a major aspect of recovery happens by virtue of the parent-infant relationship. Getting help from others for the care of your baby is crucial in the newborn period, especially if you are experiencing signs and symptoms of PPD. But it is also very important to spend time with your baby as well, since your relationship with your little one will help you recover from distress. With PPD, this process deserves support.

[Take This Self-Test: Could You Be Experiencing Postpartum Depression?]

Postpartum Depression Treatment: Parenting Is Essential to Healing

PPD and other postpartum mood disorders affect neural pathways responsible for driving parenting and attachment behaviors. This explains, in part, why you may have trouble bonding with your baby.

Too often, parents recovering from PPD believe they must distance themselves from their baby because they’ve been told PPD is “not good” for the child. Such messaging can feel devastating to a new parent, especially if you already struggle to feel close to your baby and have low confidence in your parenting.

While separation may be initially required for parents experiencing severe PPD (especially with postpartum psychosis), reunification should happen as quickly as possible. Parenting should never be separated from the PPD healing process, as active involvement in caregiving has the potential to “reset” the brain.¹ Your chances of experiencing positive, successful parenting moments — which are key to repairing bonds with your baby and raising confidence in yourself as a caregiver — can only happen through interaction.

Working with a healthcare provider who specializes in parent-infant or dyadic therapy in PPD is especially helpful. Your provider can facilitate “moments of meeting,” typically through your baby’s behaviors, that bring you closer and rewire the way you see your baby.

[Read: Postpartum Care for Mothers with ADHD — A Guide for Clinicians]

Especially if you’re recovering from acute PPD, you may require extra support for navigating the demands of parenting and of your own healing. Your provider may help you with self-regulation so you can support your baby’s regulation. You may learn how to soothe your baby, so they are available for social engagement, opening the way for those crucial moments of bonding that allow you to feel the joy in parenting to which you — and your baby – are entitled.

Postpartum Depression Treatment: Additional Coping Strategies

Your provider may have prescribed medications and/or therapy as part of your PPD treatment. As you recover from PPD, make sure the following strategies also become part of your healing process:

• Find peer support. Connect with at least one other parent who is experiencing or has experienced PPD or a postpartum mood disorder. Reflecting upon and sharing your experience with PPD and how it has affected you can be immensely healing.
• Engage in physical activity and movement, focus on nutritious meals, and stay hydrated. These are all cornerstones of the healing process.
• Establish routines and rituals to bring structure and order into your family’s life.
• Manage stress by engaging in mindfulness practices, breathing/relaxation exercises, and joyful activities, among other healthy habits.
• Sleep is vital to prevent symptoms of PPD from worsening. Understandably, sleep is scarce when caring for a baby. Know that your baby can become accustomed to bedtime routines and rituals as soon as they leave the hospital. A soothing bedtime routine can help your child move toward longer stretches of sleep, which can help you avoid sleep deprivation — a critical step in your recovery.

Postpartum Depression and Parenting: Next Steps

• Free Download: The Facts About Major Depressive Disorder in Women
• Read: Postpartum Mood Disorders — Do You Know the Early Signs?
• Research: ADHD Increases Risk for Postpartum Depression, Anxiety
• Watch: The Unspoken Truths of Postpartum Depression

Additional Resources

• Postpartum Support International
• MGH Center for Women’s Mental Health
• Postpartum Progress
• The Seleni Institute
• La Leche League International

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Unspoken Truths of Postpartum Depression: Help for Women With and Without ADHD” [Video Replay & Podcast #470] with Jayne Singer, Ph.D., IECMH-E®, which was broadcast on September 7, 2023.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

¹ Pajulo, M., & Kalland, M. (2013). Mentalizing-based intervention with mother-baby dyads. In N. E. Suchman, M. Pajulo, & L. C. Mayes (Eds.), Parenting and substance abuse: Developmental approaches to intervention (pp. 282–302). Oxford University Press. https://doi.org/10.1093/med:psych/9780199743100.003.0014

Yes, our research group found that women with ADHD were five times more likely to develop depression following use of combined hormonal oral contraceptives (i.e., pills that contain both estrogen and progesterone) than were women without ADHD who were not on these pills.¹ We came to these findings after comparing Swedish national register data of roughly 30,000 girls and young women with ADHD to more than 760,000 neurotypical peers in a control group.

More highlights from this study:

• Women with ADHD who used combined oral hormonal contraceptives (HC) or progestogen-only pills had more than five times the risk for depression compared to women without ADHD who did not use hormonal contraceptives of any kind.
• Women with and without ADHD who used non-oral preparations, such as the implant or hormonal IUD, had similar risk for developing depression, meaning that having ADHD did not change the association between the non-oral HC and the risk for depression.
• Irrespective of hormonal contraception use, women with ADHD had a 3-fold higher risk of developing depression compared to women without ADHD.

[Get This Free Download: Hormones & ADHD in Women]

What could explain the increased risk for depression among women with ADHD who take birth control? The way we see it, it’s probably not the hormones in oral contraceptives, per se, that place women with ADHD at greater risk. After all, there was no difference between combined pills (with estrogen and progesterone) and progestogen-only pills in this group.

What we think may be happening is this: When taking oral birth control, women with ADHD, due to their ADHD, might be extra susceptible to forget to take their birth control pills or may take them irregularly, causing hormonal fluctuations that may destabilize mood. Also, a woman’s hormonal levels will fluctuate during assumed pill-free intervals. As we know from the few studies on this, as well as anecdotal evidence, women with ADHD may be especially sensitive to changing hormonal levels.

In addition, poor adherence to birth control pills is also known to increase the risk of experiencing side effects like irregular bleeding, mood changes, and unplanned pregnancy, which may further increase anxiety and place susceptible women at increased risk for depression. If this is the case, women with ADHD may be better off using long-acting non-oral products like IUDs and contraceptive implants, which take working memory out of the equation and make for a more stable experience.

As you continue to find a birth control method that works for you, be sure to talk to a doctor who is knowledgeable about ADHD in women, especially one who understands the role hormonal fluctuations play in ADHD symptoms and overall mental health.

Hormones, Depression, and ADHD: Next Steps

• Read: Hormonal Changes & ADHD — A Lifelong Tug-of-War
• Read: What’s Behind the “Depression Gap” Impacting Women?
• Watch: Hormonal Fluctuations and ADHD — How Estrogen May Impact Symptoms Throughout Life

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “The Emotional Lives of Girls with ADHD” [Video Replay & Podcast #488] with Lotta Borg Skoglund, M.D., Ph.D., which was broadcast on January 23, 2024.

ADDitude readers: Sign up to access LetterLife, an app by Dr. Lotta Borg Skoglund that provides users with personalized insights — on hormonal cycles, ADHD symptoms, and lifestyle factors — to better manage ADHD.

Use the discount code ADDWEB20 to get 20% off Dr. Skoglund’s book, ADHD Girls to Women, when purchased via uk.jkp.com.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Lundin, C., Wikman, A., Wikman, P., Kallner, H. K., Sundström-Poromaa, I., & Skoglund, C. (2023). Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 62(6), 665–674. https://doi.org/10.1016/j.jaac.2022.07.847

High-intensity exercise treats depression as effectively as do cognitive behavior therapy (CBT) and medication, according to a new study that found combining SSRIs, a type of antidepressant, with exercise improved depressive symptoms more than medication alone.¹

The systematic review and meta-analysis led by a research team from the University of Queensland, Australia, found that the more intense the physical activity, the more effective it was at managing depression. More specifically, vigorous exercises (e.g., running, interval training, strength training, mixed aerobic exercise) reduced depression symptoms in participants more than light physical activity (e.g., walking and hatha yoga), although the latter did provide some benefit.

These findings emerged from examinations of 218 randomized controlled trials, including 14,170 participants diagnosed with depression, to determine the effectiveness of exercise, psychotherapy, and antidepressants in treating depression.

When the researchers narrowed their analysis by demographics, they discovered that strength training and cycling positively impacted more women than men, and yoga or qigong provided more benefits to men than women. Yoga appeared more effective among older adults, and younger adults received better results from strength training. The duration and frequency of exercise did not affect the results.

The study also suggested that men appeared to benefit more than women from combining yoga, Tai Chi, or aerobic exercise with psychotherapy. Yoga and aerobic exercise combined with psychotherapy seemed more effective among older adults.

Participants gained the most benefits from group classes or scheduled exercises. The more autonomy participants had over their exercise programs, the weaker the outcome. “When provided with more freedom, the low self-efficacy that is symptomatic of depression may stop patients from setting an appropriate level of challenge (e.g., they may be less likely to choose vigorous exercise),” the study’s authors wrote.

The researchers cautioned that definitive conclusions are impossible to draw, and more studies are needed. “Our review did not uncover clear causal mechanisms, but the trends in the data are useful for generating hypotheses,” they wrote. “It is unlikely that any single causal mechanism explains all the findings in the review.”

“Exercise should be considered alongside traditional interventions as a core treatment for depression,” report author Michael Noetel, Ph.D., said in a press release. “No matter how often people exercised, whether they had other health issues or how severe their depression was, in all scenarios, exercise had a meaningful impact on their depression. Of course, anyone getting treatment for depression should talk to their doctor before changing what they are doing, but most people can start walking without many barriers.”

Exercise and Depression

Members of ADDitude’s reader panel confirm several findings from the study published in The BMJ (British Medical Journal).

“Strenuous full-body aerobic activities like boxing, karate, swimming, or boulder climbing help me get my thoughts in the right place and boost my mood and energy,” one panelist wrote. “Physical activity also helps me fall asleep and feel less stressed overall.”

“Running helps with my anxiety and depression,” another reader said. “It’s like a vacation for my overstimulated brain.”

A recent retiree who goes to the gym six days a week for group fitness classes and strength training sessions with a personal trainer shares that physical activity helps him feel calmer and more focused. “Exercise gives me a sense of accomplishment and community,” he says. “It is truly my second medication.”

Exercise Benefits Children and Teens with ADHD

The benefits of physical activity are not limited to adults; exercise improves the mental health of children and adolescents with neurodevelopmental disorders (NDDs), including ADHD, learning and motor disorders, autism spectrum disorder (ASD), and intellectual disability, according to a recent systematic review and meta-analysis published in JAMA Pediatrics.²

The researchers found that high-frequency (more than 27) 40-minute sessions of physical activity significantly benefited cognitive function, psychological well-being (e.g., self-esteem, quality of life), internalizing (e.g., anxiety and depression), and externalizing (e.g., aggression and disruptive behavior disorders) behaviors in children and adolescents aged 5-17 years with NDDs. They examined 59 studies with more than 3,000 participants.

ADDitude caregivers recognized similar results from their children after participating in physical activities.

One reader takes their son to the YMCA at least three times per week. “Depression can really take hold of my 10-year-old son,” the parent said. “We see great improvements after physical activity. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

“My daughter has been playing hockey since she was young,” a reader said. “She says she can slow her brain down when she’s on the ice and think more clearly, and it’s as if her ‘ADHD evaporates.’”

“Intense cardio activities, like cross-country skiing and soccer, help my son burn off some of his boundless energy, and he gains self-confidence by being good at something nonacademic,” a reader said.

Another reader said, “My oldest is a distance runner. He is committed and gets up early to run his miles or workout. Running gives him that needed dopamine hit to keep his ADHD symptoms under control at the start of the school day.”

Incorporating Exercise in Depression Treatment Plans

A 2023 treatment survey of 11,000 ADDitude readers reaffirms both studies’ findings. Roughly half of the respondents who use this treatment rated exercise as “extremely” or “very” effective. A staggering 94% of caregivers and 95% of adults recommend exercise to treat ADHD symptoms. Yet only 13 % of these respondents said a doctor had recommended exercise to reduce symptoms, and only 37% of all respondents said physical activity was part of their treatment plan.

The BMJ study encourages clinicians to consider exercise a viable alternative to drug treatment or adjuvant for those already taking medication. “The findings support the inclusion of exercise, particularly vigorous exercise, in clinical practice guidelines for depression,” they wrote. “This may help bridge the gap in treatment coverage by increasing the range of first-line options for patients and health systems.”

Sources

¹Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D. et al. (2024). Effect of Exercise for Depression: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. BMJ. doi:10.1136/bmj-2023-075847.

²Liu C, Liang X, Sit CHP. (2024). Physical Activity and Mental Health in Children and Adolescents with Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis. JAMA Pediatr. doi:10.1001/jamapediatrics.2023.6251.

The trauma of an early birth is incredibly extreme. It’s being thrust onto a high-speed, rickety roller coaster with dangerous ups and downs. My baby was tiny, but he was breathing. Around a sharp turn we went as we were immediately separated after birth. The intensity of the separation was so great, it could have shattered me into a million pieces right there. He was perfectly proportioned – up, up, up – but he needed life support – down, down, down. He was a fighter, but we’d plummet as he’d battle infections. He needed so many blood transfusions. He had a good heart, but some other organs were underdeveloped. His lungs constantly collapsed. There were times when we almost derailed completely, like when he’d turned blue in my hands. Like all the times when his heart almost stopped.

The chaos during his time in the NICU never ceased. But each and every day, I was able to be there for my tiny human because I concentrated so intently on him, a phenomenon that has a name, I learned much later on – hyperfocus – and is part of ADHD.

My Son’s Survival: The Object of My Hyperfocus

So intense was my concentration that I was able to retain a barrage of new medical information, administer medicines and feeds, pump milk, sing to him, read to him, advocate for him, and fight for him even when the prognosis looked dire. One of the doctors in the NICU even asked me if I was in the medical field, too. No, I just know how to concentrate when needed and learn everything possible about a situation. My son’s survival became the object of my hyper focus. There was nothing that could derail me.

Even when he was finally discharged after a long four-month hospital stay, with prongs and adhesives on his little face, I still hyperfocused through this new winding valley. After all, there were many medications to prepare and administer, oxygen concentrators and portable tanks to adapt to, and endless invasive and painful appointments and surgeries. Through it all, I researched every aspect of his diagnoses and care, how to help him heal, and how to prepare him for what was to come.

[Read: A Playbook for Post-Traumatic Growth]

The Hyperfocus Comedown

I was in a daze when I disembarked from the rickety roller coaster of the NICU. Absorbed by my son’s health and all things relating to prematurity, I had tuned out the world around me, even myself.

Used to communicating with nurses, doctors, and others in the NICU, I had to re-learn how to communicate with others who were outside of this world. I learned the hard way (as is my tendency) that not everyone wants to hear about our journey not because they’re disinterested, but because talking about trauma makes others acutely uncomfortable. Hyper focusing on the particulars of my son’s health, it seemed, almost detached me from the pain of this harrowing experience.

The aftermath of months of hyper focus was a rubble of burnout, depression, confusion, unhealthy coping mechanisms, and loss of self-worth. My introduction to motherhood had been as a bystander. I was a nurse and an advocate for my son, but I still had to learn how to be his mother, which brought me so much guilt. I was drowning.

I drew upon all the strategies I could muster from years of therapy. I reached out to others, I asked for help, for company — even just a cup of coffee. Some told me that I was “too much” while others didn’t seem to take me seriously because I seemed fine enough.

[Read: The Good, the Bad, and the Ugly of Hyperfocus]

If I didn’t do something, I knew I’d be at the bottom of the ocean quickly.

So, once again, I grabbed on to my hyperfocus wire. I researched and researched all things medical trauma and traumatic birth, and I came out on the other end with diagnoses of post-traumatic stress disorder (PTSD), postpartum depression (PPD) and ADHD.

I found a community group that sent volunteers around a few times a week to just sit with me, have a cuppa, and hold the baby while I took a shower. Such simple things gave me the space to breathe and finally steady my feet enough to get the help I needed.

Hyperfocus Saved Me – and My Child

When I’ve hyperfocused previously – before I knew it had a name – it was often a draining experience that, like other aspects of my neurodivergent brain, was hard for me to understand and embrace.

But after my diagnoses, I have a greater understanding of how my brain works, and more grace for myself and what I’ve journeyed through. The ability to hyperfocus, as I now know, can be an incredible strength. I’m thankful that my resilient neurodivergent brain forged a pathway through trauma and saved me and my little human.

Birth Trauma and ADHD: Next Steps

• Take This Self-Test: Signs of Postpartum Depression
• Free Download: The Facts About Major Depressive Disorder in Women
• Read: Postpartum Care for Mothers with ADHD
• Subscribe: The ADDitude Newsletter for Women with ADHD

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The therapeutic potential of psychedelic drugs for treatment-resistant conditions including mood disorders has sparked renewed interest among researchers, psychiatrists, and patients. New research and ongoing clinical trials are shedding light on the safety and efficacy of these substances, used in controlled therapeutic settings, for conditions that have been challenging to treat using conventional methods. A growing body of research indicates that several classical psychedelics and “psychedelic-like” compounds (e.g. psilocybin, ketamine, MDMA, and LSD) have shown promise for the treatment of substance use disorders, post-traumatic stress disorder (PTSD), anxiety disorders, and treatment-resistant depression (TRD). Some psychedelic treatments, such as MDMA-assisted psychotherapy for PTSD, are currently undergoing phase 3 clinical trials, indicating a significant level of scientific and medical interest in their potential therapeutic applications.

In this webinar, you will learn about:

• The history of psychedelic therapy and its research
• The science behind how psychedelic compounds may be targeting clinical conditions, like major depressive disorder
• The possible benefits and side effects of using psychedelics to conditions after other conventional therapies have failed
• What questions to ask when considering psychedelic usage in a clinical setting for yourself or loved ones

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Treatment for Mood Disorders: More Resources

• Download: Solving the Bipolar and ADHD Puzzle
• Self-Test: Depression in Adults
• Read: Mental Health’s Psychedelic Revolution
• Get: 9 Conditions Often Diagnosed with ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on April 23, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Adrian Jacques H. Ambrose, M.D., MPH, MBA, FAPA, is the Senior Medical Director at ColumbiaDoctors Psychiatry at Columbia University Irving Medical Center. For over a decade, Dr. Ambrose has also served as a senior consultant in designing national and global programming in strategy, management, and operations implementation for mid-to-large-sized entities, including Fortune 500 companies. In addition, he specializes in cultivating psychological safety, team building, and culture acceleration for senior managers and executives.

Clinically, Dr. Ambrose specializes in treatment-refractory mood disorders for both the adult, child, and adolescent populations in interventional and novel therapeutics, such as neuronavigated TMS, ketamine, and psychedelics.

Dr. Ambrose completed his medical training at Dartmouth and MGH/McLean Hospital, and value-based healthcare training at the Dartmouth Institute for Health Policy. He also completed the Minority Health Policy Fellowship at Harvard Medical School.

Listener Testimonials

“Excellent information and points about balancing the potential therapeutic uses with the clinical evidence at the moment.”

“Thank you for providing so much info for practitioners! It is very helpful.”

“Great speaker! I would definitely take another of his courses!”

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ADHD doesn’t travel alone. Most teens with ADHD also have a co-occurring condition like anxiety or depression. Sometimes the co-existing condition is a result of the ADHD, and other times it operates alongside ADHD.

When a patient presents these conditions together, it can create a varied clinical picture because each diagnosis impacts, and is impacted by, the other. This can sometimes lead to misdiagnosis or inadequate treatment for at least one condition. The challenge in diagnosis and treatment can also be complicated by puberty.

In this webinar, you will learn:

• The symptoms of depression and anxiety disorders, and how to distinguish them from ADHD and normal child and adolescent development
• How depression or anxiety affects ADHD symptoms
• How ADHD can actually lead to, or affect, depression and anxiety
• How to devise a treatment plan when ADHD exists alongside anxiety or depression

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Depression, Anxiety, & ADHD in Teens: More Resources

• Download: A Parent’s Guide to Depression in Teens
• Replay: The ADHD-Depression Connection in Adults with Dr. Roberto Olivardia
• Learn: Why Anxiety Disorder Is So Often Misdiagnosed
  
• Q&A: New Approaches to Treating Depression and ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on April 9, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Roberto Olivardia, Ph.D., is a Clinical Psychologist and Clinical Instructor of Psychology at Harvard Medical School. He maintains a private psychotherapy practice in Lexington, Massachusetts, where he specializes in the treatment of attention deficit hyperactivity disorder (ADHD), executive functioning issues, and issues that face students with learning differences.

He also specializes in the treatment of Body Dysmorphic Disorder (BDD), Obsessive-Compulsive Disorder (OCD) and in the treatment of eating disorders in boys and men. He is co-author of The Adonis Complex, a book which details the various manifestations of body image problems in men. (#CommissionsEarned) Read more here.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“All of the webinars are very good. This was one of the best!”

“A fantastically rich and engaging presentation! I firmly believe that I’m now significantly better informed of the interaction and distinctions between anxiety, depression, and ADHD. Thank you, Dr. Olivardia and ADDitude!”

“Good info and good mention of cannabis findings at the end as a surprise inclusion. Did not know any of that.”

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Play Attention: ADHD and Executive function challenges can lead to anxiety, and this anxiety can further impair executive functioning by affecting the brain’s processing and decision-making abilities. That’s why Play Attention offers a personalized program designed to enhance executive function and improve self-regulation. Backed by research from Tufts University School of Medicine, Play Attention empowers individuals to improve attention, emotion regulation, and overall performance. Our NASA-inspired technology ensures tailored support for every aspect of life. Take our ADHD test or schedule a consultation to start your journey toward improved executive function and emotion regulation with Play Attention. Call 828-676-2240. www.playattention.com

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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The number of clinics offering infusions of ketamine — the only psychedelic that is legal nationwide — has exploded. Research on the drug known as ecstasy, or MDMA (3,4-methyl-enedioxymethamphetamine), has shown such promise for treating severe PTSD that pharmaceutical companies are preparing to seek FDA approval.¹ Experts say psilocybin, the psychoactive ingredient in magic mushrooms that has shown efficacy for treatment-resistant depression,² may not be far behind.

Used under medical supervision and paired with pre- and post-drug therapy, these psychedelics have been life-changing in alleviating symptoms for many patients. Bob, an ADDitude reader in Arizona, took part in a clinical trial involving psilocybin for obsessive-compulsive disorder (OCD). “I have not had OCD symptoms since I finished the trial over a year ago,” he says.

Bob has also been receiving ketamine treatments for depression, anxiety, ADHD, and complex PTSD. He says the treatments have been more effective than cognitive behavioral therapy and prescription antidepressants, and without the “difficult side effects.”

While many patients like Bob report profound benefits from psychedelics, some psychiatrists and researchers fear that the pharmaceutical industry is moving too quickly toward legalization, while important questions about long-term efficacy and safety remain.

[Read: Real Stories of Using Ketamine for Depression, Anxiety, PTSD]

Psychedelic Therapy: A Blast from the Past

Psychedelics have an ancient history of medicinal use by the Aztecs and other civilizations. In Western culture, the groundbreaking potential of psychedelics to heal disorders of the mind took root around 1950, when the first English-language paper citing their therapeutic benefits was published. By 1960, Sandoz Pharmaceuticals had begun manufacturing psilocybin and LSD, substances later popularized, in part, by iconic Harvard psychologist Timothy Leary, Ph.D.

For years, he and other therapists embraced these experimental drugs for their potential to aid patients. At the same time, LSD played a major role in the counterculture movement of the 1960s. When then-President Richard Nixon outlawed all psychedelics in 1970, the drugs became associated with criminality. That effectively ended most research into psychedelics’ therapeutic value for 30 years.

In 2000, a new era of research began when scientists from Johns Hopkins University secured regulatory approval to study the effect of psychedelics on behavior, brain function, learning and memory, and mood. In 2020, Johns Hopkins opened a psychedelics research center. Since then, most of the country’s elite universities have followed suit. Researchers at Yale, Stanford, Universities of California Berkeley and San Francisco, and New York University have conducted clinical trials investigating the therapeutic benefits of psychedelics on mental health disorders.

[Read: LSD, MDMA, Magic Mushrooms Clinical Trial Guidelines Released by FDA]

“Monumental Results”

For patients diagnosed with depression and in acute distress, waiting six weeks for commonly prescribed antidepressants to begin working may not be feasible, says Gregory Barber, M.D., a psychiatrist in Bethesda, Maryland, and author of “Ethical and Practical Implications of Psychedelics in Psychiatry,” a scientific review that was published recently in the American Psychiatric Association’s Psychiatric Services journal.³ Ketamine, however, has been shown to improve mood sometimes after only one or two infusions.

“With psychedelics, there is some evidence to suggest that even single doses have medium- to long-term effects,” Barber says. “The ability to simplify treatment in this way would be a real paradigm shift.”

Karlyn, an ADDitude reader, knows this first-hand. Diagnosed with bipolar disorder and ADHD, she had been taking antidepressants for 16 years. “My psychiatrist recommended ketamine infusions in 2021 when I was acutely suicidal. It was the best drug that I have ever used for depression. By the fourth infusion, I felt relief,” she says.

Eight percent of Americans suffer from major depressive disorder (MDD). While a majority of individuals seek treatment, about 30 percent find no relief from antidepressants.⁴ This means that millions of Americans struggle with troubling symptoms like sadness, hopelessness, and suicidality.

Elizabeth Wolfson, Ph.D., a California psychotherapist who has been in practice for 30 years, says she has integrated ketamine into her therapy with “monumental” results. “It augments and deepens the work that people do in psychotherapy and accelerates the process in a way that I see as transformative,” she says.

Psychedelic Therapy: Investigating Risks

Psychedelics’ powers to heal have been heralded in countless headlines, so it’s no surprise that the drugs have recently enjoyed a surge in popularity. According to the National Survey on Drug Use and Health, 7.1 million Americans used hallucinogens in 2020. Proof of a changing public perception is apparent in Oregon and Colorado, where citizens have voted to legalize psilocybin.

The drugs, however, are not without risk. When psychedelic use takes place outside therapeutic settings, the symptoms people are trying to improve may actually worsen. The “therapy” part of psychedelic-assisted therapy is essential to positive outcomes.

In clinical trials and at carefully selected doses, ecstasy, ketamine, and psilocybin have produced generally mild side effects. When taken at higher doses, these drugs can cause disorientation, paranoia, and panic, which can lead to dangerous behavior, accidents, self-harm, and even suicidality. Other adverse effects include the potential for hallucinogen persisting perception disorder (a rare condition in which patients previously exposed to hallucinogenic drugs continue to experience distorted perceptions of the world around them months or years later), misuse, and abuse.

“The clinical trials have had very exciting results, but those results came in carefully controlled research settings with mental health professionals who have hundreds of hours of training,” Barber says. “It doesn’t mean that you will get similar benefits in other settings.”

Important Questions Remain

Experts agree that large-scale research on the long-term effects of psychedelics is needed. Many aspects of how the drugs work, their long-term outcomes, safety concerns, and patient suitability for treatment are still not known.

“I’ve seen psychedelics transform people positively very quickly, but I’ve also seen it be very challenging for people both in the moment and after the experience,” Barber says. “Psychedelics are not going to be for everyone nor solve every problem.”

Patient Suitability

People who have the following conditions or history are not considered good candidates for psychedelic-assisted therapy:

• a personal or family history of psychosis
• unstabilized bipolar disorder
• high blood pressure
• heart disease
• thyroid disease

Psychedelics Research Timeline

1943: LSD’s psychoactive effects are discovered by Swiss chemist Albert Hoffman.

1950: First English-language publication suggests LSD may aid psychotherapy.

1957: The term “psychedelic” is coined. Life magazine publishes “Seeking the Magic Mushroom.”

1960: Harvard psychologist Timothy Leary begins experiments with psilocybin.

1963: LSD is sold on the street in sugar cubes. Timothy Leary is fired by Harvard.

1965: Sandoz stops manufacturing LSD and psilocybin.

1997: Swiss scientists publish new research on the effects of psilocybin on humans.

2000: Johns Hopkins researchers secure regulatory approval to resume psychedelics research.

2017: FDA grants “breakthrough” status to MDMA and psilocybin, putting the drugs on a fast track for approval.

2023: Findings of Phase 3 clinical trials on MDMA for PTSD are published.

Psychedelic Therapy & Mental Health: Next Steps

• Self-Test: Symptoms of Depression in Adults
• Read: Treatments for Depression and ADHD-New and Forthcoming Approaches
• Read: The Relationship Between PTSD and ADHD

Nicole C. Kear is Consumer Health Editor at ADDitude.

Sources

¹Mitchell, J.M., Bogenschutz, M., Lilienstein, A. et al. MDMA-Assisted Therapy for Severe PTSD: A Randomized, Double-Blind, Placebo-Controlled Phase 3 Study. Nat Med. 2021(27),1025–1033.

²Goodwin, G., Aaronson, S., Alvarez, O. et al. Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression. N Engl J Med. 2022 Nov 3.; 387:1637-1648. DOI: 10.1056/NEJMoa2206443

³Barber GS, Dike CC. Ethical and Practical Considerations for the Use of Psychedelics in Psychiatry. Psychiatr Serv. 2023 Aug 1;74(8):838-846. doi: 10.1176/appi.ps.20220525. Epub 2023 Mar 29. PMID: 36987705.

⁴Zhdanava M, Pilon D, Ghelerter I, Chow W, Joshi K, Lefebvre P, Sheehan JJ. The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States. J Clin Psychiatry. 2021 Mar 16;82(2):20m13699. doi: 10.4088/JCP.20m13699. PMID: 33989464.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

By Russell Barkley, Ph.D.

DSM-5 ADHD criteria are flawed for several reasons. “The DSM-5 does not capture ADHD accurately because its criteria do not conceptualize ADHD as a disorder of executive functioning and self-regulation,” says Russell Barkley, Ph.D. “This limitation greatly narrows the concept of ADHD, trivializes its nature as just an attention deficit, and discourages diagnosing clinicians from focusing on the wider range of impairments inherent in ADHD.”

Despite these flaws, Barkley explains, clinicians can ensure more accurate diagnoses by focusing more on the patient’s symptoms of disinhibition and executive dysfunction and less on the age of onset for ADHD symptoms.

Continue reading “How the DSM-5 Fails People with ADHD — and a Better Way to Diagnose”

DSM-5 ADHD Criteria Challenged: Related Resources

• Read: ADHD Is a Whole-Life Experience. The DSM Needs to Reflect That.
• Read: Why We Need U.S. Guidelines for Adults with ADHD
• Read: What do I need to understand about ADHD that is not fully represented in the DSM?
• Download: How Is ADHD Diagnosed?

2. Deciphering Irritability in Children: Causes and Links to Comorbidities

By William French, M.D., DFAACAP

“Irritability is to mental health providers what fevers are to pediatricians,” says William French, M.D., DFAACAP. “Just as a fever is a core symptom of numerous illnesses and infections, irritability is a core symptom of many mental conditions.” In this guide, French outlines possible causes of irritability and provides a detailed overview of conditions such as DMDD, ODD, ADHD, and bipolar disorder. He analyzes emerging research on treatment approaches and interventions.

Continue reading “Deciphering Irritability in Children: Causes and Links to Comorbidities”

Irritability in Children: Related Resources

• Read: The ADHD-Anger Connection
• Read: Top Emotion Regulation Difficulties for Youth with ADHD
• Self-Test: Could Your Child Have DMDD?
• Read: The Parents’ Guide to Dismantling Oppositional, Defiant Behavior

3. Treatments for Depression and ADHD: New and Forthcoming Approaches

By Nelson M. Handal, M.D., DFAPA

Rising rates of depression — a condition that often accompanies ADHD — have attracted well-deserved concern and attention. Here, Nelson M. Handal, M.D., DFAPA, reviews what we know about major depressive disorder (MDD) and ADHD, combs through the latest treatment options for depression, and touches on alternative approaches for managing depression. “The field of depression treatment is making huge advances,” Handal says, referencing psychedelics, Spravato nasal spray, Zurzuvae (zuranolone), a rapid-acting oral treatment that was approved to treat postpartum depression, and others promising treatments for MDD.

Continue reading “Treatments for Depression and ADHD: New and Forthcoming Approaches”

Treatments for Depression: Related Resources

• Read: The ADHD – Depression Link
• Read: What to Expect When You Start Depression Medication
• Download: The Facts About Major Depressive Disorder in Women
• Read: How Undiagnosed ADHD Triggers Depression and Anxiety

4. Differential Diagnosis of Bipolar and ADHD: Taking a Phenomenological Approach

By David W. Goodman, M.D., LFAPA

A thorough and accurate diagnosis is critical before treating bipolar disorder, ADHD, or the two together. However, high rates of comorbidity and a constellation of overlapping symptoms make the task of distinguishing between bipolar disorder and ADHD especially challenging. David W. Goodman, M.D., LFAPA, explains how clinicians can differentiate between the two conditions.

“To arrive at an accurate differential diagnosis, a clinician must carefully consider family psychiatric history and dial into the patient’s phenomenological experience. The latter focuses on specific symptoms and qualitative nature,” he says. “For example, there is a qualitative difference between a tension headache and a migraine headache, even though both are headaches. The same difference can be seen in sadness vs depression — a qualitative difference in the psychological experience.”

Continue reading “Differential Diagnosis of Bipolar and ADHD: Taking a Phenomenological Approach”

Bipolar Disorder and ADHD: Related Resources

• Download: Solving the Bipolar and ADHD Puzzle
• Read: How to Distinguish ADHD’s Rejection Sensitive Dysphoria (RSD) from Bipolar Disorder
• Read: The Physicians’ Guide for Distinguishing Bipolar Disorder and ADHD
• Self-Test: Bipolar Disorder in Adults

5. Prenatal and Early Life Risk Factors of ADHD: What Research Says — and What Parents Can Do

By Joel Nigg, Ph.D.

Is ADHD caused by birth trauma? Do prenatal complications like maternal obesity or hypertension increase a child’s risk for ADHD? What role do prenatal and postnatal exposures to substances, such as alcohol and smoking, play in the development of ADHD? Joel Nigg, Ph.D., explores the answers to these difficult-to-answer questions and provides an overview of the latest research and steps parents can take to protect their child’s health. “Exposure to risk factors does not guarantee ADHD, and early and effective treatment approaches can often mitigate the effects of previous complications and improve outcomes,” he says.

Continue reading “Prenatal and Early Life Risk Factors of ADHD: What Research Says — and What Parents Can Do”

What Causes ADHD? Related Resources

• Read: Epigenetics and ADHD: The Impacts of Environment, Lifestyle, and Stress
• Download: Free Guide to Hormones & ADHD in Women
• Read: Treating for Two: ADHD Meds in Pregnancy
• Watch: The Unspoken Truths of Postpartum Depression: Help for Women with and Without ADHD

6. The Future of ADHD Research Looks Like This

By Peter Jensen, M.D.

While no one can predict the scientific discoveries that lie ahead, three research areas are especially promising for improving our understanding of ADHD: neuroimaging, genetic research, and non-pharmacologic interventions, like transcranial magnetic stimulation and attention training. Here, Peter Jensen, M.D., describes these key three areas of ADHD research.

“As we discover more specific gene and brain developmental pathways, we should expect to find that different and precise interventions work for different ADHD subtypes, depending on the individual’s particular gene-environment mix and how factors unfold over time,” he says.

Continue reading “The Future of ADHD Research Looks Like This”

ADHD Research Updates: Related Resources

• Download:  Health & Fitness Lifestyle Changes for Adults with ADHD
• Read: The Evolution of ADHD: Examining the Last 25 Years — and the Future
• Watch: ADHD Then and Now: How Our Understanding Has Evolved
• Read: Beyond Genes: Leveraging Sleep, Exercise, and Nutrition to Improve ADHD

7. Sobering Advice: How to Treat ADHD Alongside SUD

By Timothy Wilens, M.D.

ADHD medications — both stimulants and non-stimulants — may be used to treat patients with comorbid substance use disorder and typically improve outcomes for patients with both conditions. “Unfortunately, many patients who have an active SUD (or even a past history of substance use issues) are either not diagnosed with ADHD or, even with a diagnosis, they are denied medication and appropriate treatment for their co-occurring ADHD due to overstated and misplaced fears, bias, and misinformation,” says Timothy Wilens, M.D. “In other words, far too many clinicians discriminate against patients with comorbid ADHD and SUDs.” Here, Wilens examines the role ADHD medications play in SUD treatment and suggests steps to curtail prescription misuse.

Continue reading “Sobering Advice: How to Treat ADHD Alongside SUD”

Substance Use Treatment with ADHD: Related Resources

• Read:  The ADHD & Addiction Link — Addictive Behaviors in Adults Explained
• Read: Does Stimulant Medication Cause Drug Dependence?
• Self-Test: Could You Have a Substance Use Disorder?
• Read: 5 Key Facts About Substance Use Disorders

8. First-Ever Adult ADHD Guidelines Forthcoming

By Carole Fleck

ADHD diagnoses among adults are growing faster than ever in the U.S. despite the absence of formal clinical guidelines for the accurate evaluation and treatment of the condition after childhood. That’s about to change. A task force commissioned by the American Professional Society of ADHD and Related Disorders (APSARD) is developing ADHD diagnosis and treatment guidelines for adults in the U.S., to be published in 2024. In an interview with ADDitude, APSARD President Ann Childress, M.D., discussed the implications of the forthcoming guidelines. “ADHD in adults is not just a minor inconvenience — it is a major public health problem,” Childress says. “Guidelines will help practitioners who previously may have felt uncomfortable evaluating and treating adults with ADHD, and these will improve access to high-quality care.”

Continue reading “First-Ever Adult ADHD Guidelines Forthcoming”

ADHD Treatment & Diagnosis Guidelines: Related Resources

• Read: Adult ADHD Is Real — and Still Heavily Stigmatized
• Read: ADHD in Older Adults: Distinct Diagnostic and Treatment Considerations
• Download: How Common Is ADHD in Adults?
• Read: ADHD in Women and Girls — Why Female Symptoms Slip Through Diagnostic Cracks

9. How Undiagnosed ADHD Triggers Depression and Anxiety

By Nelson M. Handal, M.D., DFAPA

Depression and anxiety disorders occur with ADHD at significant rates. What explains these high comorbidity rates? “Many factors may explain the overlap, and one of them I can’t stress enough: ADHD does not happen in a vacuum, and its effects are far more impairing when the condition goes undiagnosed, untreated, or improperly treated,” Nelson M. Handal, M.D., DFAPA, says. Here, Handal shares why depression appears to take a more significant toll on women with ADHD and how undiagnosed and/or untreated ADHD manifests in patients with depression.

Continue reading “How Undiagnosed ADHD Triggers Depression and Anxiety”

Untreated ADHD in Adults: Related Resources

• Download: Signs of Depression That May Surprise You
• Self-Test: Depression in Adults
• Read: The Depression Treatment Gap for Teens — And How to Close It
• Read: What’s Behind the “Depression Gap” Impacting Women?

10. “A Daily Nightmare:” One Year into the ADHD Stimulant Shortage

By ADDitude Editors

More than one year into the ADHD stimulant shortage, patients still struggle to fill their prescriptions for Adderall XR and other stimulants like Vyvanse, Concerta, and Focalin.

According to an ADDitude survey of 11,013 caregivers and adults with ADHD, roughly 38% of all patients have had trouble finding and filling their prescription medication over the last year, and 21% continue to suffer treatment disruptions today. Here, ADDitude readers share how they have been forced to forgo medications, make do with substitutes that aren’t as effective or cause bothersome side effects, and ration out a dwindling supply, often dividing it between multiple family members with ADHD.

Continue reading “‘A Daily Nightmare:’ One Year into the ADHD Stimulant Shortage”

ADHD Medication Shortage: Related Resources

• Read: How the Adderall Shortage Is Casting a Long Shadow on ADHD Treatment
• Read: The Real Reason ADHD Medication Supply Is Lagging Demand
• Read:  Generic Adderall Shortage Extends to Vyvanse, Ritalin

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Seasonal affective disorder (SAD) is a type of depression that begins as sunlight dwindles in the fall and continues into the dark winter months. These “winter blues,” which are more common among people with ADHD, cause feelings of sadness and depression, sap energy and motivation, and bring changes to sleep patterns. Reduced sunlight in the winter is thought to disrupt the body’s internal clock, leading to:

• Feelings of depression
• A drop in serotonin, the brain’s feel-good chemical
• A disruption in melatonin levels, which play a role in sleep disturbances

Chronotherapy is a SAD treatment that works by resetting the biological clock in the brain to alter the sleep-wake cycle and to lift mood. This can be done in combination with treatment modalities including sleep-hygiene, melatonin, and light therapy. New research is also illuminating the effect of light therapy on ADHD symptoms as well as SAD. In one study from prof. Kooij’s team involving delayed sleep phase syndrome, the most common sleep disturbance in adults with ADHD, chronotherapy with melatonin reduced ADHD symptoms by 14 percent.

In this webinar, you will learn:

• How to recognize seasonal mood changes and their effects on ADHD symptoms
• The ways in which late sleep patterns affects circadian rhythm and SAD
• How chronic sleep deprivation affects your health
• About therapies and strategies to improve mood, energy, and sleep during the winter months

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Seasonal Affective Disorder: More Resources

• Read: Seasonal Affective Disorder and the ADHD Brain
• Get: The Free Healthy Habits Handbook from ADDitude
• Read: 6 Ways to Overcome Winter Depression
• Self-Test: Could You Have Delayed Sleep Phase Syndrome?

Obtain a Certificate of Attendance

If you attended the live webinar on January 16, 2024 watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

J.J. Sandra Kooij is a psychiatrist at PsyQ, psycho-medical programs, and Head of the Expertise Center Adult ADHD, in the Netherlands. She is a professor of adult ADHD studies at the Department of Psychiatry, VU University Medical Center, Amsterdam. She received her PhD in 2006.

Since 2002, Dr. Kooij has been the head of the Dutch Expertise Center Adult ADHD and involved in research, treating patients, educating professionals, informing the public, publishing books, scientific papers, websites, webinars and podcasts, and launched a new ADHD app, Super Brains. She has published more than 100 peer-reviewed international papers and more than 20 books or book chapters on ADHD in adults.

Read more here.

Listener Testimonials

“Great webinar; I was unaware about how much sleep and light play a role in our health and wellbeing.”

“I learned so much from today! My brain is buzzing with all the professionals and families who need to know this.”

“Fantastic and eye-opening presentation of this data!”

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Play Attention: Research conducted at Tufts University School of Medicine demonstrates that Play Attention improves attention, behavior, executive function, and overall performance. Harnessing cutting-edge NASA-inspired technology, Play Attention offers a customized program for improving executive function and self-regulation. Through our digital trainer, you can control personalized cognitive exercises using just your mind (Attention)! Additionally, your program comes complete with a dedicated Personal Executive Function Coach who will tailor your plan as you progress. Both home and professional programs are available. Contact us at 828-676-2240 or click here to schedule your free 1:1 consultation! | www.playattention.com

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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Episode Description

The holiday season is usually portrayed as a joyous time of year. But many experience the holidays differently.  The “holiday blues, can include heightened depression, anxiety, and other mental health symptoms.

In this informational webinar, John Whyte, M.D., will talk about the holiday blues, and what to do if you or someone you love struggles with them. Dr. Whyte will share information about what this condition is (and what it’s not), including its symptoms and triggers, who is at risk, treatment, prevention, tips for coping, and when to seek professional help.

In this WebMD webinar, you’ll learn about:

• What holiday blues are, how long symptoms can last, and whether they can lead to serious long-term mental health issues
• How many people are affected and who’s at risk for experiencing the holiday blues
• What factors can trigger the holiday blues
• How to know if you’re experiencing the holiday blues or something more serious like clinical anxiety or clinical depression
• When and how to get professional help
• Tips to avoid the holiday blues and protect your mental health this holiday season

Click here to view the full list of on-demand and upcoming WebMD webinars.

More on Holidays & Mental Health

• Download: Scripts to Use When Emotionally Dysregulated
• Resource Center: Mental Health Out Loud
• Read: “Holiday Stress and Anxiety Affect My Kids. How Can We Strike a Healthy Balance?”
• Read: Does Your ADHD Help or Hurt During the Holidays?

Meet the Expert Speaker

WebMD Chief Medical Officer John Whyte, M.D., M.P.H., has communicated with the public about health issues for nearly two decades. He leads efforts to develop and expand strategic partnerships that create meaningful change around important and timely public health issues. Prior to WebMD, he was Director of Professional Affairs and Stakeholder Engagement at the Center for Drug Evaluation and Research at the U.S. Food and Drug Administration (FDA).

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Google Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Audacy