People with ADHD, or attention deficit hyperactivity disorder, may be at risk for mental health disorders like depression, post-traumatic stress disorder (PTSD), and suicide, a new study finds.
Estimates indicate that ADHD is found in about 3-6% of the adult population. The neurological disorder's symptoms range from an inability to focus to impulsiveness—and, according to the new research, additional mental health issues.
"Our study provides new insights into the complex network of causal relationships between psychiatric disorders originating from ADHD," said Dennis Freuer, PhD, a researcher on the study and chair of epidemiology at the University Hospital of Ausburg.
"We observed a relationship between ADHD and major depression disorder," he told Health. "Both mental disorders may separately and jointly increase the risk for suicide attempts or post-traumatic stress disorder."
Freuer explained that the study found an increased risk for anorexia nervosa can be attributed entirely to ADHD. On the other hand, he says there was no evidence of a causal link between ADHD and bipolar disorder, anxiety, or schizophrenia.
"The clinical implications demand that practitioners should monitor patients with ADHD for other mental disorders, especially those included in the study, and preventative measures should be initiated where possible," said Sussan Nwogwugwu, PMNHP, a regional nurse practitioner and an expert in ADHD treatment for DONE, told Health.
"This study will foster early and effective treatment of ADHD, reducing the risk and subsequently more severe occurrence of other mental conditions," she said.
Getty Images / Prostock-Studio
To determine the connection between ADHD and seven mental health disorders, researchers used a technique known as Mendelian randomization (MR). Freuer explained MR as "a powerful tool that uses genetic variation to infer causality between a risk factor and an outcome."
According to Freuer, this approach has some advantages over the “usual” observational study design.
"The idea is to utilize random assignment of genetic variation at conception to mimic a randomized controlled trial and in this way to overcome the weaknesses of observational studies, such as unmeasured confounding and reverse causality," he said.
In this way, it's possible to assess causal effects rather than correlations, Freuer explained. "In addition, the risk factor and outcome are allowed to be measured in different studies that can be combined for a specific scientific question."
The research team was focused on looking at ADHD and bipolar disorder, anxiety, depression, anorexia, PTSD, suicide, and schizophrenia. They found that having ADHD impacts risks in the following ways:
Additionally, they found that having major depression raises the risk of suicide attempt by 42% and PTSD by 67%.
"Our results point to the need for early treatment tailored to the patient," Freuer said. "From the clinician's perspective, it is necessary to monitor patients with ADHD for early signs of mental comorbidities and to initiate preventive measures if necessary."
He explained that it's important to not underestimate any symptoms, the disease itself, and its possible consequences and to seek professional help in time.
The study only included data from people of European ancestry, so it is unclear if the results can be generalizable to other ethnicities.
It is not uncommon for people to develop secondary mental health conditions when they have a primary health condition. The same is true for people with ADHD.
ADHD may hamper someone from living the life they want. This can then lead to a secondary mental health issue like depression.
"If a [young person] has been diagnosed with ADHD, and the symptoms are significantly impacting their daily life, and they are aware of this, this can lead to low self-esteem, behavioral issues, and further mental health problems, such as depression and anxiety," said Mailin Delgado, LMHC, a licensed mental health counselor and school psychologist for Plantation Counseling and Wellness.
The opposite is true as well, Delgado said. If a young person is depressed or anxious, and they have also been diagnosed with ADHD, the ADHD symptoms can affect their follow-through with treatment for the depression or anxiety, especially since working memory and overall executive functioning skills are usually affected by ADHD.
Someone's environment also could play a role, Ambrosio J. Romero, MD, FAAFP, a diplomate with the American Board of Family Medicine and an ADHD expert for MEDvidi told Health.
"Up to 90% of people with ADHD have inherited the disorder from their parents," she said, "and growing up in the household of a possibly untreated person with ADHD can result in childhood traumatic experiences or unrealistic and overburdening expectations [that lead to a mental health condition]."
Even experiences in work or school can lead to mental health conditions for people with ADHD, according to Chantal Marie Gagnon, PhD, LMHC, a licensed psychotherapist and owner of Plantation Counseling and Wellness.
"One of the [challenges] is that a majority of K-12 educators and parents value behavior over creativity and enthusiasm," Gagnon said. "Therefore, in those early years, children with ADHD are often disliked, and we know that social isolation and peer rejection are strong contributors to depression." This is true, especially in adolescents.
When it comes to reducing the risk of mental health conditions for people with ADHD, Gagnon explained therapy and psychoeducation should be at the top of the list.
"Connecting with a skilled and experienced team of mental health professionals can offer several viewpoints and solutions, all working together with the patient to achieve the best outcome," she said.
Lifestyle modification also can help reduce the risk of co-occurring conditions.
"Individuals with ADHD must focus on lifestyle factors that impact their mental health, but also improve overall well-being," said Nwogwugwu. "These include sufficient sleep, a good diet, stress management techniques, regular exercise, and a supportive social network."
It's also important to be open and honest with your healthcare provider about your symptoms, how they affect your life, and any other relevant medical history, said Romero.
For instance, you can keep a journal of your symptoms and how they affect your life and then share them with a healthcare provider. It's also worth asking questions about the different treatment options available and the potential benefits and risks of each.
While this may require some additional patience to find the right way to treat your condition, Romero emphasized the importance of continuing until the correct treatment is found.
He encourages patients to "Be willing to try different treatment options until you find one that works for you."
