As many as 10% of children with ADHD suffer from depression, which can vary in severity from a moderate mood change known as dysthymia to a more severe change with major depression or occasionally bipolar or manic depression disorder.
Dysthymic children tend to be low in mood on most days, and frequently also have poor appetite, or sometimes overeat, have sleep difficulties, low energy, have concentration difficulties and a feeling of hopelessness.
Those with major depression tend to be depressed most of the time with a marked loss of interest or pleasure in most activities, to have lost weight, to have sleep difficulties and to be agitated as well as having fatigue, feelings of worthlessness, difficulty in concentrating and may have recurrent thoughts of death or suicide.
It is now realised that manic-depressive (bipolar) illness is not solely an adult problem, and that it can co-exist with ADHD. It should be considered in children with severe ADHD, when there are multiple complications, and/or persistent irritability. It should always be considered as a possibility in those who do not respond to conventional management. Young children may not have the mood swings from mania to depression characteristic of adults, and thus may be difficult to diagnose accurately. A family history of manic depression, severe and early onset of apparent core ADHD symptoms, oppositionality and conduct disorder with significant learning disabilities can all be pointers. It tends to be an on-going rather than intermittent condition. Children may have prolonged and aggressive temper outbursts. It is a severe condition with a wide range of problems and greatly affects the child’s function. It may require the use of several medications and is probably the basis of much psychiatric hospitalisation and chronic disability.
Depression in some degree is more likely to occur in a child or adolescent with ADHD than in the normal population. Twenty-five percent of adolescents with depression have a history of ADHD. Clearly, children who have attempted suicide need to be assessed not only for their depression, but also for the possibility of co-existing ADHD. One study showed that adolescents who actually committed suicide had much higher rates of manic-depression and also of ADHD, than those who attempted suicide. The impulsiveness associated with ADHD and bipolar disorder is extremely concerning when associated with severe depression.
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