Attention-deficit/hyperactivity disorder with depression

Biederman J, Newcorn J, Sprich S. Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. Am J Psychiatry 1991 148 564-577. 

Cala S, Crismon ML, Baumgartner J. A survey of herbal use in children with attention-deficit-hyperactivity disorder or depression. Pharmacotherapy 2003 23(2) 222-230. 

Daviss WB, Bentivoglio P, Racusn R, et al. Bupropion sustained release in adolescents with comorbid attention-deficit/hyperactivity disorder and depression. J Am Acad Child Adolesc Psychiatry 2001 40 307-314. 

The developmental neurotoxicity guideline, accepted by OECD in 2007, has added the important aspect of behavioral effects of pre- and postnatal exposure to chemicals. This development arose from the notion that behavioral disorders in man such as anxiety, depression, phobias, autism, and attention deficit hyperactivity disorder, which appear to show increasing prevalences in western societies, may have a perinatal origin (4, 5). In the absence of causal inferences with respect to chemicals it seems nevertheless prudent to assess in a risk assessment whether such causal relations may exist. 

Approximately three-quarters of children with OCD have comorbid diagnoses. These include tic disorders (24%-30%) and mood disorders, especially major depression (26%-29%). Riddle and colleagues (1990) found that 38% of children with OCD have other anxiety disorders, while Swedo (1989) more specifically identified increased rates of simple phobias (17%), overanxious disorder (16%), and separation anxiety disorder (7%). Other reported comorbidities include specific developmental disabilities, adjustment disorder with depressed mood, oppositional defiant disorder, attention-deficit hyperactivity disorder (ADHD), conduct disorder, and enuresis/encopresis (Swedo et ah, 1989b Riddle et ah, 1990). 

ADHD, attention-deficit hyperactivity disorder EKG, electrocardiogram GI, gastrointestinal MD, major depression MR, mental retardation OCD, obsessive-compulsive disorder PTSD, post-traumatic stress disorder. Trade names are in parentheses. Doses are general guidelines. All doses must be individualized with appropriate monitoring. Weight-corrected doses are less appropriate for obese children. 

Younger children with manic symptoms tend to have severe functional impairment and comorbid psychopathology such as anxiety dysregulation, disruptive behaviors, and developmental delays that further complicate their clinical picture. In addition, these children may have mood symptoms that merge with other disorders, making manic episodes difficult to define. Irritability is part of the clinical picture of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). Poor concen-... 

Multiple studies have noted the comorbidity between PTSD and depressive disorders (Goenjian et ah, 1995), as well as between PTSD and externalizing disorders (Cuffe et ah, 1994 Glod and Teicher, 1996). Younger children with PTSD may present with classical features of attention-deficit hyperactivity disorder (ADHD), including hyperactivity, impulsivity, restlessness, irritability, and distractibility (Cuffe et ah, 1994 De Beilis and Putnam, 1994 McLeer et ah, 1994 Loof et al., 1995 De Beilis et ah, 1999). More serious externalizing disorders, such as conduct disorder (CD) and oppositional defiant disorder (ODD), are also commonly comorbid with PTSD (Arroyo and Eth, 1985 Steiner et al., 1997). Similarly, the relationship between PTSD and substance use disorders in children has been noted in several studies (Arroyo and Eth, 1985 Brent et al., 1995 Loof et al., 1995). 

Prescription medications such as pain relievers, central nervous system (CNS) depressants (tranquilizers and sedatives), and stimulants are highly beneficial treatments for a variety of health conditions. Pain relievers enable individuals with chronic pain to lead productive lives tranquilizers can reduce anxiety and help patients with sleep disorders and stimulants help people with attention-deficit hyperactivity disorder (ADHD) focus their attention. Most people who take prescription medications use them responsibly. But when abused—that is, taken by someone other than the patient for whom the medication was prescribed or taken in a manner or dosage other than what was prescribed—prescription medications can produce serious adverse health effects, including addiction. 

The co-3 fatty acids have numerous important functions, especially in the brain. Accordingly, a deficiency of DHA and EPA may cause dysfunction of the central nervous system and probably also the retina, thereby resulting in impaired vision. In addition, there is a variety of neurological and psychiatric disorders that have been associated with decreased levels of especially DHA and AA, such as, for example, schizophrenia and depression [3], post-traumatic stress syndrome, autism and attention deficit hyperactivity disorder. Since no primary inherited defect of essential fatty acid interconversion has yet been described, no specific explanations for the essential fatty acid concentration changes are readily available. 

Dr. Lynn Crismon s work in developing the Texas Medication Algorithms for treatment of depression in children and adults and the treatment of attention-deficit hyperactivity disorder in children" "" laid the groundwork for psychiatric pharmacists to work with psychiatrists, psychologists, other health care professionals, and consumer groups to develop and implement national therapeutic guidelines. 

Several medical, medication-induced, or substance-related causes of mania and depression have been identified (see Table 68-2 for causes of mania and Table 67-1 in Chap. 67 on depressive disorders for causes of depression). " A complete medical, psychiatric, and medication history physical examination and laboratory testing are necessary to rule out any organic causes of mania or depression. An accurate diagnosis is important because some psychiatric and neurologic disorders present with manic-like symptoms. For example, attention-deficit/hyperactivity disorder and a manic episode have similar characteristics thus individuals with bipolar disorder may be misdiagnosed and prescribed central nervous system stimulants. Use of any substance that affects the central nervous system (e.g., alcohol, antidepressants, caffeine, central nervous system stimulants, hallucinogens, or marijuana) can worsen symptoms and decrease the... 

A word about prevalence mental illness is more common than many people imagine. The current prevalence estimates are that about half the U.S. population meets the criteria for at least one mental disorder during a lifetime, with about 25 percent of the population meeting the criteria for at least one mental disorder during any given year.1 Of these disorders, the most prevalent are apparently anxiety disorders, followed by mood disorders (for example, major depressive disorder), impulse-control disorders (for example, attention deficit hyperactivity disorder [ADHD]), and substance disorders (for example, alcohol abuse). In contrast, the prevalence of psychosis as I define it here is only 2—3 percent of the U.S. population, and the world prevalence is about the same. 

Antidepressants tend to provide a more sustained and continuous improvement of the symptoms of attention-deficit/hyperactivity disorder than do the stimulants and do not induce tics or other abnormal movements sometimes associated with stimulants. Indeed, desipramine and nortriptyhne may effectively treat tic disorders, either in association with the use of stimulants or in patients with both attention deficit disorder and Tourette s syndrome. Antidepressants also are leading choices in the treatment of severe anxiety disorders, including panic disorder with agoraphobia, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder, as weU as for the common comorbidity of anxiety in depressive illness. Antidepressants, especially SSRIs, also are employed in the management of posttraumatic stress disorder, which is marked by anxiety, startle, painful recollection of the traumatic events, and disturbed sleep. Initially, anxious patients often tolerate nonsedating antidepressants poorly (Table 17-1), requiring slowly increased doses. Their beneficial actions typically are delayed for several weeks in anxiety disorders, just as they are in major depression. 

Thus, at a recent symposium sponsored by the National Institutes of Mental Health (NIMH) devoted entirely to the therapeutic use of fats in mental illness, several presenters reported the beneficial effects of EFA supplementation on depression, bipolar illness, and schizophrenia. Adding EFAs to the diets of research subjects has been associated with improvements in dyslexia and attention deficit hyperactivity disorder (ADHD) as well as improved intelligence measures in ten-month-olds and in adults with Alzheimer s disease. ... 

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