Can Adderall Cause Depression

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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How Does Adderall Affect Depression?

Over the past decade, doctors have diagnosed about six million children, ages 3 through 17, with attention deficit hyperactivity disorder. ADHD makes it difficult for kids to concentrate, focus and complete tasks, which takes a toll on their behavior at home and in school. What’s more, two out of three children with ADHD still struggle with the disorder when they grow up. Many of these individuals also have a mood disorder, too, such as depression or bipolar disorder. In fact, up to 20% of children with ADHD may also end up with depression as they age. These statistics give rise to the question of how the drugs doctors prescribe for ADHD interact with antidepressants; specifically, whether the ADHD drug Adderall makes depression worse.

What Are the Symptoms of ADHD?

First, it’s important to understand the symptoms of ADHD, which include:

  1. Difficulty sitting still
  2. Hyperactivity
  3. Short attention span
  4. Procrastination
  5. Disorganization
  6. Making careless mistakes
  7. Becoming easily distracted
  8. Forgetfulness

In children especially, it can be difficult to tell whether some of these symptoms are cause for concern. For example, most children can’t sit still for very long. Also, since many adults are disorganized, a medical diagnosis is the only way to identify and treat ADHD.

How Does Adderall Help?

Adderall is one of a handful of drugs that doctors prescribe for ADHD. It is a stimulant that contains amphetamine and dextroamphetamine. These drugs stimulate the central nervous system, initiating increased production of dopamine and norepinephrine, two neurotransmitters that help you focus and feel motivated. Together, they facilitate other essential brain functions like alertness, attention span and impulse control.

When Does Adderall Cause Depression?

If you are taking Adderall under a doctor’s supervision, incorrect dosage can cause depression. Because Adderall targets essential brain functions in children and adults, individual differences make it difficult to get the dose right on the first try. When you stop taking this stimulant, you may also become depressed due to the loss of its positive effect on your brain. Illicit use of this drug can also cause depression.

When the Dose Needs Adjustment

Too strong a dose of Adderall can cause listlessness, irritability and/or depressed behavior, especially in children. This is due to the drug-induced fluctuations in dopamine, serotonin and norepinephrine, which occur naturally in the brain. Once the doctor lowers the dose, these symptoms will likely disappear.

When ADHD Doesn’t Respond Positively

About 5% of children taking Adderall continue to be dysphoric and depressed in spite of reduced dosages. In those cases, doctors may prescribe an alternative ADHD drug such as Ritalin, a stimulant composed of methylphenidate.

Symptoms of Adderall-related depression include:

  1. Anger
  2. Loss of interest in favorite activities
  3. Loss of pleasure from favorite activities
  4. Slowness of thought and motions
  5. Difficulty speaking
  6. Sense of hopelessness
  7. Low threshold for pain

An abrupt discontinuation of the drug can cause depression, too, since the brain will feel a dopamine deficit. Therefore, it is important to make a gradual transition under medical supervision.

When Adderall Abuse Is Involved

Adderall is among the most frequently abused prescription drugs in the U.S., and it is highly addictive. Since the drug is a stimulant, adults who use Adderall without a prescription take it to stay alert, to enhance their ability to focus and to improve their performance at work or school.

Because it is addictive, adults using Adderall without a doctor’s supervision tend to continue taking it over the longer term, whereas children often grow out of ADHD and transition away from Adderall. Long-term use of the drug is more likely to give rise to depression, loss of motivation and anxiety. These symptoms may persist, even after the user is in recovery.

When You Stop Taking Adderall

Getting free of Adderall often causes depression, depending upon how you discontinue use. Withdrawal under medical supervision tends to be a gradual, carefully controlled process that aims to minimize physical and emotional distress. A more abrupt withdrawal from Adderall, similar to abrupt withdrawal from other types of addictive drugs, can cause the following side effects:

  1. Depression
  2. Anxiety
  3. Sleep disruption
  4. Irritability
  5. Fatigue
  6. Physical pain
  7. Nausea
  8. Hallucinations
  9. Tremors
  10. Excessive sweating

More severe symptoms that sometimes result from getting off Adderall include:

  1. Disorientation
  2. Paranoia
  3. Seizures

It’s important to have support throughout the process of quitting Adderall, especially if you have been taking it without a doctor’s prescription. A licensed rehab facility, an outpatient program and/or the support of family and friends will help you make it through the withdrawal process and recovery.

Is Adderall Also an Antidepressant?

As a central nervous system stimulant, Adderall is not an antidepressant. However, medical professionals sometimes prescribe it for depression in specific situations. For example, if the drugs approved for treating depression do not produce desired results, a medical team may try alternative drugs like Adderall. It does help elevate mood, improve focus and aid motor activity.

However, it can also exacerbate the symptoms of depression. With very little data to support the use of this stimulant for depression, plus evidence to the contrary, Adderall is rarely an effective treatment for this disorder. Also, given its highly addictive nature, an amphetamine medication can easily be more problematic than therapeutic in cases of depression.

Treatment for ADHD and Major Depression

When you have two disorders such as ADHD and clinical depression at the same time, you have comorbidity. In this situation, the symptoms of both may be more severe than for one disorder alone. Treatment for such comorbidity can be tricky, and it certainly calls for professional help.

Adults with ADHD and major depressive disorder (MDD) are more likely to experience suicidal thoughts and behaviors as well as hospitalizations. Treatment for ADHD with Adderall in the absence of treatment for the MDD can exacerbate these symptoms, leading to tragic outcomes.

However, an early diagnosis of ADHD and effective treatment can prevent a child from developing MDD. Also, early recognition of genetic and environmental risk factors associated with depression in children with ADHD helps medical professionals take proactive steps to prevent MDD. These risk factors include:

  1. Abuse
  2. Early exposure to domestic violence
  3. Childhood trauma
  4. Poor academic performance

Research also suggests that treating ADHD in children with the above risk factors early on can prevent the onset of MDD. In that sense, Adderall can be instrumental in preventing depression.

Difficulties in Diagnosing Comorbid ADHD and MDD

Because these two disorders overlap in terms of symptoms, difficulties tend to arise in reaching an accurate diagnosis. This delays appropriate treatment in many cases. Some of the following overlapping symptoms may also be the side effects of ADHD medications:

  1. Irritability
  2. Difficulty concentrating
  3. Changes in sleep patterns
  4. Changes in eating habits

Treatment Practices for ADHD and MDD Comorbidity

A common approach for treating comorbid disorders is to determine which one is more severe and then treating it first. For example, if ADHD is causing children or adults more difficulties in daily life than their MDD, their doctors would tend to prescribe an FDA-approved drug such as Adderall to address the ADHD.

If the targeted disorder is responding to drug therapy but MDD is worsening, the typical medical response is to add an SSRI antidepressant.

The reverse is true if the MDD is more severe than ADHD. The first line of treatment would be to find an effective drug to treat depression and monitor the client’s ADHD. If necessary, the doctor would prescribe Adderall or an alternative drug to address ADHD. Cognitive behavioral and psychosocial therapies are also key pieces of the puzzle in treating both ADHD and MDD successfully.

The ADHD-Major Depressive Disorder Connection

Research supports the contention that childhood ADHD comes with a greater risk for developing MDD in young adulthood. In fact, data suggests that children with ADHD are six times likelier to develop MDD within a year of initial diagnosis and two times more likely to develop MDD in five years’ time than those without ADHD. In addition, adults who continue to struggle with ADHD have a significantly higher risk for recurring depressive episodes.

As mentioned above, however, early treatment for ADHD prior to the development of MDD can reduce the risk for the latter disorder. However, even early treatment cannot prevent depression unilaterally.

Taking Adderall Does Not Directly Affect Depression

Adderall is an approved and effective pharmaceutical therapy for reducing the symptoms of ADHD. It is not an approved treatment for depression, but in rare situations, doctors may prescribe it when antidepressants fail to improve MDD.

Withdrawal from Adderall often results in symptoms of depression, such as fatigue, mood swings, sleep disturbances and more. While medical supervision can help address and alleviate these symptoms, abrupt withdrawal will likely exacerbate them. The addictive properties of Adderall also make withdrawal more difficult and the side effects more severe.

Although children diagnosed with ADHD have a higher likelihood of developing MDD later in life, it does not follow that prescription medications for ADHD like Adderall cause that depression. Instead, an overlap of symptoms, plus genetic and environmental factors that contribute to both disorders, are the most reliable predictors.

However, in cases of comorbid ADHD and MDD when the former is more developed, prescription Adderall, in addition to behavioral therapy, is proven to be effective. Also, the addition of selective serotonin reuptake inhibitors, the drugs doctors most frequently prescribe to treat depression, can work effectively alongside Adderall to relieve MDD symptoms.

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