Adult ADHD and comorbid depression: A consensus-derived diagnostic algorithm for ADHD

Abstract

Objective:

Many patients present to their physician with depression as their primary symptom. However, depression may mask other comorbid disorders. This article presents diagnostic criteria and treatment recommendations (and monitoring) pertaining to the diagnosis of adult attention deficit hyperactivity disorder (ADHD), which may be missed in patients who present with depressive symptoms, or major depressive disorder (MDD). Other co-occurring conditions such as anxiety, substance use, and bipolar disorder are briefly discussed.

Methods:

A panel of psychiatrist-clinicians with expertise in the area of child and adolescent ADHD and mood disorders, adult mood disorders, and adult ADHD was convened. A literature search for recommendations on the diagnosis and treatment of co-occurring conditions (MDD, anxiety symptoms, and substance use) with adult ADHD was performed. Based on this, and the panel’s clinical expertise, the authors developed a diagnostic algorithm and recommendations for the treatment of adult ADHD with co-occurring MDD.

Results:

Little information exists to assist clinicians in diagnosing ADHD co-occurring with other disorders such as MDD. A three-step process was developed by the panel to aid in the screening and diagnosis of adult ADHD. In addition, comorbid MDD, bipolar disorder, anxiety symptoms, substance use and cardiovascular concerns regarding stimulant use are discussed.

Conclusion:

This article provides clinicians with a clinically relevant overview of the literature on comorbid ADHD and depression and offers a clinically useful diagnostic algorithm and treatment suggestions.

Keywords:

• ADHD
• adult
• treatment
• diagnosis
• substance use disorder
• depression

Acknowledgements

Janssen-Ortho Inc. funded the first expert meeting. The authors did not receive payment for writing this article. Dr D McIntosh reports having received lecture and consulting fees from: Janssen-Ortho Inc., Astra Zeneca, Lilly, NovoNordisc, GlaxoSmithKline, Lundbeck, Servier, SanofiAventis, and Shire. Dr S Kutcher reports having received lecture and consulting fees from Janssen-Ortho Inc. and is a faculty member at the Lundbeck Institute. Dr A Levitt reports having received lecture and consulting fees from: Janssen-Ortho Inc., Eli Lilly, and Pfizer. Dr M Rosenbluth reports having received lecture and consulting fees from: Janssen-Ortho Inc, Astra Zeneca, Lilly, GlaxoSmithKline, Lundbeck, Wyeth, Biovail, Organon, and Pfizer. Dr A Fallu reports having received lecture and consulting fees from: Janssen-Ortho Inc, Shire, Eli Lilly, and Lundbeck. C Binder is an employee of Janssen-Ortho Inc. The authors thank Marian P. Smith for assisting with reference searches and medical writing.