Lindsay Guentzel (00:00):

You’re listening to episode 97, part two of Understanding ADHD & Depression with Lakeisha Love. My name is Lindsay Guentzel, and every week on Refocused, we dive into the incredibly complex world of ADHD, exploring the topics most important to our community by interviewing medical providers, mental health professionals, and ADHD experts.

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We also just talk to other neurodiverse folks who share what it’s like living in a world not built for them. And of course, all of that brings up lots of tips, tricks and workarounds that we can mix and match to fit in our own lives and needs. Whether you’ve been navigating ADHD your entire life or you’re just starting your journey, there’s something for everyone on Refocused. I promise that while we take this very seriously, we also have a lot of fun because light is way better with a little laughter in it.

(01:05):

Sit back, relax, or do whatever you need to do to get into your listening mode because the latest episode of Refocused gets started right now. Welcome back to our two-part discussion on ADHD and depression with nurse practitioner and ADHD Online provider, Lakeisha Love. If you haven’t listened to our last episode, feel free to give this one a pause and head over to part one to take a listen and get a solid overview on one of the most common comorbidities people with ADHD deal with, depression.

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Last week we began our discussions about ADHD and depression with a look at the symptoms of depression and how they overlap with the different presentations of ADHD. Patients are often surprised by unexpected symptoms such as sleep difficulties, eating problems, intrusive thoughts, and isolation, because it doesn’t fit the idea of what people think about when they think of depression. Oh, the misconceptions, they get us every single time.

(02:31):

We also touched on how neurobiology, our environments, and how family history and genetics play a major role in both depression and ADHD, and the importance of understanding a person’s individual symptoms to determine whether they are experiencing ADHD, depression, or both. To say making a diagnosis is challenging would be an understatement. Lakeisha shared from a provider standpoint how important it is to properly hold space for patients and how the power of motivational interviewing, a.k.a. asking open-ended questions, can be helpful to accomplish this.

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There’s so much when it comes to understanding the overlap and differences between ADHD and depression to provide the best possible care for individuals struggling with these conditions. Can I say that I am still stuck on the fact that those with ADHD have a 70% greater chance of experiencing depression than those without it? It’s such a big number. Still, I have hope when we have discussions like this on this podcast, open communication helps to educate and weaken the stigma so more people can understand and get the help they need.

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Sometimes I just want to give all the Gen Xers a big hug and thank them for being the generational cycle breakers who help to shift the mindset on mental health. Once again, today’s episode does touch on suicide and suicide ideation. Just like last week, we’ve included accessible resources for you on these topics, including the 988 number to the Suicide and Crisis Lifeline. You can find those linked in our show notes. We are so excited to have Lakeisha Love back for part two of our conversation on ADHD and depression.

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Lakeisha is a seasoned family nurse practitioner with seven years of experience in a variety of fields, including internal medicine, primary care, addiction care, and mental health. She’s currently working to add a dual certification for psychiatric mental health to her expertise. In today’s episode, we are going to talk about the brain, depression awareness, and we’ll spend a good portion of the show talking about treatment methods, including talk therapy, behavioral parent training, and medication.

(05:31):

Let’s get into part two of our conversation on understanding ADHD and depression with Lakeisha Love. Researchers have found that depression and ADHD can affect the brain in similar ways, and you’ve touched on it a little bit, but I’m wondering if you can talk more about what’s going on neurologically with these disorders.

Lakeisha Love (06:01):

There’s no right or wrong answer of why people develop certain psychiatric conditions. There’s a lot of beliefs and a lot of theories that can entail far as genetics or history with ADHD, history of head trauma as a child, or having a mother who may interact with substance as the child was in utero. There’s a lot of different theories that can predict why someone may have ADHD. The two things that really correlate with depression and ADHD is the neural transmitters, and this is what our brain makes.

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Everyone has serotonin, dopamine, and norepinephrine. With both ADHD and depression, there’s low levels. When you start understanding which no transmitter work and how it works and how it responds for us, then it starts to make sense why we would exhibit certain symptoms. For an example, serotonin, if you don’t have enough of it, you can feel sad, you can feel down and lack of motivated because serotonin regulates our mood. It’s our happy neurotransmitter, so it regulates how we feel.

(07:17):

Another one is norepinephrine. Low levels of this can cause an intensiveness, impulsive symptoms, and hyperactive symptoms. In ADHD, if you don’t make enough of it, you can see why someone can have issues with focus and concentration, be very impulsive, or have difficulty sitting for a long period of time. And then there’s dopamine. Dopamine help regulate our emotions response as well and also our mood. This is also a positive reward system. Whenever we may like something, dopamine catches a picture of it and it reminds our brain of that particular area.

(07:54):

With depression, anxiety and ADHD, the neurotransmitters are very well similar, and there’s a lot of more other neurotransmitters that I didn’t mention like GABA. That’s one that’s really important for anxiety, but our brain doesn’t make enough of it. We need more of it, and so when we take medications, it helps with that chemical imbalance.

Lindsay Guentzel (08:16):

When we’re talking about a person who has ADHD and the likelihood that they’ll develop depression, are there any demographics we can look at to see who is more likely to develop depression? Can we look at gender and age, even ADHD type? What have you seen when you’ve been talking with patients who have ADHD, but are also showing signs of having depression as a comorbidity?

Lakeisha Love (08:43):

When it comes to depression, to be honest, it’s all demographics. Obviously, people who are living in a more populated area like the US versus someone who is out of the country, maybe at Thailand or it’s Africa, they will have lower levels of depression versus being in the US where there’s a lot of different environmental causes to depression that can increase those risk factors.

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But predominantly, a lot of my clients are Caucasian. I just think that it’s because not that it’s more common in them, but they’re more openly and ready to talk about mental health and the challenges that they are having.

Lindsay Guentzel (09:32):

I know from conversations that I have had that there is a connection between women who have ADHD who tend to have inattentive type or a combined type, which means that they have inattentive as well as hyperactive, and an increased risk of depression. I’m wondering what you have seen through your time working with patients specifically with women about what it is that might be driving those numbers up.

Lakeisha Love (10:00):

Women are becoming more aware. A lot of the women that I see, a lot of the symptoms that they tell me, they recognize it because of TikTok. Having this awareness out there of ADHD symptoms of inattentive type in women is allowing them to be able to recognize that there’s some similarities of things that they’re experiencing too. They’re concerned because they’re like, “Aha, I do the same thing, or I’m struggling with the same challenges,” and then they come for help to get an evaluation and seek out if there’s anything that could help with their inattentiveness.

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Most people who I’ve encountered that are inattentive have successfully been able to complete high school and some college and even go to grad school, but it either took longer, so instead of four years, it took them five years, or they’ve studied a lot, hours and hours and hours, because it takes so long to read 10 pages. They may have to constantly read it over and over, but they still were able to complete it.

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It really didn’t translate to a lot of my female clients who have finished college that they’re having challenges until now they’re on their jobs and they’re in their careers and they’re working. We’re talking about maybe sit down roles where they’ve translated from working in office and now they’re working from home. And now they’re seeing those challenges with inattentiveness because they’re in an environment where they’re more easily distracted, and so they’re coming out for help.

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But I think social media plays a part. These podcasts is very important. It’s getting the awareness out there so people could learn about mental health, depression, anxiety, bipolar, substance abuse and understand what it is. Once you know the symptoms and if you feel that this is what you’re having challenges with, then you seek out to the right professionals to get the help you need.

Lindsay Guentzel (12:04):

You mentioned a bit about suicide ideation and how it is something that can come up for a person who has both ADHD and depression. Why is that? Where does the concern come from and what are we on the lookout for to make sure that that is something that doesn’t happen?

Lakeisha Love (12:23):

Sometimes when you’re in that very, very dark spot of feeling worthless, you tend to ask yourself, am I good enough or I don’t think I’m good enough. Those thoughts become very negative. You start having these distorted images upon yourself along with failures that you may be encountering, especially when it’s work related or you’re losing your job or you’re unable to maintain a job because you have poor productivity. That translates into those negative feelings, those negative distortions.

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You may say, “Well, what may life look like if I wasn’t here tomorrow? Will my family even miss me? Or my family may be better off if I’m not here.” The best thing to do is to ask, how do you feel? Have you ever had any thoughts of harming yourself or others? You do screening questions. Anyone who’s getting evaluated for ADHD should have a depression screening. There’s a question there on that PHQ-9 that asks about active suicidal ideations.

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When someone says yes that they’re having those, then that’s when you do that further assessment and you ask more questions like, tell me more about how you’re feeling, do you have a plan to harm yourself, and then you take their appropriate intervention. It’s a hard topic, but again, having that empathy and listening to that person and understanding where they’re coming from will go a long way, and they can hopefully open up to you so that you can understand where they’re coming from from a mental standpoint.

Lindsay Guentzel (14:02):

There’s this idea of how impulsivity plays into suicidal ideation or suicide attempts. We know impulsivity is a massive part of the ADHD brain. How do we tackle that and what is the connection and what should someone be thinking about if they are a person who is impulsive, but then are having these depressive episodes.

Lakeisha Love (14:27):

Feeling impulsive, there could be different kinds of impulsiveness. One, it can be going shopping, literally spending every last dime you have. Others, it could be more of high risky behaviors like wanting to just go out there without a care in the world and do whatever and don’t really care what’s going on or feeling suicidal where you’re impulsive to end your life. Again, I think that with ADHD, the reason why the impulsive and the suicidal ideations occur is because it has transitioned to depression.

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So then there’s not enough serotonin in the brain to make them feel happy, and there’s no happiness, and there’s no support system, because not everyone has support, right? But if there’s no support system, there’s no happiness, that person doesn’t feel the meaningful or have hope of life, it’s easy to go jump off that bridge. No one will really understand in the moment until they’ve dealt with depression themselves or dealt with those negative thoughts themselves.

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The best thing that we can do as individuals in society is to be able to fight that mental health stigma, make it more warming, and be more kind to individuals and understand that you never know what someone is going through or what dark place that they are going through. And that we should continue to be kind for people and not stigmatize ADHD and say that, “Well, you should have got rid of that when you were a child. There’s no such thing of it being in an adulthood,” or saying that, “You’re not depressed. You don’t have depression. You just need to figure out life.”

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It really is challenging to a lot of people and people may not have that support or the needs to be able to have the positive healthy coping strategies to be able to get through life. We should all be aware of the positive and the negatives and how we can encounter to make this mental health awareness better.

Lindsay Guentzel (16:36):

I want to move into talking about treatment. ADHD is a lifelong condition and depression can also be lifelong, but it can go into remission with proper care. What helps keep things on track and what causes flareups for a person?

Lakeisha Love (16:53):

I always like to advocate for a combination of cognitive behavioral therapy or psychotherapy, just regular talk therapy modalities, and also medication management, because there’s a piece that CBT can do and medication management can’t and vice versa. We know that the mechanism of action of different type of treatments for ADHD and depression is to improve the symptoms, or with depression, to help someone become from depression to remission where there’s no absolute symptoms.

(17:26):

With ADHD, it’s very impossible to have no type of symptoms at all, but medication do help reduce symptoms so that individuals can be able to be productive and less fidgety and be able to get on by their day. Again, therapy is very vital because it helps you with those strategies that you need. Having that calendar, being able to write down those important tasks, developing that alarm system, being able to write things down to help with memory, medications won’t help with that.

(18:03):

It’ll help memory to have better memory, or it’ll help you to be motivated to be able to write down something in your calendar and complete those tasks, but you still need to develop these behavioral skills and implement them to be able to be successful while you’re also taking medications at the same time.

Lindsay Guentzel (18:25):

How does lifestyle choices play a factor in whether a person can keep their depression under control?

Lakeisha Love (18:34):

Lifestyle factors is very natural. One of my favorite that I like to always discuss is having a really good exercise routine. It doesn’t have to involve going to the gym and lifting weights and trying to be a bodybuilder. But if you just incorporate a moderate exercise activity in your routine three times a week, whether it’s yoga, you’re meditating, you’re taking a 30-minute walk, or you’re actually going to the gym, this is going to help improve your endorphins and boost that serotonin that your brain needs.

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Give you more sunlight because sunlight is very important for our vitamin C, so that you can feel better, you can have a happier mood, and also have better sleeping patterns. And then once you’re eating a well-balanced diet of proteins and vegetables and healthy carbs, that will help you feel more energized and not be so fatigued throughout the day so that you can have more energy and motivation.

Lindsay Guentzel (19:35):

I’m wondering how behavioral parent training can be helpful for kids and teens who struggle with depression as well as ADHD.

Lakeisha Love (19:44):

I think behavioral training is very important, especially for parents because in order for a parent to understand what their child may be going through or exhibiting, they should really understand what ADHD is and how it can affect that child in a school setting, their social setting, and also in their home setting. The goals of behavioral parent training is to develop positive reinforcement and techniques to help strengthen behaviors for that child so that the parent can implement it in the home so the kid could have those behavioral techniques throughout their life.

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Because if you really start early on, then they’ll be more successful when they become adolescents or teenagers and when they go to college if they do decide to, and also as an adult. It’s sometimes difficult to change those behaviorals in your adulthood. It can be done, but the child is in that learning mode where they are mimicking things.

(20:55):

Helping them understand how to sit for a longer period of time, how we be quiet or teaching them important manners of raising their hands, or even when to know when to reach out for help when you need it, when you feel like you’re struggling or teaching that child certain mood behaviors, are you happy, are you sad, are you angry, teaching them those emotions so that they can be more expressive.

Lindsay Guentzel (21:22):

You’ve touched on this a little bit, but it’s like a child with ADHD does something because they’re either impulsive or they’re not paying attention, and then they get in trouble. And then we know the emotions that tend to come with that are shame and guilt, and that can lead to depressive thoughts. It’s this kind of snowball effect of how do you even get ahead of it? This parent training sounds like a great way to at least start somewhere.

Lakeisha Love (21:52):

It is. It’s very ideal. Even if parents don’t want to start their children on medications, I strongly highly recommend therapy by all means. Because again, when a child may have ADHD, it’s already difficult for them to express their emotions, but you want to teach them how to. You want to be able to recognize if they’re anxious or if they’re depressed, if they’re feeling shame, guilt, or any type of doubt. Because if they’re constantly getting in trouble at school or they’re constantly interrupting, then they may feel isolated.

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Maybe there’s a group of kids that may laugh at them because they’re awkward. Why are they always yelling or interrupting or finishing my sentences or just being very hyper and jumping off the walls? That can make that child feel down. Why don’t I have friends? Why am I always getting in trouble? Why do my parents always yell at me because I’m not listening? If this is not being discussed and not being recognized, that child grows up feeling shameful and feeling doubtful, and they’re exhibiting these behavioral patterns.

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When they translate into a teenager or an early adult, they’ve already exhibited some form of depression and anxiety because of the challenges that they face silently to get that A or B that their parents want them to have or not understanding why they’re constantly getting Fs and can’t turn in their homework on time because they’re internally really struggling. They’re having a lot of challenges.

Lindsay Guentzel (23:35):

Are there any medications that work well for people who have ADHD and also depression?

Lakeisha Love (23:42):

Yes, there’s a few out there that can be described for both. One is Wellbutrin. Bupropion is another name for it. That one is used for depression. It really helps boost the norepinephrine level. If someone is feeling depressed, but maybe they don’t have energy or no motivation, unable to concentrate, Wellbutrin helps that in all aspects of the brain. Then they found out that it was actually working well in people who have ADHD, so we use it off-label for ADHD treatment.

(24:17):

Some other medications is Strattera and also Qelbree, and they work very similar to the Bupropion as well, but these are FDA approved for ADHD management. If you have someone who have depression and ADHD, I would try to use the non-stimulant options first to treat both symptoms to see if this improves versus trying stimulant therapy.

Lindsay Guentzel (24:43):

Can Adderall ever be used in certain doses to help with both ADHD and depression?

Lakeisha Love (24:49):

I’ve seen Adderall, Vyvanse, Concerta, Ritalin, dextroamphetamine, Focalin. I’ve really seen it help in depression, and this goes to our main conversation today is recognizing where the depression is from. Because if the depression is from ADHD, once you help the ADHD factor, that depression improves because that person feels more motivated, they’re more productive, they feel their mood is more stabilized, so they no longer have those depressive symptoms once they’ve started stimulant therapy for their ADHD management.

(25:25):

I’ve seen a lot of patients come back to me and say, “I feel so much better because I’m able, again, to take the clothes from the washer to the dryer and actually fold them up altogether in one sitting.”

Lindsay Guentzel (25:40):

Is there anything we didn’t touch on today regarding the connection between ADHD and depression that you would like to share?

Lakeisha Love (25:46):

Just remembering that if anyone is having these challenges and these struggles, reach out to someone. Talk about it. It’s a safe place. Mental health awareness is very important. You’re not alone in this. There’s a lot of people all over the world that’s struggling, even professionals. We have our own challenges that we combat in our lives.

(26:08):

But it’s very important to speak up and reach out because you never know how your life can be impacted and how well it can improve once you actually get the diagnosis and understand the symptoms and how treatment or therapy can help you in the long run.

Lindsay Guentzel (26:26):

Well, Lakeisha, thank you so much for joining us. This was such a lovely conversation, and I really appreciated all of the examples you used from your time working as a provider, because I think hearing from someone who is working with people every single day is so important because it really just provides these real life examples that I think sometimes are hard to find in research or textbooks. Thank you so much.

Lakeisha Love (26:51):

You’re welcome. It’s a pleasure. Thank you for having me.

Lindsay Guentzel (27:01):

Thank you for joining me today. We learned so much from how neurotransmitters impact ADHD and depression and how societal comfort levels around discussing mental health really do play a big role in openness to seek treatment. Love it or leave it, social media is bringing awareness to the masses, letting us know about symptoms and that help is available for what’s getting us down. We also touched on suicide, something we’ve not talked much about on the show. We know it is a big topic and one that needs careful consideration in any discussion.

(27:46):

I’m so appreciative of Lakeisha for helping us better understand how suicide ideation can accompany untreated depression and how ADHD and impulsivity can compound matters there. ADHD can lead a person to dark spots of worthlessness, negative thoughts, distorted images, and feeling like a failure. Empathy and understanding, as Lakeisha said, are essential when tackling these feelings, along with advocating for a combination of cognitive behavioral therapy or therapy with medication management.

(28:30):

As always, we saw how lifestyle factors impact treatment for depression. It’s not just working out and eating well. It’s also things like having a routine, getting good sleep, rediscovering joy in your favorite activities and finding community. One topic, behavioral parent training is already an idea for a show next year. Again, a big shout-out to Gen X for bringing it back to the forefront to help parents set up a good path for their children and behavior patterns for the family. If you are facing any challenges, we want you to feel empowered to speak up and seek help.

(29:16):

Lakeisha said it best, you never know the impact it could have on your life. Have that conversation with your provider. Ask questions about medication and talk about the options that are available for you. Whether you’re looking for a second opinion, are ready to get answers for the very first time, or you just want a little extra information about your brain, ADHD Online is ready to help you on your journey. In case you missed the great news, they are now offering our listeners $20 off their ADHD Online assessment.

(29:54):

To get this offer, all you have to do is use the discount code Refocused 20 at checkout. It’s that simple. Head over to a adhdonline.com to get started today. Refocused is a collaboration between me, Lindsay Guentzel, and ADHD Online, a telemedicine mental healthcare company that provides affordable and accessible ADHD assessments and treatment plans. To learn how they can help you on your journey. Head to a adhdonline.com. A huge thanks to my managing editor, Sarah Platanitis, who is instrumental in building these conversations for you guys.

(30:34):

She is the yin to my ADHD brain yang, and I’m so lucky to have her on the team. Our coordinating producer, Phil Rodemann leads the way for all of our episode production, helping fine tune our recording process and assisting with editing responsibilities. Al Chaplin is our go-to for all things social media, and I love what they’ve been creating for us. Make sure to give it a like and a follow at @RefocusedPod over on Instagram. Refocused couldn’t happen without my partners turned friends at a ADHD Online.

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High fives to the ones I bug the most, Keith Boswell, Claudia Gatti, Melanie Meyrl, Suzanne Spruit, and Trisha Mirchandani. Our show are was created by Sissy Yee of Berlin Grey, and our music was created by Louis Inglis, a singer-songwriter from Perth, Australia, who was diagnosed with ADHD in 2020 at the age of 39. Finally, a big thanks to Mason Nelle over at Dexia in Grand Rapids, Michigan for all of his help in getting our videos ready to share with you guys. Links to all of the partners we work with are available in the show notes.

(31:50):

To connect with the show or with me, you can find us online @RefocusedPod, as well as @LindsayGuentzel. You can email the show [email protected]. That’s [email protected]. Take care of yourselves please. And in an effort to reduce the unbelievable amount of stress we all carry around with us unnecessarily, be a little kinder to yourselves this week. And finally, a reminder that next week’s episode, Understanding ADHD and Depression In Our Lives, is being moved to Wednesday, September 13.

(32:34):

Again, we are moving episode 98 from our normal Monday release to a Wednesday release to accommodate some unexpected health issues yours truly has been dealing with. But we’ll be back on track for episode 99 on September 18th, and then the great episode 100 where we will look back at some of our favorite memories from the first 100 episodes. That will be ready to go for you bright and early on September 25th wherever you get your podcasts.