Lindsay Guentzel (00:02):

On today’s show, we are continuing our look at the most common comorbidities people with ADHD find themselves dealing with. This time we’re diving into ADHD and depression with Lakeisha Love. Today’s episode discusses the connection between ADHD, depression, suicide, and suicide ideation. If you or someone you know is experiencing suicidal thoughts, there is help. Call or text the number 988 to connect directly to the Suicide and Crisis Lifeline. If you do not live in the United States, I’ve included a link in the show notes that highlights resources for help and support in other countries around the world.

(00:50):

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. 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. And I promise that while we take this very seriously, we also have a lot of fun because life is way better with a little laughter in it. So 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.

(01:56):

If you haven’t realized this by now, ADHD rarely travels alone. It has these pals called comorbidities. What are essentially other conditions that exist alongside ADHD that can greatly affect a person’s social, emotional and mental health. Like anxiety, depression is one of the most common comorbidities that people with ADHD deal with. ADHDers are four times more likely to develop depression than our neurotypical friends. In fact, some experts think that as many as 70% of ADHDers will be treated at some point in their lives for depression. We know that ADHD is a pattern of inattention with or without hyperactivity that interferes with functioning or development. Symptoms include distractibility, disorganization, trouble with follow through, and procrastination, low tolerance for boredom or frustration, impulsivity or restlessness and mood swings. Hello, emotional dysregulation.

(03:11):

Depression is a mood disorder characterized by a loss of interest in activities for a period of at least two weeks. It’s accompanied by sleep issues like insomnia or sleeping too much. It can also present as fatigue, sadness, irritability, feelings of worthlessness or guilt, and it can cause difficulty with thinking or concentrating, and even decision-making. Major depressive episodes can cause severe distress or impairment that can put all areas of a person’s life on hold. Milder episodes might mean day-to-day activities can still happen, but they take a lot of effort. We have very little concrete evidence as to why ADHD and depression coincide so frequently, and in Erin Boyle’s Health Central article, Why ADHD Makes You More Prone to Depression – And What to Do About It, therapist Misty Smith offers up the suggestion that the answer we’re looking for might not be as complicated as we think. Having ADHD is physically, emotionally and mentally exhausting. And if you take out family history and genetics, the higher risk could simply be from feeling overwhelmed, alone or simply misunderstood as a neurodiverse person constantly working against the stigmas of a neurotypical world.

(04:46):

Boyle also spoke with Dr. Marcy Caldwell, who joined us a few episodes back to talk about anxiety. One observation Dr. Caldwell shared in the article was that some people with ADHD can become animated by being around others, helping them feel momentarily buoyed up, which can make getting an accurate diagnosis for depression as a comorbidity more challenging. There can be a disconnect when a person appears more upbeat and happy while in therapy, but feels depression symptoms more strongly when they’re alone. Like so much with ADHD, there’s still a lot we’re figuring out when it comes to how depression shows up in the life of an ADHDer.

(05:34):

Joining us today is Lakeisha Love to help shed some light on what we do know. 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. It was her personal calling to help those struggling with mental health issues that moved her to join the team at ADHD Online. Her interest was peaked by the opportunity to delve into ADHD and its transformative potential in individuals’ lives.

(06:13):

What’s very clear, and you’ll hear it today, Lakeisha is drawn to the greater mission of dismantling mental health stigma surrounding ADHD and believes in the profound positive impact that tailored care can bring to individuals lives. So much so that the Phoenix based specialist is working on adding a dual certification for psychiatric mental health to her expertise. Having witnessed patients grappling with ADHD challenges in primary care, she quickly recognized the limitations of diagnosing and treating ADHD in that setting. And it’s one of the reasons why she is so passionate about her work with ADHD Online being able to lead the way on offering global accessibility for proper diagnosis and treatment. I am so excited to welcome Lakeisha to the Refocused community. And with that, let’s get into Episode 96, Understanding ADHD and Depression with Lakeisha Love.

(07:25):

Lakeisha, I am so excited to have you here today as we continue these conversations on some of the comorbidities that can come alongside ADHD. Thank you for sharing your time with us.

Lakeisha Love (07:36):

Thank you. It’s a pleasure of being here today, Lindsay.

Lindsay Guentzel (07:39):

So I think it would be really important for us to start by just defining depression. It’s one of the most common comorbidities to come alongside ADHD, but I think sometimes people might have a skewed idea of what it actually is.

Lakeisha Love (07:53):

So depression is very common. A lot of individuals in our world experience depression to some extent, at at least some point in their lives. Common symptoms of depression is lack of motivation, feeling sad or not wanting to do your favorite events or activities anymore, loss of interest in pleasure to do those favorite things. Becoming isolated, so isolating yourself around your friends or your family, crying more often. Having changes in your appetite, whether you’re overeating or undereating. Changes in your sleep patterns, whether you’re sleeping too much or you’re not sleeping enough. Lack of self-worth, worthlessness, having guilt, not having the ability to feel worthy. And in severe forms, you can have suicidal ideations of not wanting to be present or to be here or not have any type of life or purpose anymore. It only takes two weeks to have these symptoms. And so if you’re feeling any of these symptoms greater than two weeks and it’s starting to impact your daily life, your ability to be able to function and get up and be a parent or do your daily work or be able to get out the door, then it becomes more concerning.

Lindsay Guentzel (09:16):

Do we know why depression and ADHD coincide so frequently? Is there a concrete answer?

Lakeisha Love (09:23):

There’s no concrete answer obviously, but there’s a lot of research and a lot of study and evidence-based practices out there that believes there’s some co-relationship. People who have ADHD, the likelihood of them developing depression is 70% more than someone who doesn’t have ADHD. And the reason behind this is because when you are struggling with the ability to be able to function, do your tasks, do your schoolwork, be able to be the best employee that you need to be making commonly mistakes, and it’s interrupting your personal life, your interpersonal relationships, and also your work or your school life, then you can see how those symptoms can translate to depression.

(10:10):

Because if someone is feeling that they’re unable to complete their studies or perform accurately at work, maybe they’re getting reprimanded a lot or they’re easily making mistakes, then they can then come to themselves and say, why is this happening to me? Why can’t I get ahead? Why do I constantly feel like I’m failing or falling behind? And then this transitions into feeling sad or feeling like a failure or not having the motivation to want to get up and do those things. And so there’s a lot of correlation between it and depression can be mistakenly if someone is presenting these symptoms firsthand and no one thinks about ADHD. So now people are getting misdiagnosed because they’re feeling sad, they don’t have that interest or pleasure to do things, their lack of ability to focus and concentrate. But is it depression or is it really the ADHD symptoms that’s overlapping making them feel these particular symptoms?

Lindsay Guentzel (11:11):

And how does family history and genetics play a role in whether someone might be more predisposed to developing depression if they have ADHD?

Lakeisha Love (11:22):

Family history and genetics play a huge impact on the livelihood of someone developing depression or ADHD. I read some studies recently and it said that ADHD is one of the most prevalent conditions in mental health that is genetically linked. So if that mom or that father or sibling or a first degree relative has had ADHD or have ADHD, there’s a likelihood that it’s more prevalent in others. Same thing with depression. If someone mother or father has depression and their mother and father had depression, then that child is more commonly increased to have depression growing up in their adulthood or having a dysregulated mood disorder as a child or in their adolescent ears.

Lindsay Guentzel (12:13):

And I want to ask because we’re at this stage in life where we are actually talking about our mental health and that wasn’t the case for generations before us. So there are a lot of people who are coming into this, in a sense, blindly. I mean, you even think back to when I was born in the ’80’s, postpartum depression wasn’t even talked about. It was not even really discussed or known in common conversations. And so for these people who might be coming in who don’t have that family history and don’t know about it, it presents a different set of challenges, I have to imagine.

Lakeisha Love (12:46):

There’s a lot of factors. So there’s many different cases that I’ve encountered in my career of different people getting evaluated, especially when they’re coming to me as an adult. And I always ask, “Did your family or did your parents believe in mental health?” And 90% of the time the answer is “No.” Or, “My teacher brought to my parents’ attention about it, but my parents didn’t take me to the doctor to get evaluated” or “I got evaluated but my parents didn’t want to put me in therapy or start medications.” And so there’s all these different factors, and then you have religious beliefs and cultural belief and different type of demographics may believe in mental health and may not believe in mental health. So there’s so many different factors of why we’re seeing a surge of prevalence of adults coming now saying, “I need help.”

Lindsay Guentzel (13:45):

You did an amazing job of explaining a lot of the symptoms that can come alongside with depression, but I’m wondering if we could look at a Venn diagram and we’ve got a circle for ADHD and we’ve got a circle for depression, and there’s that little spot in the middle where they overlap. What does that look like for a person?

Lakeisha Love (14:02):

So we’ll start with the symptoms of ADHD and explaining how it could be misinterpreted as depression or vice versa. So obviously, there’s different types. You have inattentive type, hyperactive type, and a combination of a combined type. With inattentive ADHD, this individual may experience the inability to be able to focus, concentrate, start tasks, complete tasks, easily being distracted, having poor memory. You see it a lot, unable to pay attention and focus for longer periods of time. And when someone is hyperactive, they may become fidgety or they may become restless, they have to pace, they can’t sit for longer periods of time. They exhibit these impulsive symptoms where they’re very talkative or interruptive or they finish other people’s sentences. And so the hallmark with ADHD and depression is that if someone is exhibiting depression, they may not have the motivation to start those tasks, complete your task, and then also be able to focus and concentrate because they’re depressed, they can’t get out of bed, they can’t focus, they can’t move forward in life because they’re feeling stuck and they’re feeling so overwhelmed.

(15:21):

In a person with ADHD, they feel overwhelmed with all of these abundance of tasks that they can’t push through or get done, and everything is leading and being incomplete. With hyperactive, I see a lot of people mistaken for anxiety because with anxiety you worry, you’re restless, you’re fidgety, you’re pacing, and so it can look like anxiety when you have that hyperactivity of ADHD portion. So the Venn diagram shows that. Someone who’s depressed will struggle with being able to focus and complete tasks and be productive. And someone who have ADHD will have the same similarities. The hallmark is getting to know that person, asking them those specific questions. “Hey, how were you when you were a child? Do you remember your parents or your teachers bringing this up in conversation? How were you doing school? Did you attend college? Did you finish high school?”

(16:15):

And so that what helps me determine is it ADHD? Is it depression or maybe is a combination of both. Maybe they’ve had traumatic experiences or there’s certain situations in their life that tends to be stressful that’s leading to depression, but also maybe it’s because their ADHD symptoms aren’t being treated. So the key mark here and the discussion is get to know more about that individual. Ask questions pertaining childhood experiences, adolescent years and them as an adult and see what’s impacting and affecting them.

Lindsay Guentzel (16:51):

And I have to imagine as a provider, you have to take into account masking, which is a lot of people with ADHD, it is a gold star trait that we have. If I were sitting in front of you and I didn’t want you to know that anything was wrong, I can most of the time do a pretty good job of masking that, and that is something that we deal with. And then here you are trying to have these very honest open conversations and how do you manage that in a setting where you know that that person might go home and be alone, and without that energy there, everything might fall apart again.

Lakeisha Love (17:29):

The key is building that therapeutic relationship from the beginning, talking about goals for them. What brought you here today? What are some of the things that you are experiencing or what are you having challenges with and what are your goals moving forward after we’ve discussed a potential diagnosis? What are your plans on feeling better or getting back to your best self? And so once you build that relationship with the individual and they feel comfortable with you, they’re able to be more expressive. And a lot of things, what I like to do is motivational interviewing, and I do a lot of open-ended questions where it allows someone to be expressive so that they’re expressing their concerns and I’m here listening. And when they see that I’m listening to them, they feel a little bit more comfortable, and then they start asking questions or when I let them know what symptoms may be to a particular condition and they say, “Hmm, wow, that sounds just like me.” They say it all the time.

(18:37):

And I always tell them that there’s no right or wrong. We can’t provoke what happened in the past. You’re here today and you’re having challenges today, and how can we work together to make you feel better so that you can be a good individual to yourself so you can have that high quality self hierarchy of yourself, of feeling the best and not having that self worth or feeling worthless or that you’re incapable to be able to push forward in life and be the individual that you need to be. So that’s my little hallmark to help them unmask those symptoms is letting them know I’m here for you. I’m listening. I validate your emotions. I understand that this is difficult for you, but let’s figure out together how we can work ways to make you feel better.

Lindsay Guentzel (19:26):

I’m wondering, when you’re talking with patients about depression symptoms, if there are any symptoms that they tend to be surprised by.

Lakeisha Love (19:35):

Most people often don’t think they’re depressed, especially when sad and crying is very common. Someone’s sad or crying, okay, they may be depressed, but as little as overeating or binge eating or not wanting to eat or having sleep difficulties because your mind is racing or you’re constantly having intrusive thoughts, no one really thinks that’s more depression. And so that symptom, it’s more of a hallmark of depression when you’re having those appetite changing. It’s expected to not want to be motivated or get out of bed, but a lot of people are binge eating or they’re not eating enough or they’re becoming isolated and they lack the ability to want to be able to go play golf on every Sunday with their friends. When those activities starts to diminish and they become more of an introvert versus the extrovert that they once was, then we have symptoms of depression.

(20:38):

A lot of my patients will tell me, “I don’t think I feel depressed,” when they have ADHD that’s overlapping to depressive symptoms. They feel depressed because they’re unable to focus or be productive or pass that important exam that they have at school or even a certification that they need for work. They’re feeling down because of that. People who are struggling with major depressive disorder, sometimes there’s no reason at all. It can be a chemical imbalance in the brain. Sometimes it’s life stressors or a grief or loss of a loved one. Sometimes there could be substance abuse issue or past traumatic experiences that they’re dealing with that they haven’t gotten resolved from their childhood. And so depression just really looks different when it’s really major depression versus depression from ADHD.

Lindsay Guentzel (21:32):

And just like the stigmas that hold people back from getting an ADHD diagnosis, I imagine that there are stigmas or ideas that people have in their heads about what depression looks like, and that probably fuels a lot of people who come in and say, “I don’t feel depressed,” because we do have this idea that it has to be not getting out of bed, crying all the time, being in this very dark place, but it doesn’t present that way for every single person.

Lakeisha Love (22:00):

It doesn’t. You can have a complete person who has everything in life. They’re smiling all the time, great career, beautiful family, but still they can struggle from depression. It doesn’t have to be environmental circumstances. It’s a lot about the neurobiology and our neurotransmitters and our brain and how that’s regulated, and that plays a major role in ADHD and depression. And so some people would say, “Well, I don’t think I’m depressed because my life is great,” and that’s what we call depression with an unknown cause. Maybe it’s more chemistry versus actual experimental, environmental, a stressful event,

Lindsay Guentzel (22:44):

Which is more likely to influence the other depression or ADHD? And does figuring out what’s happening become a bit of like an archeological dig sometimes to figure out the right answer to that question.

Lakeisha Love (22:59):

When we’re comparing ADHD and depression, depression again, is seen in a lot of people who have ADHD. It’s more likely to cause it because of the inability to be able to perform. It impacts their interpersonal relationships, it impacts their self-esteem and their self-worth. Is it difficult to determine which one is which? Sometimes, but if you ask the right question, it can be very, very easy to determine if it’s major depression or ADHD. Some things that I would personally consider is that we know that depression doesn’t really start in childhood. Major depressive disorder is diagnosed for those who are 18 and over. Dysregulated mood disorder is diagnosed in children and adolescents who is less than 18, and so if you have a five and six year old who’s exhibiting symptoms of depression, there could be a lot of tons of other things going on in their family dynamics that’s causing it.

(24:04):

But if you have a five or six year old who is having trouble with reading, or they may have a learning disability, they’re behind in school, they need an IEP, they’re unable to listen or they’re having behavioral issues that’s translating to behavioral issues in the home because of the listening skills or the impulsivity, then it’s easy to determine that, well if you experienced this as a child, let’s look at ADHD as a factor versus if that child had past traumatic experience, whether it was verbal, physical, sexual abuse, or they lost a parent or they were taken out of their home, they’re in the foster system and they’re experiencing depression as an adult because of these traumatic experiences, then let’s talk about major depressive disorder. And so although the symptoms can overlap from one another, the thing is asking those very pertinent questions to help formulate your diagnosis along with validating your screening tools.

Lindsay Guentzel (25:18):

That felt like a great place to take a pause. We have so much to get to next week, including how ADHD and depression can affect the brain neurologically. We’ll also talk about risk factors that can make a person with ADHD more predisposed to developed depression. Keeping in mind that experts say that as many as 70% of ADHDers will be treated for depression at some point in their lives. We’ll talk more about the connection between ADHD impulsivity and suicide ideation, and Lakeisha will share what she looks at when developing a treatment plan when she’s working with a patient who is dealing with both ADHD and depression. What I’m finding so interesting about these episodes on comorbidities is that every conversation, I am learning something new. Even with the comorbidities I’ve personally dealt with, like depression.

(26:20):

For some, being social is almost like a neurological wonder drug for their brains. And it explains so much about my struggles in my late teens and early 20’s. I had such a hard time explaining what was going on, and the few times I did open up, I think it was hard for people to look beyond the bubbly social butterfly who was constantly chasing that next dopamine rush. It wasn’t until I was alone and that energy and safety net essentially was gone, that the real problems started popping up. And then I was alone with them. And I don’t think anyone really knew about that person, knew that that person existed. I was very, very good at masking. If you are one of the many ADHDers out there battling depression, please know we see you and we are here for you. You do not need to take this on by yourself. There are so many resources out there meant to help people just like you. And if you need to reach out to someone, you can always connect with the show [email protected], and you can find us on social media at Refocus Pod.

(27:39):

Finally, another reminder that if you or someone you know is experiencing suicidal thoughts, there is help. Call or text the number 988 to connect directly to the Suicide and Crisis Lifeline. If you do not live in the US, we’ve included a link in the show notes that highlights resources for help and support in other countries around the world. You do not have to do this alone. 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. And in case you missed the great news, they’re now offering our listeners $20 off their ADHD Online assessment. To get this offer, all you have to do is use the discount code Refocused20 at checkout. It’s that simple. Head over to a adhdonline.com to get started today.

(28:42):

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 adhdonline.com. A huge thanks to my managing editor, Sarah Platanitis, who is instrumental in building these conversations for you guys. She is the yin to my ADHD brain yang, and I am so lucky to have her on the team. Our coordinating producer, Bill [Rohdeman 00:29:21] leads the way for all of our episode production, helping fine tune our recording process and assisting with editing responsibilities. And 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 Refocus Pod over on Instagram.

(29:44):

Refocused couldn’t happen without my partner’s turned friends at ADHD Online. High fives to the ones I bugged the most, Keith Boswell, Claudia Gotti, Melanie Mile, Susanne Spruit, and Tricia Merchandani. Our show art 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 Nelly 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. To connect with the show or with me, you can find us online at Refocus Pod as well as at Lindsay Guentzel. And you can email us directly [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.