View Full Version : Do depressed ADHDers always need an antidepressant, too?


calcal
11-11-13, 08:49 PM
I mean even if someone turns out to have ADHD but also has a history of depression then would putting him on stimulants only be irresponsible cause stimulants lower serotonine and can actually cause depression (at least that is what I read)? Does this mean that a depressed person should always also take a SSRI to prevent serotonine issues or to prevent the depression from getting even worse?
I wonder about this. For me no AD so far worked and I'm pretty disappointed.
I tried celexa (SSRI), remeron (NASSA) and wellbutrin (NDRI) and none did anything. I am now planning to try stablon.
But I also wonder if I take ritalin then what if I deplete my serotonine even more and risk the depression getting even worse?

dvdnvwls
11-11-13, 09:24 PM
You're focussed on the wrong questions. You're not a doctor.

The answer to your basic question is "No, they don't". But it depends on the person and on the precise nature of the diagnosis and all the other factors that might be involved.

It's good to be an informed patient; but it's possible to be a patient who has pumped themselves full of misinformation and who becomes impossible to treat. It's absolutely necessary for you to be a follower not a leader, in some aspects of your treatment. Your worries and fears about drugs are preventing your doctor from doing a proper job. Back off a bit. Or get a pharmacology degree so that you will really understand.

The main problem is that you are un-critically taking in information from unreliable sources.

purpleToes
11-11-13, 10:01 PM
Depression isn't a common side effect of treatment with amphetamines or methylphenidates for ADHD. Most people feel better when their ADHD is treated effectively. If you're taking therapeutic doses under careful medical supervision, it's pretty safe. It's probably more a question of whether the doctor feels it's safe to let you go without antidepressants.

Has your doctor suggested it or are you thinking about requesting it?

purpleToes
11-11-13, 10:50 PM
Not everyone with depression needs antidepressants, ADHD or not.

Rebelyell
11-11-13, 11:01 PM
That is true dvd an PT but alot of times adhd is co morbid w other mental health issues alot of times, notice I didnt say everyone lol.

Nicksgonefishin
11-12-13, 12:44 AM
For those of us that use "always" and "never" statements an ssri isn't a bad idea.



Those statements are indicative of a comoribid PD of some kind.

What if. ... I don't miss those words.

davinci10
11-12-13, 04:22 AM
If you have adhd and depression then you will need anti-depressant, but if you want to put an end to depression then get a group of 5-6 ppl and start laughing together non-stop for 10 mins. your life will change completely in 3 days time.

your body cannot differentiate between real and fake laughter. So you get the same psychological and physiological benefits.

dvdnvwls
11-12-13, 06:03 AM
If you have adhd and depression then you will need anti-depressant, ...As was just mentioned, this comment is completely false.

calcal
11-12-13, 12:39 PM
Well one of the psychiatrists I have been to warned me of ritalin and told me that ritalin alone can cause depression in non-depressed persons and I am already depressed to start with. Now if it can cause depression then the serotonine depletion stuff could be true.
I just worry about that. I don't want to become more depressed than I already am.

dvdnvwls
11-12-13, 05:08 PM
That psychiatrist gave a good reason to get off Ritalin if you find it actually does cause depression in you. It is not a good reason to not try Ritalin. Again, you are over-thinking, asking the wrong questions, and trying to make decisions with little unrelated snippets of information. STOP. It isn't working. You can't make decisions this way - it's dangerous and silly. It really is necessary to "go with the flow" to a much greater extent than you are doing. You must learn more from experience. Picking up snippets of information here and there, and latching onto them as your decision-making tools, is going to get you in very big trouble.

You must either decide to trust your current doctor, or get a new doctor who you do trust - and you must stick with the doctor you trust and do what you're told, to a much greater extent than you're doing. You can't piece this whole puzzle together by yourself. (Not before you're 75, anyway.)

Please note that I am not telling you "don't ask questions" - I'm telling you you're asking too many wrong questions, and you're playing doctor but you don't know how to play doctor. Always ask questions - but ask better ones.

calcal
11-12-13, 07:53 PM
I'm just worried I mean what if I start taking ritalin continually and then my depression gets worse? This could be really dangerous. :(

BellaVita
11-12-13, 07:57 PM
I'm just worried I mean what if I start taking ritalin continually and then my depression gets worse? This could be really dangerous. :(

It could be MORE dangerous for you to continue your life not medicated....there are so many risks : getting hit by a bus cuz of lack of attention, chopping a finger off from lack of focus and attention, running red lights etc.

calcal
11-12-13, 08:11 PM
I know. But the problem is my fear of side effects and also not really knowing what to do. I mean if I ask my intern then he'd tell me to stay away from psychopharmaceuticals. This also makes me insecure. I just don't know what to do. I fear getting side effects or ending up worse. I don't have a time machine where I can try every scenario and then go back in time if it doesn't work out. :(

Or what if I take an ssri for example and then become suicidal? Ssris have these warnings. This all sounds very risky to me. I'm already under huge stress. What if I take a med and then totally freak out?

purpleToes
11-13-13, 02:03 AM
Hi, Calcal. I can feel how anxious you are about all of this. I think your anxiety condition itself may be magnifying your distress. It's not a bad thing to do a little research, but when you're new to the subject, you can end up scaring yourself with what you read. Keep in mind, you're reading those warnings out of context as a layperson untrained in clinical reasoning. Medical treatments of all sorts carry risks, but that doesn't mean no one should seek medical care. The decision is based on overall risk versus benefit. Many of the warnings you see are only relevant to special cases that a doctor is trained to be alert to. In reality, all the medications you've been asking about have a good safety record when taken correctly under medical supervision.

It sounds to me like you're engaging in some all-or-nothing, catastrophic thinking which I think is causing you to perceive the stakes of any one particular decision being higher than they truly are, and that's what's making you feel so paralyzed. If you can be more flexible and realistic about how bad it would actually be if you tried something and it didn't work, I think you will find it easier to move forward.

Are you in psychotherapy of any kind now?

dvdnvwls
11-13-13, 02:27 AM
I'm just worried I mean what if I start taking ritalin continually and then my depression gets worse? This could be really dangerous. :(
Wrong question. If you take Ritalin and it makes you depressed, then for God's sake just stop taking it!

calcal
11-13-13, 09:52 AM
@ toes

I tried therapy and they all sucked. I am done with that. It caused a lot of anger and hurt. I really despise therapists. I think they're only in for the money.

I am not afraid of a med not working. That would be acceptable. I am afraid of a med not working & causing more issues on top of that.

@ dvd

But what if I take ritalin for a while think it's all good and then after a while I suddenly find out that it makes the depression much worse or that I need to take it daily otherwise I'll fall into a deep pit? That's scary. I don't want to have to take ritalin daily. I only wanted to take it whenever I need it but not daily.

MeepMeep
11-13-13, 05:24 PM
calcal, firstly, hello there!

I too am from the UK and started Concerta a couple of weeks back.

Previous to this, I've been on an SSRI, Citalopram, in short it just made things worse for me...But I knew deep within I wasn't depressed, but thought I'd give it a go as I've always been "different"...Being slightly dishonest to my GP just made the situation a lot worse.

Came back, finally decided to be honest, saw my GP again, went through the NHS hoops and ended up with an ADHD diagnosis - wasn't expecting this...:umm1:

Anyway, what I was supposed to write about is my dealings with Methlyphenidate; I found the effects to be almost instant. If anything it's improved my moods, not euphoric, but the fact that I had a clear mind keeps me a lot happier.

I'm not a constant battle with my own mind anymore...As the days have gone on, my perception is changing, and I'm realising a lot of wrongs I've did over the years, and how I've screwed a lot of my life up via my own actions and lived in a haze...

Yeah that's some what depressing, BUT...as I've got a stronger mind, I'm dealing with it.

What I'm trying to say is, if you truly have ADHD, stimulants may be a life saver...I didn't realise how different the world is until I started taking Concerta.

Music is a lot more entertaining, not being flooded with external nose is lovely, being able to do stuff that "normal" people do is really nice.

I think the key here is be honest with your docs, take one step at a time. They won't just throw ADHD meds at you and call it a day...And neither should you give up at that point if you feel there are other issues at hand.

Take care buddy.

purpleToes
11-13-13, 08:40 PM
:goodpost: Welcome, MeepMeep!

purpleToes
11-13-13, 09:59 PM
@ toes

I tried therapy and they all sucked. I am done with that. It caused a lot of anger and hurt. I really despise therapists. I think they're only in for the money.

I am not afraid of a med not working. That would be acceptable. I am afraid of a med not working & causing more issues on top of that.

@ dvd

But what if I take ritalin for a while think it's all good and then after a while I suddenly find out that it makes the depression much worse or that I need to take it daily otherwise I'll fall into a deep pit? That's scary. I don't want to have to take ritalin daily. I only wanted to take it whenever I need it but not daily.

Sorry to hear it was such a bad experience :( I've had a couple of therapists who were duds, most were just OK and a couple were excellent. The one I have now has been amazing. Therapy can be painful sometimes but we should feel as if the therapist is on our side, helping us get through the pain, not causing it.

Thanks for clarifying about your med concerns. I can certainly understand not wanting to make things worse. I feel confident saying if you are being completely candid with your psychiatrist and using the medicines exactly as instructed, then you shouldn't have any issues that you both won't be able to see coming. Right now I see you kind of stuck trying to decide what you should do. The thing is, you're not the one who should have to be doing the clinical reasoning - it's your psychiatrist's job to figure out what treatment is most likely to help you and least likely to make things worse. The more complete a picture you paint for him, the better he will be able to do his job.

Try not to feel too discouraged by the setbacks. If treating ADHD and mental health issues were straightforward and simple, these forums wouldn't need to exist, but people do get better. Success comes from the persistence to keep trying something different until something works.

purpleToes
11-13-13, 10:18 PM
I want to add, if you can't stand the thought of trying another therapist right now, but you're still interested in incorporating a psychological approach, the folks in the Depression section can probably give you some great recommendations for self-help workbooks.

calcal
11-14-13, 01:35 PM
@ meepmeep

How much concerta are you taking? You say you feel it instantly like in a few minutes? I don't feel anything. My stuff is called Medikinet and it releases 50% instantly and 50% after 3-4 hours. My highest was 20mg which equals 10mg instant release Ritalin. I had no instant effects at all. I haven't yet tried higher doses. I'm a bit scared of them. I mean let's say I go to the max and take 40mg and then feel something then I assume that it would still be risky cause if you need to take the max dose to even feel something then this is probably not a good sign cause in case you needed more after a while you cannot go any higher.

I also suffer from depression that's obvious. For me it's not simply untreated adhd.

@ purpleToes

I think I'm gonna try stablon now. It has rather mild side effects compared to other meds.
I'm not totally against therapists but I am sick of simply trying them out and finding out that they suck. I'd rather talk to a pastor for example someone who I feel is really interested in helping and not just in the money. I can't work with someone like that. I called one therapist and asked for an appointment and this jerk didn't even call back cause he has enough customers already. That is pathetic. It says a lot about the person imo.
Self help books can't really help me. I mean I'm mostly depressed cause I'm sick but not just that my overall situation is really depressing. It's not just 1 issue it's multiple issues. I have so many things to worry about that often times I don't even know what to worry about right now cause it's overwhelming. I don't think that there is any trick or advice which I can apply and then I won't be depressed anymore.

dvdnvwls
11-14-13, 06:46 PM
calcal: You're playing the "What-If Game" again. It feels nice to play the What-If Game, because it distracts you from what's really going on - but the What-If Game is ruining your life far worse than the things you're saying you're scared of. Get scared of how badly this game is ruining you.

MeepMeep
11-14-13, 07:27 PM
@ meepmeep

How much concerta are you taking? You say you feel it instantly like in a few minutes? I don't feel anything. My stuff is called Medikinet and it releases 50% instantly and 50% after 3-4 hours. My highest was 20mg which equals 10mg instant release Ritalin. I had no instant effects at all. I haven't yet tried higher doses. I'm a bit scared of them. I mean let's say I go to the max and take 40mg and then feel something then I assume that it would still be risky cause if you need to take the max dose to even feel something then this is probably not a good sign cause in case you needed more after a while you cannot go any higher.

I also suffer from depression that's obvious. For me it's not simply untreated adhd.



Initially 18mg, within an hour noticed something different...Now on 36mg and things are dandy, gotta ride out 36mg for a month and then re-evaluate.
40mg the max? Hmm, for Concerta, I believe the recommended max is 72mg/day...And even IR meds, I've seen 60mg before...A max of 40mg sustained release sounds strange.

Concerta is worth giving a go, it has a longer duration, so if you're worried about a surge of 'speed' a pill that has a longer duration should be a lot smoother.

I don't think you realise how badly ADHD can affect your mental well being, you cannot expect to have a strong foundation if the ground work isn't solid. If you have ADHD and you leave it un-treated, sadly I think you will struggle finding inner peace.

Don't give up the fight before it's started, stay strong, you will succeed, take care.

Rebelyell
11-14-13, 07:42 PM
No not all the time, sometimes you can do cbt and work an talk thru your problems but if one has been depressed for so long they might need meds to get them out of it besides therapy.

purpleToes
11-14-13, 08:43 PM
Calcal, good luck with the new med! Something is bound to help. Crossing my fingers for ya! Meanwhile, talking to your pastor sounds like a great idea. It sounds like you're going through a terribly rough patch and having some extra support can only help.

calcal
11-15-13, 08:21 PM
18mg concerta is a low dose given the fact that it's spread out over many hours. I doubt I would have felt anything from that. The stuff I have releases 50% immediately and 50% 3 hours later and I didn't feel anything when I took 20mg which equals 10mg instant ritalin.

No I don't have a pastor. I was just saying I'd rather talking to a caring pastor than to a therapist who earns around 4 $ per minute. That is insane. Just think about that. In other countries people have to work an hour or maybe days to get 4 $. :rolleyes:
I really don't see me trying therapy again. I'm too scared of getting angry and upset again.

Actually I wanted to start with stablon but I don't dare to. I read the leaflet and the side effects profile was scarier than I thought. I mean overall the side effects which are listed are tolerable there is nothing really dangerous among them but under frequent side effects it has some major side effects like trouble breathing which is pretty scary and fainting which is also really scary. I don't know how they define frequent but it must be something like 10% or maybe more. This is totally concerning. I mean how do you deal with this? When I start taking it then I'll be afraid all the time that I might faint all of a sudden. :mad:

purpleToes
11-15-13, 10:53 PM
xxxxx

Raye
12-03-13, 09:23 AM
This is tricky IMO...

I've heard that ADHD causes depression, and if medicated properly it controls the symptoms.

But I've also heard that it doesn't work for everyone, I know some ADHD'ers who do take Anti- D's.

Since I've been put on the right ADHD med for me, I have noticed the depression has died down a lot. My new pdoc took me off Lamictal ( off label Anti- D) for a while, to see how I'm feeling.

I'm doing ok so far.

daveddd
12-03-13, 09:52 AM
Stimulants also treat depression for some people

So not always

Amtram
12-03-13, 11:03 AM
There are also certain antidepressants that seem to help some people with ADHD symptoms as well. Wellbutrin and some of its offshoots have an effect on dopamine levels, and there are patients who can take that one medication and it helps with the ADHD and depression at the same time.