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Clinical Expert: Steven Dickstein, MD
en EspañolQ I have a 15-year-old son diagnosed with ADD. He is taking 20 mg of Adderall XR. Does Adderall or other drugs used to treat ADD cause depression? I was also told by my son's psychiatrist that medications like Adderall have been prescribed for depression. What can you tell me?
Adderall in general is not used to treat depression. It has been found to be effective for treating kids and adults with ADHD.
It is possible that a child who has been prescribed Adderall, which is mixed amphetamine salts for ADHD, might begin exhibiting sad or listless behavior. There are a few explanations for this reaction. When a stimulant dose is too high for a child he may begin to look sedated or unlike himself. If this happens his psychiatrist needs to work with the family to adjust the prescription until they find the right dose. But a small percentage of children — about five percent — can become very dysphoric and even depressed-seeming on a mixed amphetamine. Their emotional reaction will end when they stop taking the medication. Again, this is a small percentage of children.
However, if your child does get depressed on amphetamine, you always have the option to try a different medication. There are two kinds of stimulants that doctors use to treat ADHD, amphetamine and methylphenidate. Sometimes a person may have side effects on one kind of stimulant but respond very well to the other. So if a child has a poor response or side effect to amphetamine, then his doctor should consider prescribing a methylphenidate-based medication.
Doctors should also work to think carefully about their diagnosis, because some symptoms of depression can look a lot like ADHD. Depression makes it difficult to concentrate and can result in struggles at school, for example. It’s helpful to consider how long you’ve been seeing symptoms. Starting at a young age, kids with ADHD present a chronic history of difficulty focusing and paying attention whereas depression symptoms are more episodic. And, of course, kids with depression experience a lot more sadness, guilt, feelings of hopelessness, and sleep problems.
For kids who have been correctly diagnosed with ADHD, it is possible that they also develop depression. Kids with ADHD are actually at a higher risk for developing major depressive disorder. It’s not completely clear why but it could be because they have more problems early in life, such as having trouble at school, trouble getting along with parents, and trouble with peers, which may lead to developing poor self-esteem. The good news is that kids can be safely treated for both disorders at the same time. Generally doctors begin treating the primary disorder first and then add treatment for the second later.
Adderall rarely causes depression in kids who take it to treat ADHD. However, a child might seem sad or listless if their dose is too high, it should be reduced until they find the right dose.
And a few kids do react to stimulant medications with a depressed mood, which will go away if they go off the medication. They should try a different medication or treatment.
In rare cases, amphetamine stimulants can cause depression in kids taking them for ADHD. There are two kinds of stimulants doctors use to treat ADHD: amphetamine, and methylphenidate. If a child has a poor response to amphetamine, their doctor should consider prescribing a methylphenidate-based medication or a non-stimulant.
ADHD medication rarely causes depression. But kids with ADHD are at a higher risk for developing major depressive disorder. This could be because they tend to have trouble in school, or struggle to get along with their parents and peers. These challenges may lead to a child developing poor self-esteem and depression.
