So here's some important facts I've learned from my doctors over recent years. Keep in mind, I'm not a doctor, and this information might be out of date (but I don't think it is).

People with ADHD are often comorbid with depression, so if a doctor doesn't treat the depression first, and gives the person with ADHD the medication to focus, it can result in the person with ADHD having enough focus to successfully make an attempt on their own life.

Fact two: many persons with ADHD doesn't make enough seratonin on their own to function, which means if you're being prescribed SSRIs, you don't have enough seratonin to selectively reuptake inhibit.

But since the antidepressants for ADHD are a different class of drugs, many doctors will run through the 'standard' list before they get to the stuff that helps ADHDers. And then once they've done that, and ruled out all the things, they'll move to "unconventional" treatment. Partly, this is because the process of trying different antidepressants can rule out things other than ADHD, and partly because they seem to want to rule out every other possible thing in addition to ADHD, before treating the ADHD. And if I were to guess, it's because giving a person ADHD medication who has a secret something else (like bipolar as an example) even though the person has ADHD, the ADHD medication can worsen the other condition to such a condition that it's better not to give ADHD medication at all.

This is why the process takes so fuckin long. And a couple years ago, I would've said it was stupid and a massive waste of time and harmful to the person with ADHD. But a year ago a friend of mine with bipolar was prescribed stimulant medication and his life absolutely went off the rails as a result, and seeing that first hand... I'd rather low and slow and not have to experience something like that.

Sorry for the word wall. I hope this helps!

[–] Initiateofthevoid@lemmy.dbzer0.com 1 points 5 hours ago* (last edited 5 hours ago)

It's not out of date so much as its woefully understudied. In other words, it could be true, but to my knowledge we really don't have enough data on cotreatment regimens to back it up.

There is a known risk factor of antidepressants in general that is similar to the suicide risk you describe with ADHD medication. SSRI's alone can put you through that process, where motivation increases first, followed after by mood stabilization.

This is why almost all antidepressants mention "increased risk of suicide" as a side effect. If you are starting antidepressants, make sure you actually understand this mechanism and coordinate with your provider and personal support system to ensure you don't trust your half-treated brain to make huge decisions during those critical first weeks.

It's not just suicide - you might find yourself abandoning otherwise positive employment or relationships because you have zero emotional satisfaction but a sudden influx of motivation.

The biggest confounding factor is the chicken or the egg - could the patient's depression be a symptom of their ADHD? That is, could the depression be a long-term psychological consequence of living with untreated executive dysfunction? If their ADHD was treated well, and they felt psychologically "capable" enough to successfully manage their responsibilities and habits, would they still be depressed?

Or is the depression a comorbidity, and it would independently manifest regardless of the severity or treatment of their ADHD symptoms?

It almost certainly varies by and within individuals over time, and can be either comorbidity or symptom, or a combination of both, and there's no real way to tell before treatment.

Some suggest just starting with whichever disorder presents itself more severely in the patient (e.g whichever has more impact on quality of life). Others suggest focusing on depression, as it carries the more immediate risks like you mentioned.

It also unfortunately carries a layer of stigma - like you described, an ADHD patient might be offended that their treatment regimen is designed to "keep them safe from themselves". Which is totally valid clinically, but can be psychologically destabilizing, especially for patients that believe they are not at any such risk right now.

Sorry for replying to your wall of text with a wall of text!

TL;DR: we need much more study on these disorders, especially cotreatment studies, but ultimately you should expect there to be differing opinions and hurdles to overcome on your personal journey.

Everyone should keep an open mind while pursuing treatment, and focus primarily on trying to find doctors and therapists that listen to you and seem to know what they are talking about.

[–] 4grams@awful.systems 5 points 1 day ago (1 children)

This does help, and thank you. In truth, I don’t even want medication, I’m middle aged and this is the brain I’m used to. Would just be nice to understand myself a little better and maybe start getting some better strategies in place.

It’s just grating that every time I ask, I’m redirected. Maybe they just think I’m pill seeking.

[–] flicker@lemmy.dbzer0.com 3 points 1 day ago

I didn't get diagnosed with ADHD (didn't even suspect I had it) until I was mid-thirties, and I gotta say... now that I have the medication, I'm glad I have it. It was a long road to get there but I mean, it's nice to know, you know?

If you want, my DMs are open. I'm always here if you wanna vent. ♥

load more comments (10 replies)