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Studies say that children with ADHD are at a higher risk of depression and other mood disorders. Quite significantly, the rate of depression is significantly higher in children with ADHD than in other children. Studies show that up to 70 percent of children with ADHD will be treated for depression at some point in their lives.

WHAT IS DEPRESSION?

Just because one is feeling down does not mean that the individual is suffering from major or clinical depression. Based on DSM-IV- TR, 2000, the manual used by mental health professionals to diagnose mental disorders, at least five or more of the following symptoms listed below must have persisted for at least two weeks:

* Depressed mood most of the day or nearly every day (in children and teens this can be irritable mood rather than depressed);

* Loss of interest or pleasure in all, or almost all, activities;

* Significant weight loss when not dieting or weight gain; or a decrease or increase in appetite

* Insomnia or hypersomnia (i.e., sleeping too much) nearly every day;

* Extreme restlessness or lethargy (e.g., very slow moving) ;

* Fatigue or loss of energy nearly every day;

* Feelings of worthlessness or inappropriate guilt;

* Diminished ability to think or concentrate nearly every day;

* Recurrent thoughts of death and/or suicidal thoughts;

It should also be determined if the symptoms cause clinically significant distress or impairment; are not side effects of a medication or general medical condition; and are not better accounted for by bereavement (i.e., loss of a loved one). The important point here is that true clinical depression is indicated by symptoms that are persistent for a sustained time period, and it is clearly more than feeling "sad" or "blue" by itself.

THE RELATIONSHIP BETWEEN ADHD AND DEPRESSION

In my last column, I mentioned that children with ADHD are more likely to suffer from low self-esteem as a result of the child's personal perception of being a failure at home and in school. They are more often at the receiving end of harsh criticisms and punishments for being extremely active, talkative and restless; or for their difficulty to pay attention, forgetting important things, and for interrupting others. They may also be labelled "not normal," "weird," or are "incapable of behaving" or worse, their peers avoid them altogether.

As all these build up over time, these children feel frustrated and demoralized. At times, they are overwhelmed with the things that happen around them and become discouraged as they face repeated failures in school, at home, and in other settings. When these negative experiences accumulate, the child with ADHD may begin to feel depressed.

In addition to being distressed or demoralized as a result of ADHD, children may also experience a true depressive illness. Unfortunately, symptoms of ADHD and depression may at times overlap thus making it more difficult for the doctor to diagnose a mood disorder like major depression.

A clear example: hyperactivity or physical agitation and poor concentration are symptoms of both ADHD and depression. If a child exhibits these symptoms and also appears to be sad, hopeless, or suicidal, the doctor may consider a diagnosis of major depression. In difficult situations such as this, it is important to see a psychologist or psychiatrist to diagnose and manage the conditions.

The prevalence of depression in children with ADHD can also be affected by the presence of other coexisting conditions. Research shows that rates of depression are substantially higher in children with ADHD and oppositional defiant disorder or conduct disorder (ODD/CD).

Significantly, nearly two thirds of children with ADHD may suffer from another condition such as depression or anxiety disorders in addition to their ADHD. …

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