Comorbidity in ADHD and Adult ADD
ByThere is a very important concept in ADHD called comorbidity. Comorbidity means that there is a co-existing disorder that causes more ‘morbidity’, or in other words difficulties in one’s life.
It is very common for people with ADHD to have comorbid (or co-existing) conditions. Only about 25-40% of kids and teens with ADHD have ADD or ADHD alone. Most of the time (i.e. 60-75% of the time), there is a second, or third diagnosis as well.
The most common comorbid conditions with ADD or ADHD in kids and teens are: Learning Disabilities, Behavior Disorders (including Oppsitional Defiant Disorder and Conduct Disorder), Anxiety Disorders, Mood Disorders (commonly Depression, rarely Bipolar Disorder), tic disorders (like tourette’s), etc.
In adults – comorbidity in ADHD is very common. Research has shown that only about 14% of adult ADHD is simple ADHD, meaning that 86% of adults with ADD or ADHD actually have a second or third disorder.
While the list of comorbid conditions in adults is similar to the one in kids, it is important to note that there are some significant additions. These include: substance abuse and dependences (i.e. drug and alcohol addiction/dependence), and personality disorders. Adults still have high rates of Learning Disabilities, Behavior Disorders, Anxiety Disorders, Depression and even Bipolar disorder.
The reason that comorbidity in ADD or ADHD is so important relates to the fact that often times, the comorbid condition can be so important that it can completely dominate or change the treatment for the whole condition.
For example, if one has ADHD and an Anxiety disorder, there is research that shows that the response to medication may be different. For example, some studies show that the use of a stimulant (like Concerta, Ritalin, Adderall, Biphentin or Metadate CD) may actually worsen the anxiety. There are other studies that show that they don’t worsen the anxiety, but don’t help it. However, Strattera, the non stimulant for ADHD, has been shown to help the anxiety and the ADHD at the same time.
Another example is if a child has ADD and a Learning Disability. If this occurs, one needs to treat both in order to get a good effect. If one were to only treat the concentration, then there could still be problems with processing information (i.e. the learning disability). If there were academic supports and treatment put in place for the learning disability, but there was not effective treatment in place for the ADHD, then the child could struggle to pay attention in order to benefit from the help in place for academics.
The bottom line: a thorough assessment for ADD or ADHD will review whether there are any comorbid (or co-existing) conditions present. Knowing about these comorbid conditions is crucial because it can actually affect the primary treatment of the ADD or ADHD.
Hi,
Many of the symptons of different conditions overlap, and also the depression could be from untreated ADHD, so of course we would try to treat both , but would treating one condition have priority over others ?
Allan
Hi Allan,
Thanks for your insightful comment.
The basic issue is that the doctor has to try to figure out what the primary concern is at the time.
So, if the depression is the main issue -then it needs to be treated first, and the ADD later.
If the ADD is the main issue (and the depression is more minor), then it will be treated first.
Unfortunately, there is little science here.
This comes down to the ‘art of medicine’, or the doctor’s clinical experience.
Of course the experience and preferences of the patient are crucial in this type of discussion and treatment planning.
I hope this helps.
Dr. Kenny
Comorbidity with Adult ADHD? NO SHIT!!!!
(Excuse the French.)
Here in Melbourne Australia there are LITERALLY two shrinks that will accept adult ADHD patients, and much less is it understoof that ADHD is never alone… there is always a “lurker” behind the scenes. I have experiences anxiety (mildly), but also teenage depression, terrible “life management” issues and the favourite: addictive tendencies. I only thank my good upbringing that this tendency never led to anything destructive.
Man, I sure wish there was more said on adult ADHD and that I had more than ONE person in my entire city of 3 Million who claimed to be an ADHD coach (in her case so-so useful).
Ranting now, but it feels good.
-Alister
Comorbidity seems to be my problem. ADD runs in my family, as well as depression. And I have been further blessed to have been diagnosed as learning disabled early in life. Depression reared its ugly head in my life at the young age of 12. Being diagnosed as ADD at the age of 17 was like a god-send and at the time, once medicated seemes to cure all three problems. However, now 27, after being on effexxor and adderall for ten years, the medication has lost its effect and all my problems have returned and I’m struggling to steer my life back on the right track and keep my head above water. But I don’t know what to do. I took myself off adderrall because I was worried it was causing more damage than good, but now I’m tempted to give it another shot. It’s hard to find a doctor who can address all my issues in a hopeful and practical way. Any advice?
Hi Brigita,
THank you for sharing your story.
The best thing to do is find a Psychiatrist who is comfortable with Adult ADD. I know, this is easier said than done.
A psychiatrist will be comfortable to help unravel which aspects are depression, which are ADD/ADHD, what psychological and social issues/stressors are having an impact, and which medications may be helpful.
Where do you find a psychiatrist comfortable with Adult ADD/ADHD?
Ask you family doctor, and if there is a medical school nearby – call them and ask for the department of psychiatry. You can then ask if they have any doctors who specialize in, or research adult ADHD.
Regarding your medicine wearing off after 10 years – it is possible that a dosage adjustment is needed, or alternatively, a different medicine may be helpful. I can’t be any more specific – but I hope that you can find a doctor to help you out.
All the best.
so now I see I’m not alone. I’m 24 years old and it’s for 1 year that I’m diagonized with ADD after diagonizing for depression ganeral anxiety and in some periods dillusional dissorder.
I’m a master student in physics and my big passionate is to continue study physics to PhD and higher but sometimes it seems that it’s quite impossible to be focussed or get realesd of my negative feelings.
also in some period in my life I had experience of Hallusination and dillusion like schisophernic peaople that time I got Haloperidol to suppress the dellusion and I still use some anti-pschcotic medicine.
It’s about two years that I leave in the Netherlands and in the first semester of university probably because too much pressure my dellusion came back and also I feel more and more restlessness and distracted in a way that I can’t be focussed that time I got so dissappoited that I decide to quit my study but after being refferd to neurologist I was diagonized first with Autism and then with ADD.
now Im on medication and feel better but still feel distracted and restlees ….
Is it ealy a way for me to live like a normal people and be successful in my study…..
Hi Samira,
Thank you for sharing your experiences.
Having ADHD, plus depression, plus autism and sometimes hallucinations must be a challenge!
I am glad that you are seeing a neurologist to get help with the medication.
In this type of situation, medication will be a very important part of your treatment plan. In addition, you’d do well to learn coping strategies as well.
If you feel like your symptoms aren’t controlled enough, be sure to speak to your doctor about whether the medicine can be adjusted.
All the best,
Dr. Kenny
Dr. Kenny,
I’m an adult with ADHD and have been sucessfully treated using Adderall, which given the research I’ve been doing, raises the seretonin level in my brain thus bringing about healthy nuerosynaptic transmission. Due to circumstances beyond my control, I had to apply to the VA to continue treatment. The doctor who interviewed me, prescribed and filled a drug called Risperodone. According to my research, this drug is an anti-psyshotic used primarily in the treatment of psychotic mental dissorders. Since my ADHD is a nuerologic dissorder and since I have had no psychotic episodes in my life, I fear rammifications this drug may give. I fear the doctor is not qualified to treat Adult ADHD or have the nuerological experience in understanding my former regimen. Is there a seperate certification for treating Adults with ADHD and apart from children? What steps do I take to find out what the certifications of this doctor are? Are my fears in taking this medication warrented?
I would appreciate any advice you could give me concerning this matter. I would appreciate an email should my question for moderation require it.
Sincerely,
RL Erwin IV
ulrider@netzero.net
Hi,
Thanks for your comments.
A few comments for you:
1) Adderall boosts the dopamine and norepinephrine. It does little to serotonin (just fyi).
2) Risperidone is an atypical antipsychotic – and was developed originally for schizophrenia. It now has great evidence – and is approved for the treatment of Bipolar Disorder (Manic Depression). Although it is not approved for these, it is commonly prescribed also to help with hard to treat depression, and anger/irritability.
Although I can’t give you the ‘green light’, at low doses, the side effects tend to minimal. I suggest that you go back to the doctor that you saw and ask more specific questions about what it is supposed to do for you.
3) Regarding qualifications on adult ADHD – there aren’t any. It really depends on any one doctor’s experience and comfort in dealing with it.
I hope this helps.
Dr. Kenny
p.s. I will be doing a course on medications in ADD/ADHD – and there will be section on Risperidone. You can sign up for the early notification list at: http://www.adhdmedicationcourse.com
If anyone knows any psychiatrist in Melbourne, Australia that specialises and treats Adult ADHD please email me at susiejas@hotmail.com. I have been going crazy looking for someone and have had no luck. My brother- aged 23 really needs help and the whole family is falling apart. Please help if you can.
I would appreciate any help
Thank you Kindly
I am looking for a doctor who works with low income adults with ADD/ADHD in San Diego, CA. Does anyone know of anyplace? I was taking adderall for several years and it worked perfectly, but have not had it for many months now. I have tried all the “natural” treatments, and none work. I just need some help. Thank you very much.
This sounds like it could be my 14 yr old son’s problem. According to popular literature he seems to be more bipolar than ADHD. But, the usual bipolar meds have never worked well or at all with him. Especially lithium, very bad manic episode. He’s currently on gabapentin and adderall and very ODD. He was on concerta, but, Pdoc switched to adderall and he’s gotten worse. We’re thinking about trying strattera. We feel we have nothing to lose at this point. Its gotten to the point where we don’t even like having him in the house.
My husband has mild tourette’s and ADHD. He was prescribed Strattera and it has had no impact on his significant ADHD symptoms. He recently was prescribed Ritalin and even up to 15 mg he has no noticeable or helpful change in symptoms. The Ritalin did not increase his tics. He is going to try Adderall XR, but we are feeling very discouraged. He is extremely earnest in finding the right med/dose/strategies to create more balance in his brain, but the process is rough. He is slightly irritable on the Ritalin and he is a slow processor as well. Any ideas?
Jill,
Try the adderall – and hopefully it helps.
Unfortunately, sometimes it takes a while to find the right medicine/combo of treatment.
Let us know how it goes.
Dr. Kenny
[...] highly distractible, impulsive, lacking self-awareness, has a co-morbid condition (up to approx. 85% of us have at least one, the most prevalent ones being depression, OCD, anxiety disorders, [...]
Hello, I have been taking Adderall xr 20 mg and at first Sertraline together for over a year.. When the winter came, it seemed as though I was zoning out and unable to focus.. Went back to my doctor and she prescribed Cybmalta 60 mg and upped my Adderall xr to 25mg..started to feel little more anxiety rather than focus–so then she switched me to Vyvanse 20mg–Still taking Cymbalta along with it..Feeling so tired and unfocused.. Get a little hyper and silly around 2pm like I am tired and cant think straight need coffee or a bed.. I called her today and asked her if she could please up the Vyvanse dose or something because I am so tired and my face feels heavy–not sure if that makes sense…She wants me to wait 2 weeks.. I think the Vyvanse dose is way too low due to be taking Adderall xr for a year?? Not sure what to do.. Just feel like crying and like I am going to fall apart for the next 2 weeks.. I feel like she has no idea what she is doing.. Please help.. Thanks, K