A meta-analysis of studies on children and adolescents with ADHD found that they are at an increased risk of depression and anxiety disorders. However, taking stimulant medication for ADHD was associated with a reduced risk of depression. The paper was published in the Journal of Psychiatric Research.
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects attention, impulsivity, and activity levels. People with ADHD tend to struggle with staying focused, following instructions, or controlling impulses. It is commonly diagnosed in childhood (usually at the start of school) but can continue into adulthood.
ADHD medications are commonly divided into stimulants and non-stimulants. Stimulants, such as methylphenidate (Ritalin, Concerta) and amphetamine-based drugs (Adderall, Vyvanse), are the most effective and work by increasing levels of the neurotransmitters dopamine and norepinephrine in the brain. Non-stimulants, like atomoxetine (Strattera) and certain blood pressure medications (guanfacine, clonidine), are alternatives for those who do not respond well to stimulants. Medication is often combined with behavioral therapy and lifestyle changes for optimal ADHD management.
Study author Yanyi Zhang and her colleagues sought to assess the effects of ADHD and its medication on the risk of depression and anxiety in children and adolescents. They noted that some previous studies indicate that children with ADHD might be at an increased risk of these disorders and that taking ADHD medication can affect that risk. However, other studies found no link between ADHD and depression.
The authors conducted a meta-analysis. They searched the PubMed, Embase, Cochrane Library, and Web of Science databases for papers mentioning ADHD, depression, anxiety, and their synonyms and spelling variants. They looked for studies on children and adolescents recently diagnosed with ADHD that compared them to a control group without ADHD and examined depression and anxiety disorders.
Anxiety disorders are a group of mental health conditions characterized by excessive fear, worry, and nervousness that interfere with daily life. These include generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, and phobias.
The search resulted in 22,519 studies. However, after removing duplicates and studies that did not meet the authors’ criteria, the number was reduced to 33. Five of these studies were qualitative, while the remaining studies used statistical methods to report their results.
Analysis of these studies showed that children and adolescents with ADHD have a 2.27 times higher risk of exhibiting depressive symptoms than children without ADHD. In adults with ADHD, the risk was 1.46 times higher. Children and adolescents with ADHD also had more than twice the risk of dysthymic disorder (a chronic form of depression lasting two years or more) and of being diagnosed with major depressive disorder.
These children and adolescents had approximately a 1.7 times higher risk of anxiety disorders in general compared to their peers without ADHD. The risk was about twice as high for generalized anxiety disorder, 1.7 times higher for social phobia and specific phobias, 2.6 times higher for separation anxiety disorder, and approximately 1.9 times higher for panic disorder. Their risk of suffering from agoraphobia (fear of open spaces) was five times higher than that of individuals without ADHD, and they were three times more likely to suffer from obsessive-compulsive disorder.
Finally, the analysis showed that the risk of depression was somewhat reduced (20% lower) in individuals with ADHD taking stimulant medications. The effect of non-stimulant medication was not confirmed, and there was no association between taking medications and the risk of anxiety.
“In conclusion, children and adolescents with ADHD had higher risks of depressive disorder, major depressive disorder, specific phobia, social phobia, and agoraphobia than those without ADHD. Stimulant medications for ADHD were associated with a reduced risk for depression,” the study authors concluded.
This study integrates scientific findings regarding the links between ADHD, depression, and anxiety. However, it should be noted that ADHD subtypes could have different associations with anxiety and depression, but most of the analyzed literature did not report associations within these subtypes. Additionally, the studies that examined the effects of medication were conducted on small groups of participants and might have missed some important effects.
The paper, “Effects of ADHD and ADHD medications on depression and anxiety in children and adolescents: A systematic review and meta-analysis,” was authored by Yanyi Zhang, Wenjing Liao, Yanxiao Rao, Weijia Gao, and Rongwang Yang.