Listening to music while practicing mindfulness exercises may improve focus, mood, and emotional wellbeing in people with symptoms of ADHD, anxiety, and depression, according to two new studies.

A systematic review examining the relationship between music and ADHD found that music listening activates brain regions involved in sensory processing, motor control, and motivation — networks that are often dysregulated in individuals with attention deficit.¹

Traditional thinking suggests that quiet environments help sustain attention; however, the opposite may be true. The review, published in Behavioral Science, indicated that music, especially calm music with or without lyrics, can improve focus and performance in individuals with ADHD, especially when it is heard before or during tasks. Listening to music can also help filter out distractions, leading to improved learning and mood.

“People with ADHD benefit from ‘rhythmic entrainment,’ using strong, steady rhythms to imprint structure and consistency. This assists with regulation of attention and behavior,” said Roberto Olivardia, Ph.D., Clinical Instructor of Psychology at Harvard Medical School, during his presentation titled, “We Got the Beat: The Impact of Music on ADHD,” at the 2024 Annual International Conference on ADHD.

Listening to music could become counterproductive if it causes overstimulation or if the listener is doing a challenging task that requires significant cognitive resources, the researchers noted.

Music Therapy Boosts Emotional, Social Skills

Music listening may be self-directed or facilitated by a trained music therapist, as part of music therapy. Music therapy sessions often incorporate active music listening, playing instruments, songwriting, or singing, as well as passive music listening.

The review made a compelling case for using music therapy to complement ADHD medications and other recommended therapies, citing evidence for the efficacy of music therapy in reducing symptoms of ADHD. For example, active music-making can enhance working memory and social skills while decreasing aggression. Conversely, passive music listening may improve learning and reduce disruptive behaviors.

“These insights highlight the potential for music to contribute to more holistic, non-pharmacological approaches, offering individuals with ADHD new avenues for enhancing cognitive functioning and overall wellbeing,” the study’s authors wrote.

The systematic review included 20 studies published between 1981 and 2023, reflecting data from 1,170 participants aged 2 to 56 years. Several limitations exist: The studies primarily focused on children and adolescents, rather than adults. Variations in study methods and design also resulted in some inconsistent findings.

“Despite these limitations, this review provides a valuable foundation for future research on the interaction between ADHD and music,” the study’s authors wrote.

Mindfulness Paired with Music Reduces Stress, Improves Mood

Another recent, smaller study, published in Frontiers in Neuroscience, suggests that listening to music while performing mindfulness exercises activates areas of the brain and body related to stress and emotional regulation that could reduce moderate symptoms of anxiety and depression in adults.sup>2

The study, led by a team of researchers from the Yale School of Medicine, assessed the physiological impact of music mindfulness by recording heart rates and EEGs from 38 participants, aged 18 to 65, as they engaged in a bilingual, two-week mindfulness program centered on “focus” and “mindfulness.”

“Anxiety and depression reduce autonomic system activity, as measured by Heart Rate Variability (HRV), and exacerbate cardiac morbidity, while both music and mindfulness have been shown to increase HRV,” wrote the researchers.

They found that music mindfulness quickly improved HRV — a sign of better stress regulation — and changed brain wave patterns (measured by EEG) in areas of the brain linked to emotion, awareness, and decision-making.

Both virtual and in-person sessions incorporated similar guided mindfulness exercises, accompanied by live improvised music, music listening, or no music at all. In addition to wearing mobile heart rate and EEG monitors during each session, participants completed surveys regarding their stress levels, degree of mindfulness, state of consciousness, and level of social connection before and after each session.

The virtual group exhibited a significant decrease in stress and a significant increase in altered states of consciousness during the “focus” sessions, but not the “motivation” sessions. This contrasted with the in-person sessions, where stress decreased and mindfulness and altered state of consciousness increased during both Focus and Motivation sessions.

The researchers said that the differences in music composition features (tempo, key, mode) between “focus” and “motivation” sessions may explain the physiological differences observed in heart rate variability.

In-person sessions with music boosted feelings of social connection more than the virtual sessions did, underscoring the value of live, shared experiences in therapeutic settings.

“Our results imply that, while virtual sessions reduce stress, they do not have as extensive an effect on psychological states as in-person sessions do,” the researchers wrote. “Important aspects of live social interaction may drive feelings of social connection and serve as a key differentiator between live and virtual sessions.”

The researchers also observed gender-specific effects via HRV; women appeared to benefit more physiologically from music mindfulness than men.

While the findings from the Behavioral Science and Frontiers in Neuroscience studies contribute to a growing body of evidence supporting the use of music as a viable adjunct treatment for ADHD and mood disorders, both research teams emphasize the need for further investigation. Future studies would include randomized controlled trials, long-term outcome assessments, and greater representation of adult populations.

Sources

¹Saville, P., Kinney, C., Heiderscheit, A., Himmerich, H. (2025). Exploring the intersection of ADHD and music: A systematic review. Behav. Sci. https://doi.org/10.3390/bs15010065

²Ramirez, C., Alayine, G.A., Akafia, C., Selase, K., Adichie, K. et al. (2025). Music mindfulness acutely modulates autonomic activity and improves psychological state in anxiety and depression. Frontiers in Neuroscience. https://doi.org/10.3389/fnins.2025.1554156

Serotonin neurons signal to the brain the expected value of near-future rewards, a discovery that helps to clarify the neurotransmitter’s complex role in regulating mood, learning, and more, according to a new study in Nature. ¹ The research puts forth a unifying theory that makes sense of previously irreconcilable contradictions regarding the understanding of how serotonin functions, based on what its interdisciplinary team of scientists from the University of Ottawa calls a “prospective code for value.”

Serotonin, involved in the regulation of everything from mood and movement to appetite and sleep, has been historically deemed a “feel good” chemical. However, previous research revealed that serotonin is activated by pleasure, pain, and surprise, a finding that led scientists to suspect that its role in the central nervous system is more complex than was previously understood.

The Canadian researchers combined ideas from reinforcement learning theory (used to understand learning, behavior, and decision making) with insights into the properties of the dorsal raphe nucleus (the region of the brain containing neurons that release serotonin) to arrive at a nuanced understanding of the messages sent by the serotonin system.

The study found that serotonin tells the brain what reward to expect in the near future, information the brain needs to make decisions about what to do next. This function of serotonin may resemble that of dopamine, which is centrally involved in reward prediction. In fact, the authors were inspired by advances in the dopamine research field, which have paved the way for research of this kind.²

“Your brain needs to compute the expected value of the actions you contemplate and undertake as you interact with a changing world,” explains Jean-Claude Béïque, Ph.D., co-author of the study and professor in the Department of Cellular and Molecular Medicine. “What we think serotonin actually does in the brain is encode the expected value of a particular environment or course of actions in order to ultimately guide everyday decisions.”

This unifying theory explains why serotonin neurons are activated by both rewards and punishments, why they are more strongly activated by surprising rewards but not by surprising punishments and why negative uncertainty results in slow changes in neuron activity.

According to the study’s lead author, Emerson Harkin, Ph.D., the serotonin system is essentially updating the brain with the following message: “Here’s our best guess about how good your near future will be, and here’s how quickly that guess is improving.”

“Serotonin might promote patient waiting by increasing perceived reward availability,” the authors write regarding the brain’s response to the serotonin-fueled information it receives. “Whether serotonin sustains reward-seeking behavior in general, and how this relates to behavioral reinforcement, remains unclear.”

Implications for Understanding ADHD, Depression, and More

This new research may impact scientific thinking about ADHD, which impacts the brain’s reward system.

“Key aspects of the dopamine reward system are underactive in ADHD brains, making it difficult to derive reward from ordinary activities,” explains Ellen Littman, Ph.D., in the ADDitude article “Never Enough? Why ADHD Brains Crave Stimulation.” “Deficits in the reward pathway, including decreased availability of dopamine receptors, decrease motivation. Indeed, ADHD brains struggle to sustain motivation when rewards are mild or are linked to long-term gratification.”

The research may also inform the treatment of mood disorders like depression, in which serotonin is thought to play a central role. Selective serotonin reuptake inhibitors (SSRIs) that increase levels of serotonin in the brain are the first-line treatment for depression, which affects 21.9 million adults in the U.S (8.5% of all adults).³

Among individuals with ADHD, depression is the second most common comorbidity. The risk of developing depression is about 2.5 times higher for people with ADHD than it is for the general population. What’s more, for people with mood disorders, having comorbid ADHD is associated with an earlier onset of depression, more recurrent episodes, more frequent hospitalizations, and higher risk of suicide.⁴

It’s unclear whether the new research will impact interventions for depression or neurodevelopmental disorders, however a deeper understanding of what Harkin calls the brain’s “notoriously difficult to understand” neurons is noteworthy.

Sources

¹Harkin, E.F., Grossman, C.D., Cohen, J.Y. et al. A prospective code for value in the serotonin system. Nature (2025). https://doi.org/10.1038/s41586-025-08731-7

²Sousa, M., Bujalski, P., Cruz, B., et al. Dopamine neurons encode a multidimensional probabilistic map of future reward. bioRxiv (2023).11.12.566727; doi:https://doi.org/10.1101/2023.11.12.566727

³Substance Abuse and Mental Health Services Administration. (2023). Key Substance Use and Mental Health Indicators in the United States: Results from the 2023 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.

⁴McIntyre RS, Kennedy SH, Soczynska JK, Nguyen HT, Bilkey TS, Woldeyohannes HO, et al. Attention-deficit/hyperactivity disorder in adults with bipolar disorder or major depressive disorder: results from the international mood disorders collaborative project.

Children and adolescents with avoidant restrictive food intake disorder (ARFID) are more likely to have comorbid neurodevelopmental and psychiatric disorders like autism, ADHD, and anxiety, according to a new study¹ published in The Journal of Child Psychology and Psychiatry.

Among the 30,795 children included in the large-scale study, those with ARFID (n=616) were 14 times more likely to have autism and nine times more likely to have ADHD than were children without ARFID. They also demonstrated an increased risk for OCD, separation anxiety, generalized anxiety disorder (GAD), depression, learning disorders, conduct disorder, and more.

These results stand out amid the relatively scarce research data on ARFID, an eating disorder added to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) in 2013.

“This study is one of the few large-scale epidemiological investigations of ARFID comorbidities in a general population sample,” the researchers wrote. “The findings emphasize the importance of incorporating routine screening for neurodevelopmental disorders, anxiety, and depression into ARFID assessments.”

Individuals with ARFID avoid foods based on sensory characteristics, a lack of interest in eating, and/or fear-related concerns over adverse eating experiences — not due to the body image concerns that compel other eating disorders like anorexia nervosa. ARFID is characterized by a “failure to meet appropriate nutritional and/or energy needs.”

Despite affecting 1-2% of children and adolescents², ARFID is often excluded from eating disorder discourse and clinical examinations. ARFID’s high comorbidity can complicate symptom identification, according to researchers.

“It’s important to really think about those with ADHD being at risk for a variety of eating disorder thoughts and behaviors, not just binge eating,” said Christine Peat, Ph.D., in a 2024 ADDitude webinar, “Eating Disorders Comorbid with ADHD: What You Need to Know About ARFID, Anorexia, and Others.” “In clinical contexts, ARFID and atypical anorexia nervosa may be overlooked, even in very routine eating disorder screenings.”

The study’s results emphasize the importance of identifying ARFID, the diagnosis of which may shed light on comorbidities.

“Early identification of these comorbidities can facilitate timely, targeted interventions and improve treatment outcomes,” the researchers wrote.

One ADDitude reader, Tiffany Bird, suffered decades of poor health before being diagnosed with ARFID in her late 20s. “For the first time, a doctor fully examined me and determined that I’ve been severely malnourished my entire life, no matter what ‘the numbers’ might have said. It made complete sense,” wrote Bird in an ADDitude guest blog post, “I went Over 25 Years Without Consuming a Vegetable.”

ARFID and Neurodevelopment Disorders

The study examined parent reports for 30,795 children born between 1992 and 2008, at 9 or 12 years old (depending on their cohort), from the Child and Adolescent Twin Study in Sweden. The parents rated their child using three measures of neurodevelopmental and psychiatric disorders: the A-TAC inventory, the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Short Mood and Feelings Questionnaire (SMFQ). The researchers examined the relationship between having ARFID and showing symptoms of other disorders using linear and logistic regressions.

The link between ADHD and ARFID found in the study reflects preliminary research in this area. According to Peat, one study found that 25% of adults with ARFID also had ADHD, and another reported that 10% of children and adolescents with ARFID had been diagnosed with ADHD at some point in their lives.

“We are so far from having causal explanations for this overlap,” Peat said. “But maybe kids and adults with ADHD are just sort of more biologically predisposed to have difficulty with sensory characteristics with food, so maybe that makes them more vulnerable to going on to develop something like ARFID.”

The study’s results regarding autism and ARFID also mirror prior research. One meta-analysis reported that autism was present in 16% of individuals with ARFID³.

People with ARFID are more likely to have autism than those without, and vice versa, possibly due to heightened sensory issues and inflexibility due to anxiety around change, both symptoms of autism, according to an article in ARFID Awareness UK.

ARFID and Psychiatric Disorders

According to the study, children with ARFID were four to six times more likely to have a psychiatric disorder, with OCD and anxiety presenting the greatest risks.

The most common type of anxiety found in the study was separation anxiety, which contrasts previous research that found GAD to be more common. This could be because of the younger age of onset characteristic of separation anxiety or younger age of the sample, the researchers wrote. However, they also hypothesize another reason their results differed.

“One hypothesis worth exploring is that separation anxiety is increased in ARFID because children fear separation from caregivers due to the potential for unanticipated exposure to feared foods or feeding-related situations,” the researchers wrote.

The study also found a higher rate of oppositional defiant disorder (ODD) (19.4%) than reported in previous studies, suggesting a possible overlap of symptoms between the two disorders.

“Our findings suggest that food-related conflicts may underlie the observed risk of ODD in ARFID, but further research is needed to confirm this association,” the researchers wrote.

Children with ARFID were found to face a higher risk for anxiety than depression. Depression is common among children with other eating disorders, according to the researchers. This discrepancy in comorbidities highlights the differences between ARFID and other eating disorders.

“The defining feature [of ARFID] is a persistent and pervasive eating or feeding disturbance in which someone is simply not meeting all of their nutritional needs,” Peat said. “In ARFID, these people don’t necessarily have that fear of fat or fear of weight gain.”

Gender and ARFID

Prior research may suggest that ARFID is more common in young males. However, this study found no gender-based differences in comorbidity rates associated with ARFID, meaning that the likelihood of having symptoms of another disorder in conjunction with ARFID did not significantly differ based on sex.

The results did indicate that, overall, boys had higher odds of developing a neurodevelopmental disorder, depression, and sleep problems; girls had higher rates of anxiety disorders (except for panic disorder).

“Unlike other eating disorders, the distribution of males and females with ARFID has been reported to be approximately equal,” the researchers wrote. “Given the sex differences observed in the prevalence of (neurodevelopmental disorders) and psychiatric conditions, it is important to investigate whether these sex differences are also present in individuals with ARFID.”

The study’s sample did not include transgender and nonbinary youth, a major limitation considering that transgender, nonbinary, and gender-expansive kids are at higher risk for eating disorders compared with their cisgender peers.

“There remains an urgent need to develop integrated treatment approaches that address both ARFID and its co-occurring conditions,” the researchers wrote.

Sources

¹ Nyholmer, M., Wronski, M.-L., Hog, L., Kuja-Halkola, R., Lichtenstein, P., Lundström, S., Larsson, H., Taylor, M.J., Bulik, C.M. and Dinkler, L. (2025), Neurodevelopmental and psychiatric conditions in 600 Swedish children with the avoidant/restrictive food intake disorder phenotype. J Child Psychol Psychiatr. https://doi.org/10.1111/jcpp.14134

² D’Adamo, L., Smolar, L., Balantekin, K.N., Taylor, C.B., Wilfley, D.E., & Fitzsimmons-Craft, E.E. (2023). Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: A cross-sectional study. Journal of Eating Disorders, 11, 214. https://doi.org/10.1186/s40337-023-00939-0

³ Sader M, Weston A, Buchan K, Kerr-Gaffney J, Gillespie-Smith K, Sharpe H, Duffy F. (2025) The Co-Occurrence of Autism and Avoidant/Restrictive Food Intake Disorder (ARFID): A Prevalence-Based Meta-Analysis. Int J Eat Disord. 58(3):473-488. https://doi.org/10.1002/eat.24369

Spravato, the esketamine nasal spray approved in 2019 for use alongside oral antidepressants for treatment-resistant depression, has been approved by the U.S. Food and Drug Administration (FDA) as a standalone monotherapy with no oral medication required.

Esketamine is a form of the dissociative agent ketamine, commonly used as an anesthetic; it works by targeting the neurotransmitter glutamate. According to a randomized, double-blind, placebo-controlled study, 22.5% of patients who took Spravato alone for four months achieved remission from depression (as measured by MADRS) compared with 7.6% of patients taking placebo.¹

Common side effects in clinical trials were disassociation, dizziness, nausea or vomiting, sedation, headache, decreased sensitivity, anxiety, increased blood pressure, and feeling of intoxication. Due to these potential risks, the treatment is available only through the Risk Evaluation and Mitigation Strategy Program and must be self-administered in certified health care settings. Spravato is approved for use in adults with major depressive disorder (MDD) who have had an inadequate response to two or more oral antidepressants.

Eight percent of Americans suffer from MDD, with far higher rates of prevalence found among people with ADHD. According to a decade-long study that looked at nearly 400,000 young adults with ADHD and an equal number of neurotypical young adults, approximately half of the ADHD group had a diagnosed depressive episode — more than twice the frequency seen in the non-ADHD group. The rate of attempted suicide was four times higher among the ADHD group than in the neurotypical control. ²

These findings echoed the results of an earlier study of people with mood disorders that found having comorbid ADHD was associated with a higher risk of suicide, more frequent hospitalizations, more recurrent episodes, and an earlier onset of depression.³

“MDD affects every aspect of a person’s life and makes it seem as though life is not worth living,” writes William Dodson, M.D., LF-APA, a psychiatrist specializing in adult ADHD, in his ADDitude article, “6 Unexpected Signs of Depression.” “The World Health Organization ranks depression as the single largest contributor to global disability.⁴ It’s a serious problem that needs to be addressed.”

Spravato may increase blood pressure and heart rate, a side effect also common with stimulant medications used to treat ADHD, like Adderall and Ritalin. Thus, taking both medications may increase risk of high blood pressure. This is one reason healthcare providers monitor patients’ heart rate and blood pressure in the two hours after medication is administered.

Treatment-Resistant Depression: Readers’ Experiences

About a third of individuals with depression find no relief from oral antidepressants.⁵ Consequently, millions of Americans who have tried multiple kinds of depression medication continue to struggle with symptoms like hopelessness and suicidality.

In recent years, a growing number of these individuals have sought relief through the monitored use of ketamine, a close relative of esketamine. FDA-approved as an anesthetic, ketamine must be used “off-label” to treat depression.

“I took ketamine for complex PTSD, depression, and suicidal ideation and it helped massively,” says Mia, an ADDitude reader in Texas.

Bob, a reader in Arizona explains that ketamine-assisted therapy helped him “immensely” with his depression: “My psychiatrist offered ketamine treatments for patients with treatment-resistant depression who likely would have checked themselves into a psychiatric hospital otherwise.”

Karlyn, in South Africa, credits ketamine treatments, recommended by her psychiatrist, with helping her through a period of acute suicidality when nothing else worked: “It was the best drug that I have ever used for the treatment of depression.”

Sources

¹Janik A, Qiu X, Lane R, et al. SPRAVATO (esketamine nasal spray) as a monotherapy for treatment-resistant depression (TRD). American Society of Psychopharmacology Annual Meeting.; May 28-31, 2024. Poster W80.

²Babinski DE, Neely KA, Ba DM, Liu GL (2020) Depression and suicidal behavior in young adult men and women with ADHD: Evidence from claims data. Journal of Clinical Psychiatry, 81 (6) 7-13.

³Zhang, Z., Zhang, L., Zhang, G., Jin, J., & Zheng, Z. (2018). The effect of CBT and its modifications for relapse prevention in major depressive disorder: a systematic review and meta-analysis. BMC Psychiatry, 18. https://doi.org/10.1186/s12888-018-1610-5.

⁴Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017, https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf

⁵Zhdanava M, Pilon D, Ghelerter I, Chow W, Joshi K, Lefebvre P, Sheehan JJ. The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States. J Clin Psychiatry. 2021 Mar 16;82(2):20m13699. doi: 10.4088/JCP.20m13699. PMID: 33989464.

Spravato (generic name: esketamine) is the first and only FDA-approved nasal spray used for adults with treatment-resistant depression. Depression is considered “treatment-resistant” when individuals have tried at least two different oral anti-depressant medications and symptoms persist. An estimated 30% of people with major depressive disorder have treatment-resistant depression¹.

In 2019, the U.S. Food & Drug Administration approved Spravato for use alongside an oral antidepressant; in early 2025, the spray was authorized as a standalone treatment. A recent Phase 4 clinical trial¹ found that, four weeks after starting Spravato, 22.5% of participants with major depressive disorder who took the nasal spray alongside an oral antidepressant achieved remission from depression symptoms, compared to 7.6% of participants achieving relief on an oral antidepressant and placebo spray.

It is not known whether SPRAVATO® is safe and effective in children.

How Does Spravato Work?

Spravato works by blocking a receptor in the brain activated by glutamate, a chemical messenger. This mechanism is similar to that found in other antidepressants, which target receptors for chemical messengers like seratonin and dopamine.

What Ingredients Are in Spravato?

The main active ingredient in Spravato is esketamine, which is conventionally used as an anesthetic similar to its parent compound, ketamine. Esketamine is more concentrated than ketamine, requiring a lower dose for efficacy.

Inactive ingredients include citric acid monohydrate, edetate disodium, sodium hydroxide, and water.

How Do You Use Spravato?

The medication is an intranasal spray that is self-administered under the supervision of a healthcare provider at a certified SPRAVATO® treatment center. Patients are required to remain for at least two hours after administration, so healthcare providers can monitor any side effects.

To prevent nausea, it is recommended that patients do not eat at least two hours before receiving the drug and not drink at least 30 minutes before.

What Is the Dosage for Spravato?

The optimal dosage of Spravato varies by patient. The typical dose is 28 mg (two sprays), administered biweekly.

For updated information about dosages, interactions, and precautions, see the Spravato (Esketamine) drug monograph on WebMD.

What Side Effects Are Associated with Spravato?

The most common side effects include:

• Disassociation (feeling disconnected from yourself, thoughts, feelings, and surroundings)
• Dizziness/spinning sensation
• Nausea/vomiting
• Sedation, sleepiness, lack of energy
• Decreased feeling of sensitivity
• Anxiousness
• Increased blood pressure
• Feeling intoxicated
• Headache
• Feeling very excited or happy

Side effects will typically occur 40 minutes after taking the drug and tend to go away within two hours.

Spravato also may have serious side effects, including:

• Allergic reactions: breathing problems, racing heart, fever, stomach cramps
• Memory or thinking problems: unusual changes in judgment/decision-making, trouble concentrating or paying attention, and remembering things
• Bladder problems
• Breathing problems: slow or shallow breathing
• May increase the risk of suicidal thoughts or actions

Consult your healthcare provider about these possible side effects before beginning Spravato.

Visit the Spravato website to see the full list of side effects.

What Precautions Are Associated with Spravato?

You should not take Spravato if you have a history of blood vessel disease or brain bleeding, an abnormal connection between your veins and arteries, or are allergic to esketamine, ketamine, or any other ingredients in Spravato.

Taking Spravato can lead to physical and psychological dependence. If you have a history of drug or alcohol abuse, make sure to discuss it with your doctor before taking Spravato.

This spray has not yet been proven safe and effective for children or for reducing and preventing suicidal thoughts.

Does Spravato Interact with ADHD Stimulants?

Spravato may increase blood pressure and heart rate, a side effect also common with stimulant medications used to treat ADHD, like Adderall and Ritalin. Thus, taking both medications may increase risk of high blood pressure. This is one reason healthcare providers monitor patients’ heart rate and blood pressure in the two hours after medication is administered.

Can You Take Spravato with Another Antidepressant?

According to the label, SPRAVATO® can be used:

• “with or without an antidepressant taken by mouth, to treat adults with treatment-resistant depression”
• “with an antidepressant taken by mouth, to treat depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions.”

What Else Does Spravato Interact With?

When taken with central nervous system depressants, like opioids and benzodiazepines, patients may experience excessive drowsiness and dizziness. The risk of experiencing dizziness and sleepiness may increase with alcohol consumption while taking Spravato.

There are no known interactions between Spravato and foods, herbs, and vitamins. Cannabis use may increase risk of side effects. Patients should discuss these and any other interactions with their healthcare providers.

Limitations of Use

SPRAVATO® is not for use as a medicine to prevent or relieve pain (anesthetic). It is not known if SPRAVATO® is safe or effective as an anesthetic medicine or if it is safe and effective for use in preventing suicide or in reducing suicidal thoughts or actions.

Spravato Nasal Spray and Other Depression Medications: Next Steps

• Read: Treatments for Depression and ADHD: New and Forthcoming Approaches
• Read: What to Expect When You Start Depression Medication
• Self-Test: Depression in Adults
• Free Download: Understanding Depression in Teens
• Read: How to Treat Depression

Sources

¹ Mayes, S.D., Becker, S.P. & Johnson & Johnson pivotal study of seltorexant shows statistically significant and clinically meaningful improvement in depressive symptoms and sleep disturbance outcomes. (2024, May 29). JNJ.com. https://www.jnj.com/media-center/press-releases/johnson-johnson-pivotal-study-of-seltorexant-shows-statistically-significant-and-clinically-meaningful-improvement-in-depressive-symptoms-and-sleep-disturbance-outcomes

Leaded gasoline and exposure to its exhaust may help explain an estimated 151 million U.S. cases of psychiatric disorders, including ADHD, depression, and anxiety, according to a new cross-sectional study spanning the last 75 years published in the Journal of Child Psychology and Psychiatry.¹

Exposure to leaded gasoline from car exhaust was tied to population-wide cases of mental health disorders from 1940 to 2015 by researchers from Duke University, Florida State University, and the Medical University of South Carolina. They estimated that more than half of the current U.S. population was exposed to harmful levels of lead in childhood, resulting in profound effects on their mental health, personality traits, and overall well-being. People born between 1966 and 1986 (referred to as Generation X) experienced the highest rate of lead exposure and are at the greatest risk for anxiety, depression, ADHD, and personality changes.

“Research on lead as a developmental neurotoxicant is robust,” says Joel Nigg, Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “Its correlation with ADHD is also well established. Even low levels of exposure have an effect on ADHD.”², ³

Nigg was the principal investigator on several studies suggesting that lead exposure has a causal role in ADHD. One study published in Psychological Science found that children with ADHD who had the HFE C282Y gene mutation exhibited significantly more symptoms of hyperactivity and impulsivity than did children with ADHD who lacked the mutation.⁴

“Because the C282Y gene helps to control the effects of lead in the body, and the mutation was spread randomly in the children, it is difficult to explain these findings unless lead is, in fact, part of the cause of ADHD, not just associated with it. Numerous animal studies also support a link,” he says.

Leaded Gasoline Exposure Is a Public Health Crisis

Nigg’s study and others have linked lead exposure to life-long mental, physical, and behavioral issues; lowered IQ points; and personality changes.⁵, ⁶, ⁷, ⁸ However, the findings from the Journal of Child Psychology and Psychiatry’s study highlight the historic and pervasive effects of lead exposure on the cognitive and psychological health of a staggering slice of the U.S. population.

“Lead’s potential contribution to psychiatry, medicine, and children’s health may be larger than previously assumed,” the researchers wrote.

The study analyzed lead levels in children’s blood collected for the CDC’s National Health and Nutrition Examination Surveys (NHANES) and correlated that with historic leaded-gasoline data. The researchers calculated “mental illness points” based on the fraction of changes in the mental health of Americans born in different years and the population elevations of mental health symptoms associated with lead exposure.

The researchers identified a cumulative increase of 602 million general psychopathology points across the population, corresponding to an estimated 151 million additional mental disorders. They found that lead exposure heightened the risks for anxiety, depression, and ADHD; increased neuroticism, associated with negative emotionality; and decreased conscientiousness, reflecting less self-control and goal-oriented behavior.

While the study’s results do not prove causation, the researchers say that their findings will provide doctors with insights about their patients’ symptoms and underscore the need for expanded lead testing in patients and the recognition of lead poisoning as a neurodevelopmental disorder within a psychiatric diagnostic framework.

Leaded Gasoline Exposure: Next Steps

Lead was added to gasoline in the 1920s to improve engine performance. During the early childhood years of Generation X, leaded gasoline became the predominant fuel type in the U.S. In the mid-1970s, the U.S. Environmental Protection Agency (EPA) began phasing out leaded gasoline, but a U.S. ban did not go in effect for on-road vehicles until 1996. Lead is still found in some paints, children’s toys, and deteriorating water pipes.

According to The CDC, high levels of lead exposure can lead to seizures, vomiting, memory loss, and even death. Exposure to even small amounts of lead can be harmful. Children 6 years or younger are most vulnerable to lead poisoning, which can cause development and growth delays, hearing and speech problems, difficulty learning and paying attention, and serious illness and death.

Symptoms of lead poisoning can be hard to recognize in children. The CDC recommends discussing possible lead exposure with a child’s healthcare provider and testing children ages 1 to 5 for lead if they:

• Live in a home built before 1978
• Receive Medicaid services
• Are an immigrant, refugee, or adopted from another country
• Live near a known source of lead, such as a lead smelter or mine

Sources

¹McFarland, M.J., Reuben, A. and Hauer, M. (2024). Contribution of Childhood Lead Exposure to Psychopathology in the US Population Over the Past 75 Years. J Child Psychol Psychiatr.https://doi.org/10.1111/jcpp.14072

²Sanders, T., Liu, Y., Buchner, V., Tchounwou, P.B. (2009). Neurotoxic Effects and Biomarkers of Lead Exposure: A Review. Rev Environ Health. https://doi.org/10.1515/reveh.2009.24.1.15

³Nigg, J. T., Knottnerus, G. M., Martel, M. M., Nikolas, M., Cavanagh, K., Karmaus, W., & Rappley, M. D. (2008). Low Blood Lead Levels Associated with Clinically Diagnosed Attention-Deficit/Hyperactivity Disorder and Mediated by Weak Cognitive Control. Biological Psychiatry. 63(3), 325–331. https://doi.org/10.1016/j.biopsych.2007.07.013

⁴Nigg, J. T., Elmore, A. L., Natarajan, N., Friderici, K. H., & Nikolas, M. A. (2016). Variation in an Iron Metabolism Gene Moderates the Association Between Blood Lead Levels and Attention-Deficit/Hyperactivity Disorder in Children. Psychological Science.https://doi.org/10.1177/0956797615618365

⁵Reuben, A., Schaefer, J.D., Moffitt, T.E., Broadbent, J., Harrington, H., Houts, R.M., Ramrakha, S., Poulton, R., Caspi, A. (2019). Association of Childhood Lead Exposure With Adult Personality Traits and Lifelong Mental Health. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2018.4192

⁶Heidari, S., Mostafaei, S., Razazian, N. et al. (2022). The Effect of Lead Exposure on IQ Test Scores in Children Under 12 Years: A Systematic Review and Meta-Analysis of Case-Control Studies. Syst Rev. https://doi.org/10.1186/s13643-022-01963-y

⁷Roy, A., Bellinger, D., Hu, H., Schwartz, J., Ettinger, A.S., Wright, R.O., Bouchard, M., Palaniappan, K., Balakrishnan, K. (2009). Lead Exposure and Behavior Among Young Children in Chennai, India. Environ Health Perspect. https://doi.org/10.1289/ehp.0900625

⁸Schwaba, T., Bleidorn, W., Hopwood, C.J., Gebauer, J.E., Rentfrow, P.J., Potter, J., Gosling, S.D. (2021). The Impact of Childhood Lead Exposure on Adult Personality: Evidence from the United States, Europe, and A Large-Scale Natural Experiment. Proc Natl Acad Sci USA. https://doi.org/10.1073/pnas.2020104118

The mental health of U.S. high school students is trending upward after a decade of unprecedented  depression, violence, and suicidality among adolescents. Still, the youth mental health crisis is far from over, as more teens are experiencing school-based violence and school absenteeism, according to a new report by the Centers for Disease Control and Prevention (CDC) comparing 10-year trends and data from the 2021-2023 Youth Risk Behavior Survey (YRBS).¹

Among the 20,000 public and private high school students surveyed, 40% said they experienced persistent sadness or hopelessness in 2023, down from 42% in 2021. Suicidality rates also fell slightly: One-fifth of students seriously considered suicide, compared to 22% two years ago.

Survey results broken down by students’ sexual and gender identity revealed that depressive symptoms remained stable or declined in most subgroups:

• 65% of LGBTQ+ students experienced sadness or hopelessness, down from 69%.
• 53% of female students experienced sadness or hopelessness, down from 57%.
• 41% of LGBTQ+ students seriously considered suicide, down from 45%.
• 28% of male students experienced sadness or hopelessness, unchanged from 2021.
• 27% of teen girls seriously considered suicide, down from 30%.
• 14% of male students seriously considered suicide, unchanged from 2021.

The Mental Health Status of Girls

Though the changes appear small, these incremental decreases represent potentially significant changes in teen mental health, especially for girls. Just last year, the CDC reported that nearly 60% of teen girls “were suffering through an unprecedented wave of sadness and trauma,” which was double the rate reported a decade ago and twice the rate in boys.²

Girls with diagnosed and undiagnosed ADHD are at a much higher risk for depression, suicidal thoughts and behaviors, and sexual violence than their neurotypical peers. According to the Berkeley Girls ADHD Longitudinal Study (BGALS), girls with combined type ADHD are three to four times more likely to attempt suicide than their neurotypical peers, and they are 2.5 times more likely to engage in non-suicidal self-injuring behavior.³

“Girls and women with untreated ADHD are at double the risk for engaging in self-harm and significantly more likely to attempt suicide,” said Julia Schechter, Ph.D., of the Duke Center for Girls and Women with ADHD.

A 2022 ADDitude survey of 1,187 caregivers shared similar findings: Eighteen percent of girls with ADHD had engaged in self-harm within the past two or three years compared to 9% of boys.

“The emotional toll of ADHD on teen girls is profound — especially when it isn’t diagnosed early,” said Lotta Borg Skoglund, M.D., Ph.D., during the 2024 ADDitude webinar, “The Emotional Lives of Girls with ADHD.” “And, for teens who menstruate, we can’t ignore fluctuating hormones, which invariably affect emotions, behaviors, and functioning. Is it any wonder that so many teen girls and young women say that regulating emotions and energy levels are their biggest ADHD-related problems?”

“Being a teen girl sucks. Being a teen sucks. ADHD intensifies everything,” said an ADDitude reader from Kansas.

“Schools should do a better job acknowledging the needs of teen girls,” said an ADDitude reader from Florida. “There needs to be better support to accommodate their needs that filters into clubs, after-school sports, etc.”

The improved state of adolescent mental health, especially for girls, is encouraging, but it is no cause for celebration. “As seen in 2021, female students are faring more poorly than male students across almost all measures of substance use, experiences of violence, mental health, and suicidal thoughts and behaviors,” the CDC report stated.

Disparities persist among students who identify as (LGBTQ+). The report found that LGBTQ+ students still experience more violence, signs of poor mental health, and suicidal thoughts and behaviors than their male, cisgender, and heterosexual peers.

Rise in School Violence and Bullying

“These data show that we’ve made some progress in tackling these issues in recent years, which proves that they are not insurmountable,” said Kathleen Ethier, Ph.D., director of the CDC’s Division of Adolescent and School Health. “However, there’s still much work ahead.”

Returning to school was a welcome relief for caregivers and students after the COVID-19 pandemic. However, in-person classes have created more opportunities for physical encounters — and consequently more school violence and bullying, the CDC says. From 2021 to 2023, bullying in school grew from 15% to 19%. In 2023, 16% of students experienced electronic bullying via text, Instagram, SnapChat, or other social media channels.

“School bullying remains a serious problem in U.S. schools, particularly for students with ADHD, autism, learning differences, and other comorbidities,” said Rosanna Breaux, Ph.D., during the 2023 ADDitude webinar, “Teen Bullying Solutions: Help for Neurodivergent Adolescents.”

In a 2022 ADDitude survey, 61% of more than 1,000 caregivers said their neurodivergent child was bullied at school. Kids were also bullied through social media (32%), on the school bus (30%), and via text messages (27%).

“My girl is anxious and worries about bullying, girls pranking her, and kids saying she is ‘fat,’” shared an ADDitude reader from South Carolina.

Upward trends in injuries with a weapon on school property and sexual violence among high school students are cause for concern. LGBTQ+ students reported significantly higher rates of sexual violence than their cisgender and heterosexual peers. Of the 9% of high school students who had ever been physically forced to have sexual intercourse, 17% identified as LGBTQ+ compared to 13% of female and 4% of male students. In addition, 11% of high school students said they were forced to perform sexual activities (including kissing, touching, etc.); of those, one-fifth identified as LGBTQ+.

Increases in School Refusal Behaviors

Alongside bullying and violence, rates of school avoidance have risen sharply as well. According to the CDC,

• School absenteeism due to students feeling unsafe at school or traveling to and from school rose from 9% to 13%.
• Female students who missed school because of safety concerns increased from 10% to 16%.
• Male students who missed school because of safety concerns increased from 7% to 10%.

“It’s so important that children get treatment for school refusal behaviors,” said Alana Cooperman, LCSW, senior social worker for the Anxiety Disorders Center at the Child Mind Institute during the recent ADDitude webinar, “School Avoidance & Refusal: Root Causes and Strategies for Parents and Educators.”

School refusal can begin with negative self-talk and quickly spiral to self-harm or suicidality. The long-term effects of school avoidance can lead to declining grades, peer alienation, and increased tension at home. “These struggles don’t go away,” Cooperman said. “They follow children as they become adults. We see increases in anxiety and depression and potential substance abuse as adults.”

“Our girls are not okay,” said an ADDitude reader from California. “My 11-year-old daughter with ADHD was the victim of sexual harassment at her school. As a result, she developed PTSD. She had extreme emotional dysregulation, experienced suicidal ideation, and refused to go to school out of fear. She has not returned to her school since.”

Cooperman recommends treating school refusal behaviors with cognitive behavioral therapy (CBT) and that caregivers work collaboratively with their child’s school and therapist to develop a comprehensive treatment plan.

Mental Health Resources

The CDC recommends the following programs to help schools and communities improve adolescent health, well-being, and safety.

• What Works in Schools
• Promoting Mental Health and Well-Being in Schools: An Action Guide for School and District Leaders
• Violence Prevention in Practice: | VetoViolence (cdc.gov)
• Youth Violence Prevention Resource for Action (cdc.gov)

Get Help

Suicide &Crisis Lifeline: Call or Text 988
988lifeline.org

National Sexual Assault Helpline: 1-800-656-HOPE

National Substance Abuse Helpline: 1-800-662-HELP

Stop Bullying

Contact the 988 Suicide & Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support.

If you or someone you know may be considering suicide or be in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline

Sources

¹Centers for Disease Control and Prevention. Youth Risk Behavior Survey Data Summary & Trends Report: 2013–2023. U.S . Department of Health and Human Services; 2024 https://www.cdc.gov/yrbs/dstr/index.html

²Centers for Disease Control and Prevention (2023). U.S. Teen Girls Experiencing Increased Sadness and Violence. Youth Risk Behavior Survey cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf

³Hinshaw, S. P., Nguyen, P. T., O’Grady, S. M., & Rosenthal, E. A. (2022). Annual Research Review: Attention-Deficit/Hyperactivity Disorder in Girls and Women: Underrepresentation, Longitudinal Processes, and Key Directions. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480

When administered at carefully selected dosages in clinical settings and combined with therapy before and after treatment, psychedelics like MDMA, ketamine, and psilocybin have been found to provide rapid relief from some of the most difficult-to-treat mental health conditions.

Learn more about the most promising psychedelics for treatment in this ADDitude Patient Resource Guide.

In this download, you will learn:

• How MDMA, ketamine, and psilocybin are being used to treat depression, post-traumatic stress disorder (PTSD), and other mental health conditions
• The legal status of MDMA, ketamine, and psilocybin
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Information about depression found online is commonly misleading. Many popular health websites mislabel depression as a cause of symptoms rather than a description of those symptoms, according to a study published in Psychopathology.¹

Thirty organizations, including top institutions such as the American Psychiatric Association (APA) and the World Health Organization (WHO), were included in the study. Descriptions of depression from each website were classified into one of three groups: causally explanatory, descriptive, or unspecified.

More than half (53%) of websites presented depression as explicitly causing symptoms or used language that was both descriptive and causal. The remainder (46%) used language that was not clearly defined. Examples of each category include:

• Causally explanatory: A website states that “depression causes feelings of low mood, loss of pleasure, fatigue…”
• Descriptive: A website states that “depression describes a pattern of psychiatric symptoms including low mood, loss of pleasure…”
• Unspecified: A website states that “people with depression experience a low mood, loss of pleasure…”

Psychiatric diagnoses are purely descriptive; yet, none of the organizations directly referred to depression in this way. “The American Psychiatric Association, in the DSM-5, makes explicitly clear that the diagnostic criteria of mental disorders are descriptive in nature because the underlying pathologies are not known,” wrote authors Jani Kajanojaa and Jussi Valtonenb.

Rather, the authors noted that many leading health authorities used circular reasoning — a logical fallacy — when referencing depression. Circular reasoning occurs when a condition (or claim) and its cause (or evidence) are made synonymous. Circular reasoning is also commonly associated with ADHD ² — a disorder that is highly comorbid with depression. People with ADHD are three times more likely to experience depression compared to those without ADHD.

“While it would be entirely correct to say that the human experiences that the diagnostic criteria describe can feel like an illness, it is different from claiming that an identified external biomedical pathological entity is really causing the symptoms.”

What Is Depression?

Depression is one of the most prevalent mental disorders impacting 6.7% of U.S. adults. There is no single proven cause; its onset is nuanced and its presentation can vary. To say otherwise is scientifically inaccurate.

Per the results, however, descriptions of depression are not clear and can easily misguide readers and patients. This can, in turn, impede public trust in medical authorities during a time when online information about mental health is already poor, according to the authors. ³⁴

Social media further compounds this issue. A 2022 study published by The Canadian Journal of Psychiatry and reported on by ADDitude found that at least half of trending videos about ADHD on TikTok — a platform that attracts more than 1 billion active monthly users — are misleading. Although none of the videos were uploaded by major health organizations, they exemplify the need for reliable information on the Internet.

Understanding mental illness and its potential causes has been shown to help patients and readers regulate negative emotions, according to a recent study in Psychological Science cited by the authors. ⁵ Education complements treatment plans, which typically incorporate psychotherapy and medication ― although this combination can vary, says Karen Swartz, M.D.

“For some individuals, it’s psychotherapy alone,” she said in an ADDitude webinar on depression in teens. “For others, it’s primarily medication. That’s very individualized. But almost every study that’s looked at this has found that the combination is far superior to either one alone.”

“Part of it is that you need to learn about yourself and how to manage your symptoms, recognize them, and understand what it means to have a serious medical problem… In addition to these treatments, it’s important to include education and support so people understand what they have and how they’re going to manage it.”

By contrast, misleading causal claims can impede a patient’s ability to regulate their emotions. The authors note that viewing depression as having a known pathological disease process can impair treatment outcomes by discouraging patients and “effectively obscuring the links between mental distress, personal history, meaning, and cultural context.”

One approach to avoid circular reasoning is to frame depression within the context of stressful life experiences. Traumatic events have been associated with an increased risk of depression; thus, depression may be described as an “adaptive response,” “functional signal,” or “meaningful reaction” to adversity.

Similarly, ADHD has been associated with adverse life events, or “ACEs,” said Cheryl Chase, Ph.D., in the following clip from her ADDitude webinar about brain development under stress.

Still, it’s essential for professionals to be clear about what a descriptive diagnosis is. Accurate depictions include: ⁶

• “Depression is not a word that describes just one state of mind, but refers to a whole array of different feelings and thoughts…”
• “The experience we call depression is a form of distress…”

Doing so “provides more room, not less, to explore the various potential ways in which individuals can seek to understand the meaning of their lived experiences,” the authors wrote.

Limitations & Future Research

The analysis included 30 organizations: 13 governmental institutions, 9 non-governmental organizations, 3 professional psychiatric associations, 3 universities, and 2 intergovernmental bodies. Google was used to identify the top websites most likely to appear when users search “depression.”

Future research should include a systematic review of leading health websites. The process of searching for and analyzing popular health organizations in the present study was not exhaustive, thus limiting the scope of the results. Additional studies should further explore the impact of misleading information about mental health diagnoses, including the use of circular reasoning, on readers’ beliefs and treatment outcomes.

Sources

¹ Kajanojaa, J., & Valtonen, J. (2024). A descriptive diagnosis or a causal explanation? Accuracy of depictions of depression on authoritative health organization websites. Psychopathology. DOI: 10.1159/000538458

² Meerman S. T., Freedman, J. E., & Batstra, L. (2022). ADHD and reification: Four ways a psychiatric construct is portrayed as a disease. Frontiers in Psychiatry, 13. DOI: 10.3389/fpsyt.2022.1055328

³ Reavley, N.J., & Jorm, A.F. (2011). The quality of mental disorder information websites: a review. Patient Educ Couns, 85(2):e16–25. https://doi.org/10.1016/j.pec.2010.10.015

⁴ Demasi, M, & Gøtzsche, P.C. (2020). Presentation of benefits and harms of antidepressants on websites: a cross-sectional study. Int J Risk Saf Med, 31(2):53–65. https://doi.org/10.3233/JRS-191023

⁵ Millgram, Y., Nock, M. K., Bailey, D. D., & Goldenberg, A. (2023). Knowledge about the source of emotion predicts emotion-regulation attempts, strategies, and perceived emotion-regulation success. Psychological Science, 34(11), 1244-1255. https://doi.org/10.1177/09567976231199440

⁶  Bowden, G,, Holttum, S., & Shankar, R. (2020). Understanding depression: why adults experience depression and what can help. British Psychological Society. https://cms.bps.org.uk/sites/default/files/2022-07/Understanding%20depression.pdf

Dramatically higher rates of self-harm among youth with ADHD are reflected in many studies, including the Berkeley Girls ADHD Longitudinal Study (BGALS), which found that girls with combined-type ADHD are 2.5 times more likely than their neurotypical peers to engage in non-suicidal self-injury, and 3 to 4 times more likely to attempt suicide. A recent study found that, among self-harming teens, the incidence of hyperactivity and emotional dysregulation were so much higher than in the control group that the researchers concluded that self-harm may serve as a first presentation of ADHD, especially among girls who might otherwise go undiagnosed.² They further suggested that all teens who present with self-harm should be screened for ADHD.

The newest research has revealed that rates of self-harm among youth with ADHD may be even higher than past studies suggested. A 2024 study published in Psychiatry Research³ that involved 5,100 youth in Australia found that subjects with ADHD were 25 times more likely to self-harm than were their neurotypical peers.

Why Do Kids and Teens Self-Harm?

For some people, self-injury is an effective way to regulate unwanted emotions like anxiety and sadness, which they feel very, very strongly in their bodies. For some individuals, self-harm may bring them back into their body if they feel disassociated or emotionally numb.

Sometimes, the function of the self-injury is to communicate needs, or for kids to feel in control of their bodies and minds. There’s something about the behavior, symbolically, that allows kids and teens to take something amorphous — a bundle of abstract feelings — and put it somewhere on their body. They claim the power of defining the look of it, of expressing, “this is what these emotions look like,” and then the body heals it.

[Read: We Demand Attention on Self-Harm, Intimate Partner Violence, and Substance Abuse Among Women with ADHD]

Typically, the self-injury results from a trigger, causing a cascade of intense emotion that the person then wants to be rid of. Common categories of triggers include:

• Interpersonal stressors: a sense of rejection or relationship stress
• Performance anxieties

Self-Harm Patterns and Red Flags

While self-injuring behaviors vary by individual, studies have provided us with data about general patterns of self-harm among children and teens: ^{4 5}

• Average age of onset: 11-15 years old
• 25% of youth who self-injure do so only once
• 75% of youth report multiple episodes of self-injury
• Most youth who repeatedly self-injure stop within 5 years
• Self-injury can be cyclical and occur again after periods of stopping

[Read: Teen Girls Are Not Alright. ADHD Magnifies the Crisis.]

Self-Harm Red Flags:

Non-physical signs:

• Persistent changes in mood or character

Physical signs:

• Scars or wounds, especially multiple injuries clustered together
• Wrist coverings or inappropriate dress for the season (i.e. long sleeves in summer)
• Confusing paraphernalia in unexpected places (i.e. sharp object in bed)

What to Do If Your Child is Self-Harming?

If you find out your child is self-injuring, it’s important to form your response thoughtfully. Parents’ reactions to self-harm matter: Conversations that go well can really open doors for healing, but conversations that go poorly can do the opposite.

1. Remain neutral. Don’t display shock, pity, or judgment.

Discovering your child has been self-injuring can trigger many emotions including fear, shock, guilt, confusion, and anger, but it’s very important that you don’t attempt to talk to your child until you’ve worked through and subdued these feelings. Broach the topic only when you feel you can be dispassionate and centered.

It’s common to feel anger, which often results from worry, and there may be an urge to ask, “What are you doing? Why would you do this? Stop it!” Be sure to refrain from any condemnation, shame or criticism, as this may exacerbate the behavior.

2. Communicate three sentiments:

“I love you.”

“I’m sorry you’re hurting.”

“I’m here to help.”

Verbalize these messages to your child. It’s what they need to hear.

3. Don’t fixate on the wounds:

While it’s normal to be concerned about self-inflicted wounds, you should steer clear of placing too much emphasis on the physical injuries themselves. Instead, focus on the underlying reasons for the injurious behavior. Research shows that is what kids want to talk about, and understanding what’s causing the behavior is the first step toward meaningfully and effectively addressing it.

If kids don’t want to talk: That’s okay. Evasiveness is common at first. The most important thing isn’t getting the information you want, it’s establishing a connection, and keeping that connection open.

If you blow it: Don’t spend too much time worrying about it. Just go back to your child later and say, “That didn’t go the way I wanted it to go. Let’s try again.”

Distinguishing Non-suicidal Self Injury from Suicidal Ideation

Self-injury, most often, is not a suicidal gesture. The behavior typically originates from kids and teens wanting to feel better, not wanting to end their life.

That said, self-injury is a sign of distress and, in some cases, children and teens who engage in this behavior may be considering suicide. It’s important to differentiate between non-suicidal self-injury, and self-injury associated with suicidality.

The best way for parents to find out if the child is having suicidal ideation? Ask them.

Ask your child: “Can you tell me if you feel or have felt like you want to end your life?” If they say yes, you should determine how immediate the threat is by asking, “Are you feeling that now?” If the answer is “yes,” you need to reach out to a professional right away.

If your child responds, “no,” but you suspect they’re not being totally honest, tell them, “I love you. I’m here for you,” then continue to observe them and broach the topic again at a later time. The most important thing for parents to do is to keep the door of connection open.

Is Self-Harm Addictive?

Early detection is important because self-harm can become habit-forming. One quarter of youth who have self-injured report that they only did it once, but for three quarters of youth, there were multiple episodes. Individuals report having to do more over time to get the same response and they report feeling the desire to self-injure outside of a triggering situation.

It isn’t uncommon for people to acquire more contexts and reasons to self-injure as time goes on and this makes it harder to stop. As it becomes a more central part of how a person manages their emotions, it becomes a bigger lift to replace it with something else over time.

Is Self-Harm Contagious?

Self-injury can be contagious, especially within institutions, such as schools.

If your child is self-injuring and you believe it’s also something their peers are doing, it can help to find the person who is likely the epicenter of the behavioral trend. Often, this is a high-status peer, who may be signaling that this is cool, even if that is not their intent.

Try to engage this student as an ally and explain that there’s some contagion happening, and they have the ability to help in many ways, from minimizing the attention they give to self-injury to getting help themselves. Don’t assume that this child is your enemy: often, they’re not aware of what’s happening, and they don’t want their friends to be hurting.

Self-Harm Treatment

If a child is self-injuring, especially if they have other underlying issues including anxiety, depression, and/or ADHD, it’s important to find a good therapist. Look for providers who have experience working with young people and with dialectical behavioral therapy (DBT), which is the most commonly used modality to treat self-harm. DBT’s focus on understanding and accepting emotions and distress tolerance as well as learning healthy coping skills can be effective for addressing self-harm.

It’s important to note that self-injury can be tough to treat because it works very effectively for some people to down-regulate. We all have preferred ways of coping, and this becomes some people’s deeply preferred way. It’s not as easy as just replacing the behavior with other techniques.

Because of this, therapists often won’t start by addressing the self-injury directly. Instead, they might start by addressing an underlying issue that’s driving it, the psychological architecture that gave rise to it in the first place.

Kids and teens who self-injure have to learn to lean on something else that feels as effective, which just takes time, practice, and guidance. 

Self-Harm and ADHD: Next Steps

• Read: Straight Talk on Suicide and ADHD
• Free Download: Get a Grip on Tough Emotions
• Read: DBT Skills – The Go-To Treatment for ADD?

Janis Whitlock, MPH, Ph.D., is director of the Cornell Research Program of Self-Injury and Recovery.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Swannell, S.V., Martin, G.E., Page, A., Hasking, P., & St. John, N.J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior, 2, 1-31.

²Ward JH, Curran S. Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health. 2021 Nov;26(4):303-309. doi: 10.1111/camh.12471. Epub 2021 May 3. PMID: 33939246.

³Ping-I Lin, Weng Tong Wu, Enoch Kordjo Azasu, Tsz Ying Wong. (2024), Pathway from attention-deficit/hyperactivity disorder to suicide/self-harm, Psychiatry Research, Volume 337, https://doi.org/10.1016/j.psychres.2024.115936.

⁴Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: a systematic review. Frontiers in psychology, 8, 1946.

⁵Whitlock, J.L. & Selekman, M. (2014). Non-suicidal self-injury (NSSI) across the lifespan. In M. Nock (Ed.), Oxford handbook of suicide and self-injury. Oxford Library of Psychology, Oxford University Press.

Undergraduate college students are more likely to experience depression and anxiety today than ever before. Among those students, non-binary and LGBQ+ individuals have recently experienced a particularly significant increase in diagnoses for depression and anxiety compared to their heterosexual peers.¹

According to new research published in the Journal of Affective Disorders, about one-third of students in the 2011-2012 school year said they felt “so depressed it was hard to function.” By 2017-2018, this number grew to 42% — a 13% annual increase, according to the study authors. Among LGBQ+ students — defined as lesbian, gay, bisexual, queer, and others — the rate of diagnosis and treatment for depression rose 23% per year during the same time frame.

Further, the number of non-binary BIPOC (Black, Indigenous, and People of Color) students diagnosed with or treated for depression rose 61% between 2016 and 2019; among non-binary non-Hispanic white students, depression diagnoses rose 49% over the same period.

The study reported a notable rise in the number of students diagnosed with or treated for anxiety. Among LGBQ+ students, the incidence of anxiety increased 22% each year; for heterosexual students, it rose 12% each year.

The number of students who seriously thought about suicide nearly doubled from 7.4% to 13% over the study period, with a more pronounced increase among LGBQ+ and BIPOC students, especially women.

“These results indicate that it is imperative to better address the mental health challenges faced by non-binary and LGBQ+ students while avoiding actions that may lead to their alienation, isolation, and oppression,” the study’s authors wrote.

They attribute the rising mental health challenges in college students to factors such as academic stress and burnout, poor social support, poor sleep, less in-person social interaction, and more isolation.¹

For the study, researchers analyzed data from the American College Health Association and National College Health Assessment II: 2016–2019, which included a sample of 228,640 undergraduate students, ages 18-24, from 442 campuses.

Poor Mental Health Reported in Non-Binary Transgender Adults

A February 2024 study of 1.5 million people, including nearly 8,000 transgender people aged 16 or older in England, reported similar results. The study, published in The Lancet Public Health journal, found that gender-diverse adult populations experience a much higher prevalence of mental health conditions compared to cisgender adult populations, with inequalities concentrated in patients younger than 35 years.²

The study revealed that long-term mental health conditions impact approximately one in two non-binary transgender adults and one in six transgender men, women, and cisgender non-binary adults; in contrast, just one in ten cisgender men and women were diagnosed with a mental health condition.

The English research team suggests that mental health outcomes for this patient population could benefit from practitioners who conduct better training for their medical staff, adopt inclusive language, and standardize electronic healthcare record systems to include transgender, non-binary, and gender-diverse identities, which would “reduce the psychological burden associated with repeated explaining or being misgendered, again reducing minority stress and potentially improving mental health.”

Sources

¹ Samek, D.R., Akua, B.A., Crumly, B., Duke-Marks, A. (2024). Increasing Mental Health Issues in College Students from 2016-2019: Assessing the Intersections of Race/Ethnicity, Gender, and Sexual Orientation. J Affect Disord.354:216-223.https://doi.org/10.1016/j.jad.2024.03.068

²Watkinson, R. E., Linfield, A., Tielemans, J., Francetic, I., & Munford, L. (2024). Gender-Related Self-Reported Mental Health Inequalities in Primary Care in England: Cross-Sectional Analysis Using the GP Patient Survey. The Lancet Public Health. 9(2), E100-E108.https://doi.org/10.1016/S2468-2667(23)00301-8

Females are more likely than males to have complex presentations of ADHD, potentially leading to delayed diagnosis and treatment, according to new research published in the Journal of Attention Disorders. The study found that females with ADHD are more likely than males to have inattentive ADHD, are diagnosed at older ages, and have higher rates of anxiety and depression diagnoses both before and after their ADHD diagnoses. ¹

The retrospective observational study was conducted using data from four U.S. health databases. The researchers sought to explore the relationship between sex as well as ADHD subtype and diagnosis timing. They also hoped to assess whether receiving an ADHD diagnosis had an impact on pre-existing diagnoses of depression and anxiety in women and girls, who receive treatment for these comorbidities at higher numbers.

Age of ADHD Diagnosis Rates by Sex and Subtype

The study revealed:

• The average age of ADHD diagnosis by gender:
  • Females:16 to 29 years
  • Males: 11 to 23 years
• Across both sexes, the average age of diagnosis by ADHD type:
  • Inattentive Type: 17 years to 27 years
  • Hyperactive impulsive Type: 10 years to 20 years
• Females were substantially more likely than males to be diagnosed with inattentive ADHD

How Mood Disorders Fit Into the Diagnostic Picture

• Females were twice as likely as males to have depression or anxiety diagnoses and treatments in the year before their ADHD diagnosis.
• Females were more likely than males to receive new diagnoses or treatments for depression or anxiety in the year following an ADHD diagnosis.
• The number of females with pre-existing depression or anxiety diagnoses with symptoms that did not continue after their ADHD diagnosis was higher than the number of males. In these cases, ADHD may have been misdiagnosed as anxiety or depression.
• Patients with inattentive ADHD were more likely to receive a prior diagnosis of depression or anxiety:
  • Inattentive ADHD: 13% to 18% (depression) and 17% to 26% (anxiety)
  • Hyperactive impulsive ADHD: 5% to 12% (depression) and 9% to 20% (anxiety)

Repercussions of Delayed Diagnosis

The study’s finding that females are diagnosed five years later than males, on average, together with other key data points lead researchers to conclude that diagnoses in females tend to occur “only once ADHD symptoms become more severe,” and underscores the importance of addressing this gap in health equity.

The consequences of undiagnosed ADHD are dire, especially for women.

“Women who live undiagnosed until adulthood experience significant negative outcomes in the areas of self-esteem, social interaction, and psychosocial wellbeing beginning in childhood and continuing into adulthood,” concluded the authors of a systematic review of research published in March 2023. “Women in these studies engaged in less task-oriented coping and more emotion-oriented coping and often turned to recreational drugs, alcohol, nicotine, and sex to self-medicate for symptoms of undiagnosed ADHD.” ²

A female ADDitude reader explains the lived experience of late diagnosis this way: “I have lived with the misleading belief that I was a loser, lazy, incompetent. What are the long-term impacts of these self-defeating beliefs?”

The Complicating Presence of Mood Disorders

The connection between ADHD and mood disorders, including depression, is well-established. According to a recent study in BMJ Mental Health: ³

• People with ADHD are 9% more likely to have MDD
• An MDD diagnosis increases the risk for ADHD by 76%

These findings are echoed in the responses to a recent ADDitude survey of 6,810 adults, which found that 72% reported having anxiety and 62% having reported depression.

In addition to the over-representation of mood disorders among individuals with ADHD, previous research has documented that women in general are twice as likely as men to suffer from MDD and General Anxiety Disorder (GAD).

While rates of mood disorders are unequivocally higher among women with ADHD than either men with ADHD or women without the condition, the new study lends credence to what many women have reported anecdotally: They are also more likely than men to have ADHD initially misdiagnosed as depression or anxiety.

“Because of stigma and thoughts related to gender role presentations, when females do present with ADHD symptoms, it can be thought that it’s more likely due to anxiety or depression, because those are presentations that people are used to seeing in females early on,” explained Dave Anderson, Ph.D., in the ADDitude webinar “ADHD Then and Now: How Our Understanding Has Evolved.” “So, people say, ‘She’s distracted because she’s anxious or sad,’ not because she has ADHD. That’s something that we’re actively trying to fight, even in clinician bias.”

The new study, and research like it, helps shed light on the unique toll exacted on women by ADHD. More investigation is desperately needed, explains Dawn K. Brown, M.D., in the ADDitude article, We Demand Attention! A Call for Greater Research on Women with ADHD.

“Further research regarding these topics is indeed crucial,” Brown explains. “By conducting in-depth investigations into the gender-specific nuances of ADHD presentation and impact, healthcare professionals, policymakers, and advocates can promote greater awareness, understanding, and tailored support for women with ADHD.”

Read on to learn about the Top 10 research priorities detailed in ADDitude’s groundbreaking, cross-platform initiative : We Demand Attention! A Call to Action for Greater Research on Women with ADHD.

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

1. Sex Difference in ADHD
2. The Health Consequences of Delayed ADHD Diagnoses on Women
3. How Hormonal Changes Impact ADHD Symptoms in Women
4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
5. The Elevated Risk for PMDD and PPD Among Women with ADHD
6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

Sources

¹  Siddiqui, U., Conover, M. M., Voss, E. A., Kern, D. M., Litvak, M., & Antunes, J. (2024). Sex Differences in Diagnosis and Treatment Timing of Comorbid Depression/Anxiety and Disease Subtypes in Patients With ADHD: A Database Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547241251738

²  Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders, 27(7), 645-657. https://doi.org/10.1177/10870547231161533

³  Meisinger, C. & Freuer, D., (2023) Understanding the Causal Relationships of Attention Deficit/Hyperactivity Disorder with Mental Disorders and Suicide Attempt: A Network Mendelian Randomisation Study. BMJ Mental Health. doi.org/10.1136/bmjment-2022-300642

When administered at carefully selected dosages in clinical settings, and combined with therapy before and after treatment, psychedelics have been found to provide rapid relief from some of the most painful and difficult-to-treat mental health conditions. Ketamine is being used for depression and suicidality in clinical trials. MDMA is treating severe post-traumatic stress disorder (PTSD), and psilocybin is being used for treatment-resistant depression, alcohol use disorder, and more.

However, important questions remain about the long-term efficacy and safety of psychedelics, as well as patient suitability. Several large-scale studies are now under way to address these concerns, including the first-ever phase 3 clinical trial on psilocybin-assisted therapy — the largest randomized, controlled, double-blind study on the drug, with more than 800 participants. Initial results are expected this summer.

How Do Psychedelics Work?

Research shows that psychedelics improve many neuropsychiatric disorders, but the way they work is less clear. Functional MRIs and laboratory studies offer possible explanations:

• Ketamine binds to NMDA receptors in the brain, increasing levels of a mood-regulating neurotransmitter called glutamate.¹
• MDMA increases oxytocin, dopamine, and other chemical messengers related to positive emotions.²
• Psilocybin stimulates the brain’s serotonin 2A receptors, appearing to decrease activity across the default mode network.³

But these biochemical explanations don’t tell the full story, says Gül Dölen, M.D., Ph.D., professor of psychology and researcher at University of California Berkeley’s Center for the Science of Psychedelics. Psychedelics only reliably improve psychiatric conditions when administered with therapy. “Therapy is the context to get the cure,” Dölen explains. “You can’t take MDMA and go to a rave and expect it to cure your PTSD.”

Indeed, when taken on their own, psychedelics aren’t hugely effective, according to studies; therapy unlocks the drugs’ enduring benefits. Also, there are serious risks to taking the drugs without medical supervision.

[Read: The Truth About Lion’s Mane, Psychedelics & Caffeine]

A Brand-New Framework

Most psychiatric medications must be taken daily, often for a lifetime. By contrast, a single dose of certain psychedelics paired with therapy can result in full-blown remission. This claim appears too good to be true when viewed through the traditional “biochemical imbalance” model of neuropsychological disease that has dominated the field for the past 50 years. “The idea is that depression, for example, is a biochemical imbalance in serotonin,” Dölen says. “So, we’ll restore serotonin levels with a pill, and you’ll get better.”

But what if there were an approach that treated depression by restoring the fundamental ability to learn (and unlearn) behaviors and ways of thinking, and not by raising serotonin levels? It’s an entirely different framework for understanding neuropsychiatric disorders — the learning model — and Dölen says it’s the best way to comprehend how psychedelics work.

Psychedelics act like master keys unlocking what scientists call “critical periods” of learning—specific times when individuals have a heightened ability to soak in new information. During brain development, these are the critical windows in which we acquire vision, language, motor development, and more. And after these critical windows close, they remain locked.

Or so we thought.

Psychedelics Restore Child-Like Learning

In a study that involved giving mice MDMA, Dölen found that the drug unlocks a critical period for social reward learning, restoring adult mice to child-like levels of openness for social development.⁴ Dölen’s next study uncovered the potential of all psychedelics—including LSD, psilocybin, ketamine, and ibogaine—to open these critical periods.⁵

[Watch: “Psychedelic Therapy for Mood Disorders: Research & Potential”]

“This is a big deal,” says Dölen. “And if it’s true, it’s going to revolutionize things, but only if we understand what a critical period is. It’s not that you take a pill and you speak Japanese. It’s that you take a pill and you restore the ability to learn Japanese.”

The drugs open the mind to learning. The therapy provides the learning itself.

“Patients talk about how they had an epiphany, how the trip enabled them to see how they’d built their lives around a foundational myth that wasn’t true, whether about their relationship to other people, their personality, their deserving to be in the world,” Dölen says. The post-trip therapy, in turn, allowed them to identify how that myth led to maladaptive ways of interacting with the world, and understand how to integrate that knowledge into their daily lives.

The potential of psychedelics to re-open critical periods has far-reaching implications. Dölen’s lab is exploring the possibilities of treating conditions like stroke and blindness with psychedelics through a project called PHATHOM (Psychedelic Healing: Adjunct Therapy Harnessing Opened Malleability).

“Psychedelics are not going to be the magic bullet that fixes everything, but we’re excited about the possibilities,” Dölen says. “Being able to restore child-like learning is a major therapeutic opportunity.”

Psychedelics Therapy and Mental Health: Next Steps

• Self-Test: Symptoms of Depression in Adults
• Free Download: Signs of Depression That May Surprise You
• Read: Real Stories of Using Ketamine for Depression, Anxiety, PTSD

Nicole C. Kear is Consumer Health Editor at ADDitude.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Matveychuk D, Thomas RK, Swainson J, Khullar A, MacKay MA, Baker GB, Dursun SM. Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers. Ther Adv Psychopharmacol. 2020 May 11;10:2045125320916657. doi: 10.1177/2045125320916657. PMID: 32440333; PMCID: PMC7225830.

² Mitchell, J.M., Bogenschutz, M., Lilienstein, A. et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med 27, 1025–1033 (2021). https://doi.org/10.1038/s41591-021-01336-

³ Smausz R, Neill J, Gigg J. Neural mechanisms underlying psilocybin’s therapeutic potential – the need for preclinical in vivo electrophysiology. J Psychopharmacol. 2022 Jul;36(7):781-793. doi: 10.1177/02698811221092508. Epub 2022 May 30. PMID: 35638159; PMCID: PMC9247433.

⁴ Nardou, R., Lewis, E.M., Rothhaas, R. et al. Oxytocin-dependent reopening of a social reward learning critical period with MDMA. Nature 569, 116–120 (2019). https://doi.org/10.1038/s41586-019-1075-9

⁵ Nardou, R., Sawyer, E., Song, Y.J. et al. Psychedelics reopen the social reward learning critical period. Nature 618, 790–798 (2023). https://doi.org/10.1038/s41586-023-06204-3

The causes of postpartum depression (PPD) and postpartum mood disorders are complex and combine differing sources for different people. These sources are not always fully understood. Genetic and biological factors, including dramatic hormonal fluctuations after birth, are thought to play a major role. However, hormones or biology alone do not fully explain why someone might develop a postpartum mood distress or disorder. While no parent is immune to developing PPD or other postpartum mood disorders, the following psychological and psychosocial factors are known to increase risk for these conditions: ^{1 2 3 4}

• a history of depression or anxiety
• experiencing depressive/anxious/high stress symptoms during pregnancy
• a history of trauma
• a history of significant mood changes during menstruation
• a history of significant reactions to sleep deprivation
• an unwanted pregnancy
• a lack of social supports, particularly stress in a primary parenting partner relationship
• social isolation
• a lack of access to basic needs
• low socioeconomic status

[Take This Self-Test: Signs of Postpartum Depression]

Black women and individuals of other ethnic and racial groups who have been historically under-resourced and overlooked also face higher risk for postpartum depression, largely because of expressed concerns not being adequately tended to by the helping professions. ^{5 6}

The ADHD-Postpartum Depression Link

Recent studies show that ADHD is a risk factor for PPD. A 2023 study found that mothers with ADHD, even those without a history of depression, are 24% more likely to be diagnosed with PPD than are mothers without ADHD.⁷ This link may be partly explained by increasing rates of first-time diagnosis of ADHD among adults, and among women in particular of childbearing age ⁸, which is likely contributing to better identification of individuals with ADHD who have developed postpartum depression.

Another 2023 study of more than 773,000 women who gave birth found that about 25% of women with ADHD were diagnosed with anxiety disorders postpartum compared to 4.6% of women without ADHD. In addition, about 17% of women with ADHD had PPD compared to 3.3% of women without ADHD.⁹ Researchers are still working to understand what underscores the disproportionate link between postpartum depression and ADHD. Both ADHD and postpartum depression and anxiety disorders represent challenges in self-regulation.

Frequent Screenings Are Key for Postpartum Parents

Though about one in eight women or birthing parents — and as many as one in 10 fathers or caregiving partners — develop a postpartum mood disorder, ^{6 10} these conditions are still largely overlooked. In a live ADDitude webinar poll, about 70% of respondents said their doctor missed their symptoms of postpartum depression. In a separate poll, about 45% of ADDitude readers said they wouldn’t be able or aren’t sure if they’d be able to identify postpartum depression in themselves or in others.

[Free Download: The Facts About Major Depressive Disorder in Women]

Frequent screenings are the most powerful tool for early detection of PPD and other postpartum mood disorders. Early detection is important to curb the development of severe forms of postpartum mood disorders. While postpartum mood disorders typically onset within three weeks of a child’s birth, they can develop through the first postpartum year. Screenings, therefore, should occur all through the first year after childbirth. Like most women and birthing parents, you likely won’t see your OB-GYN after your six-week postpartum appointment. In that case, your primary care provider and pediatrician should screen you.

At the same time, it’s critical that you know the signs of PPD and other postpartum mood disorders. Do not wait to talk to your doctor(s) if you think you show any of the signs. Insist on formal screeners, especially if you have a risk factor for PPD.

Postpartum Depression: Next Steps

• Free Download: Hormones & ADHD in Women
• Read: Postpartum Care for Mothers with ADHD
• Read: Healing Through Parenting — The Key to Postpartum Depression Recovery

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Unspoken Truths of Postpartum Depression: Help for Women With and Without ADHD” [Video Replay & Podcast #470] with Jayne Singer, Ph.D., IECMH-E®, which was broadcast on September 7, 2023.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Stewart, D. E., & Vigod, S. N. (2019). Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics. Annual Review of Medicine, 70, 183–196. https://doi.org/10.1146/annurev-med-041217-011106

² Beck C. T. (2002). Revision of the postpartum depression predictors inventory. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN, 31(4), 394–402. https://doi.org/10.1111/j.1552-6909.2002.tb00061.x

³ Buttner, M. M., Mott, S. L., Pearlstein, T., Stuart, S., Zlotnick, C., & O’Hara, M. W. (2013). Examination of premenstrual symptoms as a risk factor for depression in postpartum women. Archives of Women’s Mental Health, 16(3), 219–225. https://doi.org/10.1007/s00737-012-0323-x

⁴ Choi, K. W., Houts, R., Arseneault, L., Pariante, C., Sikkema, K. J., & Moffitt, T. E. (2019). Maternal depression in the intergenerational transmission of childhood maltreatment and its sequelae: Testing postpartum effects in a longitudinal birth cohort. Development and psychopathology, 31(1), 143–156. https://doi.org/10.1017/S0954579418000032

⁵ Onyewuenyi, T. L., Peterman, K., Zaritsky, E., Ritterman Weintraub, M. L., Pettway, B. L., Quesenberry, C. P., Nance, N., Surmava, A. M., & Avalos, L. A. (2023). Neighborhood Disadvantage, Race and Ethnicity, and Postpartum Depression. JAMA network open, 6(11), e2342398. https://doi.org/10.1001/jamanetworkopen.2023.42398

⁶ Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo Mph, D. V., Warner, L., Folger, S., Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression – United States, 2018. MMWR. Morbidity and mortality weekly report, 69(19), 575–581. https://doi.org/10.15585/mmwr.mm6919a2

⁷ Bartelt K, Piff A, Vitek G, Barkley E. Maternal ADHD Correlated with Increased Risk of Postpartum Depression. Epic Research. https://epicresearch.org/articles/maternal-adhd-correlated-with-increased-risk-of-postpartum-depression.

⁸ Russell J, Franklin B, Piff A, Allen S, Barkley E. Number of ADHD Patients Rising, Especially Among Women. Epic Research. https://epicresearch.org/articles/number-of-adhd-patients-rising-especially-among-women. Accessed on March 18, 2024.

⁹ Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069

¹⁰ Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA, 303(19), 1961–1969. https://doi.org/10.1001/jama.2010.605

Postpartum Depression: Key Takeaways

• Postpartum depression is characterized by significant emotional challenges that affect the parent-child bond.
• Hands-on parenting, not separation, is essential in powering recovery from postpartum depression and in repairing bonds.
• Self-care and other coping strategies are an important part of postpartum depression recovery.

The Fourth Trimester: What No One Talks About

The first few months after a baby is born — sometimes called the “fourth trimester” — is a critical time for the emerging parent-infant relationship. You and your newborn are rapidly adjusting to a new way of life, a reality that is often complex and unexpected.

• You may feel ambivalent. We’re told that pregnancy and parenthood should be happy and joyous, but experiencing mixed feelings after a baby arrives is common — and normal. You might well not feel the rush of falling in love that you might have expected.
• You may have held unrealistic expectations of your baby. There may be a disconnect between the baby you imagined or wished for and the baby in front of you.
• You may feel overwhelmed. Like many expectant parents, you might have imagined your new baby smiling and cooing all the time. But newborns more often cry and fuss and sleep as they learn to regulate (and do so with help from parents). The round-the-clock care babies require, which invariably disrupts sleep and daily routines, is a major adjustment for any parent.
• You may feel worried about your baby’s health and wellbeing, about your emotions about your baby, and your emerging parenting skills.
• You are likely sleep deprived. You are learning to care for a newborn during a period of acute disruption of your sleep.
• You may feel discouraged. Especially if your baby is fussy or requires special caregiving needs, you may struggle with feeling successful as a parent and emotionally attached to your baby.
• You may feel under pressure to return to work and make childcare decisions and arrangements.
• There may be friction in the parenting partnership or lack of partnership if you’re a single parent.

These common factors — combined with dramatic hormonal fluctuations following childbirth — can increase risk for postpartum depression (PPD) during this critical stage.

Characterized by persistent and acute feelings of sadness, guilt, irritability, anxiety, and lethargy — well beyond the baby blues — PPD is a condition that interferes with your wellbeing and how you bond with your baby. It is important for your health and wellbeing – and the healthy development and wellbeing of your baby – for you to seek and accept help. You deserve relief!

PPD is treatable, and a major aspect of recovery happens by virtue of the parent-infant relationship. Getting help from others for the care of your baby is crucial in the newborn period, especially if you are experiencing signs and symptoms of PPD. But it is also very important to spend time with your baby as well, since your relationship with your little one will help you recover from distress. With PPD, this process deserves support.

[Take This Self-Test: Could You Be Experiencing Postpartum Depression?]

Postpartum Depression Treatment: Parenting Is Essential to Healing

PPD and other postpartum mood disorders affect neural pathways responsible for driving parenting and attachment behaviors. This explains, in part, why you may have trouble bonding with your baby.

Too often, parents recovering from PPD believe they must distance themselves from their baby because they’ve been told PPD is “not good” for the child. Such messaging can feel devastating to a new parent, especially if you already struggle to feel close to your baby and have low confidence in your parenting.

While separation may be initially required for parents experiencing severe PPD (especially with postpartum psychosis), reunification should happen as quickly as possible. Parenting should never be separated from the PPD healing process, as active involvement in caregiving has the potential to “reset” the brain.¹ Your chances of experiencing positive, successful parenting moments — which are key to repairing bonds with your baby and raising confidence in yourself as a caregiver — can only happen through interaction.

Working with a healthcare provider who specializes in parent-infant or dyadic therapy in PPD is especially helpful. Your provider can facilitate “moments of meeting,” typically through your baby’s behaviors, that bring you closer and rewire the way you see your baby.

[Read: Postpartum Care for Mothers with ADHD — A Guide for Clinicians]

Especially if you’re recovering from acute PPD, you may require extra support for navigating the demands of parenting and of your own healing. Your provider may help you with self-regulation so you can support your baby’s regulation. You may learn how to soothe your baby, so they are available for social engagement, opening the way for those crucial moments of bonding that allow you to feel the joy in parenting to which you — and your baby – are entitled.

Postpartum Depression Treatment: Additional Coping Strategies

Your provider may have prescribed medications and/or therapy as part of your PPD treatment. As you recover from PPD, make sure the following strategies also become part of your healing process:

• Find peer support. Connect with at least one other parent who is experiencing or has experienced PPD or a postpartum mood disorder. Reflecting upon and sharing your experience with PPD and how it has affected you can be immensely healing.
• Engage in physical activity and movement, focus on nutritious meals, and stay hydrated. These are all cornerstones of the healing process.
• Establish routines and rituals to bring structure and order into your family’s life.
• Manage stress by engaging in mindfulness practices, breathing/relaxation exercises, and joyful activities, among other healthy habits.
• Sleep is vital to prevent symptoms of PPD from worsening. Understandably, sleep is scarce when caring for a baby. Know that your baby can become accustomed to bedtime routines and rituals as soon as they leave the hospital. A soothing bedtime routine can help your child move toward longer stretches of sleep, which can help you avoid sleep deprivation — a critical step in your recovery.

Postpartum Depression and Parenting: Next Steps

• Free Download: The Facts About Major Depressive Disorder in Women
• Read: Postpartum Mood Disorders — Do You Know the Early Signs?
• Research: ADHD Increases Risk for Postpartum Depression, Anxiety
• Watch: The Unspoken Truths of Postpartum Depression

Additional Resources

• Postpartum Support International
• MGH Center for Women’s Mental Health
• Postpartum Progress
• The Seleni Institute
• La Leche League International

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Unspoken Truths of Postpartum Depression: Help for Women With and Without ADHD” [Video Replay & Podcast #470] with Jayne Singer, Ph.D., IECMH-E®, which was broadcast on September 7, 2023.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

¹ Pajulo, M., & Kalland, M. (2013). Mentalizing-based intervention with mother-baby dyads. In N. E. Suchman, M. Pajulo, & L. C. Mayes (Eds.), Parenting and substance abuse: Developmental approaches to intervention (pp. 282–302). Oxford University Press. https://doi.org/10.1093/med:psych/9780199743100.003.0014