Over 6 months of follow-up, patients who initiated medication for attention-deficit/hyperactivity disorder (ADHD) while already taking antidepressants continued taking antidepressant medication at rates and dosages similar to patients not diagnosed with ADHD, according to a study published in Neuropsychiatric Disease and Treatment.

“These results suggest that, in patients with depression and comorbid ADHD, depressive symptoms may be adequately controlled following the initiation of ADHD medication without requiring antidepressant dose increases, even though depression is more likely to be more severe in people with ADHD than in those without,” researchers wrote. “Therefore, in patients presenting with severe and persistent depressive symptoms, the coexistence of ADHD should be considered in the earlier stages of treatment.”

The retrospective observational study, based in Japan, analyzed electronic medical record data for 239 adult patients taking antidepressant medication who subsequently initiated ADHD medication. Participants were matched for sex, age, baseline antidepressant dosage, and any comorbid psychiatric disorders with a control group of 239 patients without ADHD also taking antidepressants. The analysis followed patients for 6 months to investigate changes in the percentage of patients prescribed antidepressants and average antidepressant doses.

ADHD Comorbidities Complicate Diagnosis of the Disorder

During the last month of observation, the proportion of patients prescribed antidepressants decreased from 100% at baseline to 77.0% in the ADHD group and 78.7% in the control group, according to the study. Neither percentage of patients prescribed antidepressants nor average prescribed dose differed significantly between groups at any point during the study period.

Although researchers had expected to see a larger decrease in antidepressant prescriptions and dosages in the ADHD group, results did not support the expectation — possibly because the study’s observation period was not long enough, they wrote

“[F]rom the viewpoint of physicians in clinical practice, at least 1 year of observation after the introduction of a prescription for ADHD medication would be required to detect any changes in antidepressant prescriptions,” researchers wrote, “and longer-term observation may substantiate these hypotheses.”

Reference

Sakai C, Tsuji T, Nakai T, et al. Change in antidepressant use after initiation of ADHD medication in Japanese adults with comorbid depression: a real-world database analysis. Neuropsychiatr Dis Treat. Published online September 23, 2021. doi.org/10.2147/NDT.S325498