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.

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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.

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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

Q: “What are the causes of postpartum depression? As an expectant parent with ADHD, what should I know about factors that increase risk for postpartum mood disorders? How can I protect myself after I have my baby?”

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

Yes, our research group found that women with ADHD were five times more likely to develop depression following use of combined hormonal oral contraceptives (i.e., pills that contain both estrogen and progesterone) than were women without ADHD who were not on these pills.¹ We came to these findings after comparing Swedish national register data of roughly 30,000 girls and young women with ADHD to more than 760,000 neurotypical peers in a control group.

More highlights from this study:

• Women with ADHD who used combined oral hormonal contraceptives (HC) or progestogen-only pills had more than five times the risk for depression compared to women without ADHD who did not use hormonal contraceptives of any kind.
• Women with and without ADHD who used non-oral preparations, such as the implant or hormonal IUD, had similar risk for developing depression, meaning that having ADHD did not change the association between the non-oral HC and the risk for depression.
• Irrespective of hormonal contraception use, women with ADHD had a 3-fold higher risk of developing depression compared to women without ADHD.

[Get This Free Download: Hormones & ADHD in Women]

What could explain the increased risk for depression among women with ADHD who take birth control? The way we see it, it’s probably not the hormones in oral contraceptives, per se, that place women with ADHD at greater risk. After all, there was no difference between combined pills (with estrogen and progesterone) and progestogen-only pills in this group.

What we think may be happening is this: When taking oral birth control, women with ADHD, due to their ADHD, might be extra susceptible to forget to take their birth control pills or may take them irregularly, causing hormonal fluctuations that may destabilize mood. Also, a woman’s hormonal levels will fluctuate during assumed pill-free intervals. As we know from the few studies on this, as well as anecdotal evidence, women with ADHD may be especially sensitive to changing hormonal levels.

In addition, poor adherence to birth control pills is also known to increase the risk of experiencing side effects like irregular bleeding, mood changes, and unplanned pregnancy, which may further increase anxiety and place susceptible women at increased risk for depression. If this is the case, women with ADHD may be better off using long-acting non-oral products like IUDs and contraceptive implants, which take working memory out of the equation and make for a more stable experience.

As you continue to find a birth control method that works for you, be sure to talk to a doctor who is knowledgeable about ADHD in women, especially one who understands the role hormonal fluctuations play in ADHD symptoms and overall mental health.

Hormones, Depression, and ADHD: Next Steps

• Read: Hormonal Changes & ADHD — A Lifelong Tug-of-War
• Read: What’s Behind the “Depression Gap” Impacting Women?
• Watch: Hormonal Fluctuations and ADHD — How Estrogen May Impact Symptoms Throughout Life

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “The Emotional Lives of Girls with ADHD” [Video Replay & Podcast #488] with Lotta Borg Skoglund, M.D., Ph.D., which was broadcast on January 23, 2024.

ADDitude readers: Sign up to access LetterLife, an app by Dr. Lotta Borg Skoglund that provides users with personalized insights — on hormonal cycles, ADHD symptoms, and lifestyle factors — to better manage ADHD.

Use the discount code ADDWEB20 to get 20% off Dr. Skoglund’s book, ADHD Girls to Women, when purchased via uk.jkp.com.

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

¹Lundin, C., Wikman, A., Wikman, P., Kallner, H. K., Sundström-Poromaa, I., & Skoglund, C. (2023). Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 62(6), 665–674. https://doi.org/10.1016/j.jaac.2022.07.847

High-intensity exercise treats depression as effectively as do cognitive behavior therapy (CBT) and medication, according to a new study that found combining SSRIs, a type of antidepressant, with exercise improved depressive symptoms more than medication alone.¹

The systematic review and meta-analysis led by a research team from the University of Queensland, Australia, found that the more intense the physical activity, the more effective it was at managing depression. More specifically, vigorous exercises (e.g., running, interval training, strength training, mixed aerobic exercise) reduced depression symptoms in participants more than light physical activity (e.g., walking and hatha yoga), although the latter did provide some benefit.

These findings emerged from examinations of 218 randomized controlled trials, including 14,170 participants diagnosed with depression, to determine the effectiveness of exercise, psychotherapy, and antidepressants in treating depression.

When the researchers narrowed their analysis by demographics, they discovered that strength training and cycling positively impacted more women than men, and yoga or qigong provided more benefits to men than women. Yoga appeared more effective among older adults, and younger adults received better results from strength training. The duration and frequency of exercise did not affect the results.

The study also suggested that men appeared to benefit more than women from combining yoga, Tai Chi, or aerobic exercise with psychotherapy. Yoga and aerobic exercise combined with psychotherapy seemed more effective among older adults.

Participants gained the most benefits from group classes or scheduled exercises. The more autonomy participants had over their exercise programs, the weaker the outcome. “When provided with more freedom, the low self-efficacy that is symptomatic of depression may stop patients from setting an appropriate level of challenge (e.g., they may be less likely to choose vigorous exercise),” the study’s authors wrote.

The researchers cautioned that definitive conclusions are impossible to draw, and more studies are needed. “Our review did not uncover clear causal mechanisms, but the trends in the data are useful for generating hypotheses,” they wrote. “It is unlikely that any single causal mechanism explains all the findings in the review.”

“Exercise should be considered alongside traditional interventions as a core treatment for depression,” report author Michael Noetel, Ph.D., said in a press release. “No matter how often people exercised, whether they had other health issues or how severe their depression was, in all scenarios, exercise had a meaningful impact on their depression. Of course, anyone getting treatment for depression should talk to their doctor before changing what they are doing, but most people can start walking without many barriers.”

Exercise and Depression

Members of ADDitude’s reader panel confirm several findings from the study published in The BMJ (British Medical Journal).

“Strenuous full-body aerobic activities like boxing, karate, swimming, or boulder climbing help me get my thoughts in the right place and boost my mood and energy,” one panelist wrote. “Physical activity also helps me fall asleep and feel less stressed overall.”

“Running helps with my anxiety and depression,” another reader said. “It’s like a vacation for my overstimulated brain.”

A recent retiree who goes to the gym six days a week for group fitness classes and strength training sessions with a personal trainer shares that physical activity helps him feel calmer and more focused. “Exercise gives me a sense of accomplishment and community,” he says. “It is truly my second medication.”

Exercise Benefits Children and Teens with ADHD

The benefits of physical activity are not limited to adults; exercise improves the mental health of children and adolescents with neurodevelopmental disorders (NDDs), including ADHD, learning and motor disorders, autism spectrum disorder (ASD), and intellectual disability, according to a recent systematic review and meta-analysis published in JAMA Pediatrics.²

The researchers found that high-frequency (more than 27) 40-minute sessions of physical activity significantly benefited cognitive function, psychological well-being (e.g., self-esteem, quality of life), internalizing (e.g., anxiety and depression), and externalizing (e.g., aggression and disruptive behavior disorders) behaviors in children and adolescents aged 5-17 years with NDDs. They examined 59 studies with more than 3,000 participants.

ADDitude caregivers recognized similar results from their children after participating in physical activities.

One reader takes their son to the YMCA at least three times per week. “Depression can really take hold of my 10-year-old son,” the parent said. “We see great improvements after physical activity. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

“My daughter has been playing hockey since she was young,” a reader said. “She says she can slow her brain down when she’s on the ice and think more clearly, and it’s as if her ‘ADHD evaporates.’”

“Intense cardio activities, like cross-country skiing and soccer, help my son burn off some of his boundless energy, and he gains self-confidence by being good at something nonacademic,” a reader said.

Another reader said, “My oldest is a distance runner. He is committed and gets up early to run his miles or workout. Running gives him that needed dopamine hit to keep his ADHD symptoms under control at the start of the school day.”

Incorporating Exercise in Depression Treatment Plans

A 2023 treatment survey of 11,000 ADDitude readers reaffirms both studies’ findings. Roughly half of the respondents who use this treatment rated exercise as “extremely” or “very” effective. A staggering 94% of caregivers and 95% of adults recommend exercise to treat ADHD symptoms. Yet only 13 % of these respondents said a doctor had recommended exercise to reduce symptoms, and only 37% of all respondents said physical activity was part of their treatment plan.

The BMJ study encourages clinicians to consider exercise a viable alternative to drug treatment or adjuvant for those already taking medication. “The findings support the inclusion of exercise, particularly vigorous exercise, in clinical practice guidelines for depression,” they wrote. “This may help bridge the gap in treatment coverage by increasing the range of first-line options for patients and health systems.”

Sources

¹Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D. et al. (2024). Effect of Exercise for Depression: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. BMJ. doi:10.1136/bmj-2023-075847.

²Liu C, Liang X, Sit CHP. (2024). Physical Activity and Mental Health in Children and Adolescents with Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis. JAMA Pediatr. doi:10.1001/jamapediatrics.2023.6251.

The trauma of an early birth is incredibly extreme. It’s being thrust onto a high-speed, rickety roller coaster with dangerous ups and downs. My baby was tiny, but he was breathing. Around a sharp turn we went as we were immediately separated after birth. The intensity of the separation was so great, it could have shattered me into a million pieces right there. He was perfectly proportioned – up, up, up – but he needed life support – down, down, down. He was a fighter, but we’d plummet as he’d battle infections. He needed so many blood transfusions. He had a good heart, but some other organs were underdeveloped. His lungs constantly collapsed. There were times when we almost derailed completely, like when he’d turned blue in my hands. Like all the times when his heart almost stopped.

The chaos during his time in the NICU never ceased. But each and every day, I was able to be there for my tiny human because I concentrated so intently on him, a phenomenon that has a name, I learned much later on – hyperfocus – and is part of ADHD.

My Son’s Survival: The Object of My Hyperfocus

So intense was my concentration that I was able to retain a barrage of new medical information, administer medicines and feeds, pump milk, sing to him, read to him, advocate for him, and fight for him even when the prognosis looked dire. One of the doctors in the NICU even asked me if I was in the medical field, too. No, I just know how to concentrate when needed and learn everything possible about a situation. My son’s survival became the object of my hyper focus. There was nothing that could derail me.

Even when he was finally discharged after a long four-month hospital stay, with prongs and adhesives on his little face, I still hyperfocused through this new winding valley. After all, there were many medications to prepare and administer, oxygen concentrators and portable tanks to adapt to, and endless invasive and painful appointments and surgeries. Through it all, I researched every aspect of his diagnoses and care, how to help him heal, and how to prepare him for what was to come.

[Read: A Playbook for Post-Traumatic Growth]

The Hyperfocus Comedown

I was in a daze when I disembarked from the rickety roller coaster of the NICU. Absorbed by my son’s health and all things relating to prematurity, I had tuned out the world around me, even myself.

Used to communicating with nurses, doctors, and others in the NICU, I had to re-learn how to communicate with others who were outside of this world. I learned the hard way (as is my tendency) that not everyone wants to hear about our journey not because they’re disinterested, but because talking about trauma makes others acutely uncomfortable. Hyper focusing on the particulars of my son’s health, it seemed, almost detached me from the pain of this harrowing experience.

The aftermath of months of hyper focus was a rubble of burnout, depression, confusion, unhealthy coping mechanisms, and loss of self-worth. My introduction to motherhood had been as a bystander. I was a nurse and an advocate for my son, but I still had to learn how to be his mother, which brought me so much guilt. I was drowning.

I drew upon all the strategies I could muster from years of therapy. I reached out to others, I asked for help, for company — even just a cup of coffee. Some told me that I was “too much” while others didn’t seem to take me seriously because I seemed fine enough.

[Read: The Good, the Bad, and the Ugly of Hyperfocus]

If I didn’t do something, I knew I’d be at the bottom of the ocean quickly.

So, once again, I grabbed on to my hyperfocus wire. I researched and researched all things medical trauma and traumatic birth, and I came out on the other end with diagnoses of post-traumatic stress disorder (PTSD), postpartum depression (PPD) and ADHD.

I found a community group that sent volunteers around a few times a week to just sit with me, have a cuppa, and hold the baby while I took a shower. Such simple things gave me the space to breathe and finally steady my feet enough to get the help I needed.

Hyperfocus Saved Me – and My Child

When I’ve hyperfocused previously – before I knew it had a name – it was often a draining experience that, like other aspects of my neurodivergent brain, was hard for me to understand and embrace.

But after my diagnoses, I have a greater understanding of how my brain works, and more grace for myself and what I’ve journeyed through. The ability to hyperfocus, as I now know, can be an incredible strength. I’m thankful that my resilient neurodivergent brain forged a pathway through trauma and saved me and my little human.

Birth Trauma and ADHD: Next Steps

• Take This Self-Test: Signs of Postpartum Depression
• Free Download: The Facts About Major Depressive Disorder in Women
• Read: Postpartum Care for Mothers with ADHD
• Subscribe: The ADDitude Newsletter for Women with ADHD

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The therapeutic potential of psychedelic drugs for treatment-resistant conditions including mood disorders has sparked renewed interest among researchers, psychiatrists, and patients. New research and ongoing clinical trials are shedding light on the safety and efficacy of these substances, used in controlled therapeutic settings, for conditions that have been challenging to treat using conventional methods. A growing body of research indicates that several classical psychedelics and “psychedelic-like” compounds (e.g. psilocybin, ketamine, MDMA, and LSD) have shown promise for the treatment of substance use disorders, post-traumatic stress disorder (PTSD), anxiety disorders, and treatment-resistant depression (TRD). Some psychedelic treatments, such as MDMA-assisted psychotherapy for PTSD, are currently undergoing phase 3 clinical trials, indicating a significant level of scientific and medical interest in their potential therapeutic applications.

In this webinar, you will learn about:

• The history of psychedelic therapy and its research
• The science behind how psychedelic compounds may be targeting clinical conditions, like major depressive disorder
• The possible benefits and side effects of using psychedelics to conditions after other conventional therapies have failed
• What questions to ask when considering psychedelic usage in a clinical setting for yourself or loved ones

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the  symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO.

Treatment for Mood Disorders: More Resources

• Download: Solving the Bipolar and ADHD Puzzle
• Self-Test: Depression in Adults
• Read: Mental Health’s Psychedelic Revolution
• Get: 9 Conditions Often Diagnosed with ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on April 23, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Adrian Jacques H. Ambrose, M.D., MPH, MBA, FAPA, is the Senior Medical Director at ColumbiaDoctors Psychiatry at Columbia University Irving Medical Center. For over a decade, Dr. Ambrose has also served as a senior consultant in designing national and global programming in strategy, management, and operations implementation for mid-to-large-sized entities, including Fortune 500 companies. In addition, he specializes in cultivating psychological safety, team building, and culture acceleration for senior managers and executives.

Clinically, Dr. Ambrose specializes in treatment-refractory mood disorders for both the adult, child, and adolescent populations in interventional and novel therapeutics, such as neuronavigated TMS, ketamine, and psychedelics.

Dr. Ambrose completed his medical training at Dartmouth and MGH/McLean Hospital, and value-based healthcare training at the Dartmouth Institute for Health Policy. He also completed the Minority Health Policy Fellowship at Harvard Medical School.

Listener Testimonials

“Excellent information and points about balancing the potential therapeutic uses with the clinical evidence at the moment.”

“Thank you for providing so much info for practitioners! It is very helpful.”

“Great speaker! I would definitely take another of his courses!”

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ADHD doesn’t travel alone. Most teens with ADHD also have a co-occurring condition like anxiety or depression. Sometimes the co-existing condition is a result of the ADHD, and other times it operates alongside ADHD.

When a patient presents these conditions together, it can create a varied clinical picture because each diagnosis impacts, and is impacted by, the other. This can sometimes lead to misdiagnosis or inadequate treatment for at least one condition. The challenge in diagnosis and treatment can also be complicated by puberty.

In this webinar, you will learn:

• The symptoms of depression and anxiety disorders, and how to distinguish them from ADHD and normal child and adolescent development
• How depression or anxiety affects ADHD symptoms
• How ADHD can actually lead to, or affect, depression and anxiety
• How to devise a treatment plan when ADHD exists alongside anxiety or depression

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the  symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO.

Depression, Anxiety, & ADHD in Teens: More Resources

• Download: A Parent’s Guide to Depression in Teens
• Replay: The ADHD-Depression Connection in Adults with Dr. Roberto Olivardia
• Learn: Why Anxiety Disorder Is So Often Misdiagnosed
  
• Q&A: New Approaches to Treating Depression and ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on April 9, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Roberto Olivardia, Ph.D., is a Clinical Psychologist and Clinical Instructor of Psychology at Harvard Medical School. He maintains a private psychotherapy practice in Lexington, Massachusetts, where he specializes in the treatment of attention deficit hyperactivity disorder (ADHD), executive functioning issues, and issues that face students with learning differences.

He also specializes in the treatment of Body Dysmorphic Disorder (BDD), Obsessive-Compulsive Disorder (OCD) and in the treatment of eating disorders in boys and men. He is co-author of The Adonis Complex, a book which details the various manifestations of body image problems in men. (#CommissionsEarned) Read more here.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“All of the webinars are very good. This was one of the best!”

“A fantastically rich and engaging presentation! I firmly believe that I’m now significantly better informed of the interaction and distinctions between anxiety, depression, and ADHD. Thank you, Dr. Olivardia and ADDitude!”

“Good info and good mention of cannabis findings at the end as a surprise inclusion. Did not know any of that.”

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Play Attention: ADHD and Executive function challenges can lead to anxiety, and this anxiety can further impair executive functioning by affecting the brain’s processing and decision-making abilities. That’s why Play Attention offers a personalized program designed to enhance executive function and improve self-regulation. Backed by research from Tufts University School of Medicine, Play Attention empowers individuals to improve attention, emotion regulation, and overall performance. Our NASA-inspired technology ensures tailored support for every aspect of life. Take our ADHD test or schedule a consultation to start your journey toward improved executive function and emotion regulation with Play Attention. Call 828-676-2240. www.playattention.com

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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