Major Depression with ADHD: In Children and Adolescents.

The objective of this paper is to review recent studies on comorbidity and treatment of major depression (MD) and attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Both ADHD and MD are commonly associated with other DSM-IV Axis I psychiatric disorders. ADHD is more commonly associated with oppositional defiant disorder and conduct disorder in children and adolescents. The literature on comorbidities of MD and ADHD suggests that when these two disorders occur together, they bring their own unique profiles, often including a number of other psychiatric disorders and severe symptoms. The guidelines for the use of first-line ADHD medications (psychostimulants and atomoxetine) and the use of antidepressants in patients with MD comorbid with ADHD (with and without psychostimulants) will also be reviewed. Recommendations for the sequencing of these medications in patients with comorbid MD and ADHD and other disorders (anxiety disorders, oppositional defiant disorder, conduct disorder) will also be made. The concept of "goodness of fit" as it applies to medication choices will also be outlined. Some antidepressants, such as imipramine, desipramine, and bupropion have been effective in treating major depression, anxiety disorders, and ADHD in adults. Tricyclic antidepressants have not been as effective in treating MD in children and adolescents; however, they can be used to treat adults with ADHD and MD. Some of the SSRIs are proven to be effective and safe in children and adolescents and can be considered in patients with comorbid MD and ADHD.