Low hedonic tone and attention-deficit hyperactivity disorder: risk factors for treatment resistance in depressed adults

Sternat, Tia; Fotinos, Kathryn; Fine, Alexa; Epstein, Irvin; Katzman, Martin A.

doi:10.2147/ndt.s170645

Cited by 20 publications

(11 citation statements)

References 44 publications

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“…There is increasing evidence that improved management of ADHD can help a range of co-occurring health problems, in addition to reducing the core symptoms and impairments of ADHD. For example, ADHD is associated with treatment resistance in comorbid depression [ 99 ] which may be reduced by regular treatment for ADHD [ 88 ]. Rates of depression, mania, emotional dysregulation and substance abuse may all reduce during treatment of ADHD with stimulant medication [ 30 , 100 ].…”

Section: Results and Consensus Outcomementioning

confidence: 99%

Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations

Asherson

Leaver²,

Adamou

et al. 2022

BMC Psychiatry

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Background ADHD in adults is a common and debilitating neurodevelopmental mental health condition. Yet, diagnosis, clinical management and monitoring are frequently constrained by scarce resources, low capacity in specialist services and limited awareness or training in both primary and secondary care. As a result, many people with ADHD experience serious barriers in accessing the care they need. Methods Professionals across primary, secondary, and tertiary care met to discuss adult ADHD clinical care in the United Kingdom. Discussions identified constraints in service provision, and service delivery models with potential to improve healthcare access and delivery. The group aimed to provide a roadmap for improving access to ADHD treatment, identifying avenues for improving provision under current constraints, and innovating provision in the longer-term. National Institute for Health and Care Excellence (NICE) guidelines were used as a benchmark in discussions. Results The group identified three interrelated constraints. First, inconsistent interpretation of what constitutes a ‘specialist’ in the context of delivering ADHD care. Second, restriction of service delivery to limited capacity secondary or tertiary care services. Third, financial limitations or conflicts which reduce capacity and render transfer of care between healthcare sectors difficult. The group recommended the development of ADHD specialism within primary care, along with the transfer of routine and straightforward treatment monitoring to primary care services. Longer term, ADHD care pathways should be brought into line with those for other common mental health disorders, including treatment initiation by appropriately qualified clinicians in primary care, and referral to secondary mental health or tertiary services for more complex cases. Long-term plans in the NHS for more joined up and flexible provision, using a primary care network approach, could invest in developing shared ADHD specialist resources. Conclusions The relegation of adult ADHD diagnosis, treatment and monitoring to specialist tertiary and secondary services is at odds with its high prevalence and chronic course. To enable the cost-effective and at-scale access to ADHD treatment that is needed, general adult mental health and primary care must be empowered to play a key role in the delivery of quality services for adults with ADHD.

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Section: Results and Consensus Outcomementioning

confidence: 99%

Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations

Asherson

Leaver²,

Adamou

et al. 2022

BMC Psychiatry

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“…Individuals with unrecognised ADHD might present to adult services with related or comorbid symptoms, which may take precedence in diagnosis and subsequent treatment. It was suggested that treatment efficacy of other disorders is limited when the underling ADHD is not treated (Katzman et al, 2017; Sternat et al, 2018). This finding has important clinical implications.…”

Section: Discussionmentioning

confidence: 99%

ADHD in Adults: A Systematic Review and Meta-Analysis of Prevalence Studies in Outpatient Psychiatric Clinics

Adamis

Flynn

Wrigley³

et al. 2022

J Atten Disord

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Objective: Systematic review and meta-analysis to estimate the pooled prevalence of ADHD in adult attendees of outpatient mental health clinics and to investigate factors influencing prevalence rates. Methods: The following were extracted: demographics, design of the study (screening only or two-phase), scales/criteria for diagnosis of ADHD, number of ADHD, and non-ADHD participants. Results: The pooled prevalence of ADHD from screening studies ( n = 9) was 26.7%, (95% CI [17.2–37.4]), ADHD = 1727, No ADHD = 3,578. From studies employing a two-stage design ( n = 5), prevalence was 14.61%, CI [10.39–19.41], ADHD = 561, No ADHD = 3,578. Age and gender did not have any significant effect on the estimated prevalence. By contrast exclusion of psychotic disorders lowers prevalence. The screening scale used also influence prevalence rates. Conclusion: Meta-analysis shows high rates of adult ADHD among psychiatric outpatient clinics. Applying DSM-5 criteria increased prevalence rates. More methodologically robust studies, using two-stage design, need to be conducted to help assist in service planning.

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“…A recent meta‐analysis reported that anhedonia might be related to poor response to antidepressants (Noma et al, 2019). Patients with treatment‐resistant MDD had higher severity of anhedonia, suicidal ideation (Sternat et al, 2018), and a greater number of past suicide attempts (Sagud et al, 2013) than non‐treatment‐resistant individuals. While we did not address treatment resistance, anhedonia might contribute to the suicidal behavior in these patients.…”

Section: Discussionmentioning

confidence: 99%

Physical and social anhedonia are associated with suicidality in major depression, but not in schizophrenia

Šagud

Tudor

Šimunić

et al. 2020

Suicide & Life Threat Behav

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Objective This cross‐sectional study investigated the association of physical and social anhedonia with suicidality in patients with major depressive disorder (MDD), schizophrenia, and in non‐psychiatric controls. Method All participants completed the revised Physical Anhedonia Scale (RPAS) and the revised Social Anhedonia Scale (RSAS) and were subdivided according to positive life‐time suicide attempt history. MDD patients were evaluated with the Montgomery‐Ãsberg Depression Rating Scale (MADRS), healthy respondents with the Patient Health Questionnaire‐9 (PHQ‐9), and schizophrenia patients with the Calgary Depression Scale for Schizophrenia (CDSS). Results In 683 study participants, the prevalence of each anhedonia was the highest in MDD, followed by schizophrenia, and lowest in the control group. Among MDD patients, those with physical and social anhedonia had greater rates of recent suicidal ideation, while a higher frequency of individuals with life‐time suicide attempts was detected in those with only social anhedonia. In contrast, no association between either anhedonia and life‐time suicide attempts or recent suicidal ideation was found in patients with schizophrenia. Conclusions Assessing social and physical anhedonia might be important in MDD patients, given its association with both life‐time suicide attempts and recent suicidal ideation. Suicidality in schizophrenia, while unrelated to anhedonia, might include other risk factors.

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Low hedonic tone and attention-deficit hyperactivity disorder: risk factors for treatment resistance in depressed adults

Cited by 20 publications

References 44 publications

Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations

Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations

ADHD in Adults: A Systematic Review and Meta-Analysis of Prevalence Studies in Outpatient Psychiatric Clinics

Physical and social anhedonia are associated with suicidality in major depression, but not in schizophrenia

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