ADHD and Obesity: A Connection?

. ADHD and obesity

 

For years, ADHD experts have recognized the link between untreated ADHD and obesity. As for weight-control experts and gastric-bypass surgeons? Most missed the memo. Is it territorial jealousy? Willful ignorance? “ADHD Denial”?

Let’s be charitable. Consider it one more casualty of our highly specialized medical system. One that too often overlooks undiagnosed ADHD’s contributions to many physical issues.

But make no mistake: Anyone considering drastic weight-loss surgeries should first consider screening for ADHD.

Yes, Research Points to A Connection

With their research, two Toronto-based clinicians and researchers sought to bridge this cross-disciplinary knowledge. Physician Lance Levy and psychologist John Fleming set out to determine if medically treating severely obese subjects with newly diagnosed ADHD would result in sustained weight loss.

Let’s examine two of their studies, hear from a veteran ADHD expert who early on spotted the connection between ADHD and eating patterns, and take a peek at the mounting literature.

The connection is undeniable: ADHD is associated with obesity. Moreover, stimulant medication reduces the risk of obesity for these people.

By the way, remember a few decades ago when millions more Americans smoked cigarettes? Remember when some complained of gaining weight every time they tried to quit?  Nicotine is a fairly effective (if highly problematic) stimulant. Read more at ADHD & Nicotine: Historical Ads.

But  First: the Takeaway Points

Update to the original version of this post, in response to this e-mail politely asking for an executive summary:

Gina,  Good article but one question.

I’m at work and CAN’T GET DISTRACTED and don’t have the PATIENCE  today to give it deep thought (sounds ADHD like). What are the 2 or 3 bullet points as to why we gain weight and can’t get rid of it?  My quick take – from my experience would be the ‘food high’ or stimulation of eating and esp trying new foods.  I then overeat.  Can regular ADHD meds help to curb this?

Thanks again
Ron
Great idea, Ron. I should also be providing an “executive summary”.
  1. Yes, stimulant medication has been shown to reduce vulnerability to obesity.
  2. Yes, eating can be “stimulating” (see #1 for a better stimulant).
  3. Disorganization means no food at home, poor inclination to cook, plan meals, etc….so eat fast food or whatever’s handy (chips, donuts, etc.).
  4. Forgetting when you last ate!
  5. Poor read of the signals (e.g. Body says, “we’re full now” but you don’t hear it…you can’t “put on the brakes”).
  6. Poor sleep contributes, too.
  7. Disorganization and lack of follow-through in getting regular exercise.

 

ADHD and obesity

Digesting the Research: ADHD and Obesity

Here are the summaries for two early and important studies:

  1. The first study: Researchers found that among study subjects who had failed to lose weight by other means, 33 percent were found to have ADHD. After 466 days of stimulant-medication treatment, subjects lost 13 percent of their original weight.
  2. The second study evaluated for ADHD 76 women who had been referred to a medical specialist for the non-surgical treatment of obesity. Of the 76 women, 26.7 percent reported significant symptoms of ADHD in both childhood and adulthood

Now let’s examine the details for each study.

Study #1: Will ADHD Treatment Help?

The first study identified subjects who had a history of difficulty with weight-loss and who likely had ADHD. The hypothesis? Untreated ADHD was proving an impediment to weight loss.

The title: Treatment of refractory obesity in severely obese adults following management of  newly diagnosed ADHD

(For reference, refractory means “hard or impossible to manage” and comorbid means co-existing.)

OBJECTIVE:

To determine whether attention deficit hyperactivity disorder (ADHD) pharmacological treatment of severely obese subjects with newly diagnosed ADHD would result in sustained weight loss.

DESIGN:

Longitudinal clinical intervention study of the effects of ADHD medication on weight change over 466 days.

SUBJECTS:

78 subjects (6 male, 72 female, mean age 41.3 years, BMI 42.7 kg m(-2)) out of 242 consecutively referred severely obese, weight loss refractory individuals were diagnosed as having ADHD. Sixty-five subjects received treatment and 13 remained as controls.

METHODS:

  • Standard screening tests identified subjects likely to have ADHD. A diagnosis was made in 78 subjects by semi-structured clinical interview.
  • ADHD subjects were screened for comorbid conditions (binge eating disorder, mood disorder, sleep apnea, chronic pain, gastroesophageal reflux disease).
  • Satisfactory resolution of symptoms of comorbid conditions was achieved prior to the introduction of pharmacotherapy for ADHD.
  • Subjects not accepting, tolerating or remaining on ADHD medication served as controls.
  • Weight was measured at sequential clinic visits after initiation of pharmacotherapy.

RESULTS:

Comorbid [or, co-existing] conditions were found to be highly prevalent :

  • Sleep apnea 56.4%
  • Binge eating disorder 65.4%
  • Mood disorder 88.4%.

After an average of 466 days (s.d.=260) of continuous ADHD pharmacotherapy, weight change in treated subjects was -12.36% of initial weight and in controls +2.78%, P<0.001.

Weight loss in treated subjects was 15.05 kg (10.35%) and weight gain 3.26 kg (7.03%) in controls, P<0.001.

CONCLUSIONS:

ADHD is a highly prevalent condition in the severely obese population. Treatment of ADHD is associated with significant long-term weight loss in individuals with a lengthy history of weight loss failure.

  • This result is likely because of the positive effects of treatment on self-directedness, persistence and novelty-seeking behaviors.
  • ADHD should be considered as a primary cause of weight loss failure in the obese.
  • Individuals seeking medical or surgical weight loss should be evaluated for ADHD and treated appropriately before intervention.
  • This may improve the outcome for medically managed patients and avoid complications in surgical subjects because of poor compliance with diet and supplement requirements.

International Journal of Obesity advance online publication, 17 February 2009; doi:10.1038/ijo.2009.5

adhd and obesity

Study #2: How Many Obese Study Subjects had ADHD?

The title:  Symptoms of attention deficit hyperactivity disorder in severely obese women

OBJECTIVE:

Past and current symptoms of Attention Deficit Hyperactivity Disorder (ADHD) were assessed in a clinical sample of severely obese females.

METHOD:

Core symptoms of ADHD were examined in 75 consecutive, severely obese (BMI > or = 35) women referred to a medical specialist for the non-surgical treatment of obesity.

Subjects completed both a retrospective report of childhood symptoms of ADHD (Wender Utah Scale) and two standardized adult ADHD symptom scales.

RESULTS:

  • The frequency of clinically suggestive elevations in ADHD scores was substantially and significantly higher than the normative samples in 9 out of 11 symptom subscales.
  • Inattentive symptoms, but not hyperactive symptoms of ADHD, were frequently reported.

Overall, 26.7% of the sample reported significant symptoms of ADHD in both childhood and adulthood.

CONCLUSIONS:

This preliminary study suggests that severely obese women report significant symptomatology related to both childhood and adult ADHD.

The website for Dr. Fleming includes informative articles and video interviews, including articles on these topics:

ADHD and obesity

Early Connections: ADHD and Eating Patterns

I first read about this topic in a book chapter called “Disordered Eating and ADHD.” It was contributed by the researchers above, Levy and Fleming, to the groundbreaking Gender Issues and ADHD: Research, Diagnosis, and Treatment, edited by Patricia Quinn, M.D. and Kathleen Nadeau, Ph.D. 2002.

By the way, psychologist Kathleen Nadeau, and physician Patricia Quinn teamed up originally to address the long-overlooked needs of women and girls with ADHD. They founded The National Center for Girls and Women with ADHD [update: closed in 2013].

In the process —through their many books, lectures, and other efforts—this pioneering pair expanded our knowledge in all aspects of ADHD, across genders and the lifespan. [See a recent post about their new book, Understanding Girls with ADHD: “A Must-Read about Girls with ADHD”.]

Therefore, it’s unsurprising that Quinn and Nadeau stood on the vanguard of creating awareness on this ADHD-obesity issue.

Consider this excerpt from an early article written by Nadeau, entitled “Diet and Weight Management Strategies for Adults with ADD (ADHD).”

The ADHD/disordered-eating connection is not difficult to understand.

Healthy dietary regulation requires organization and planning— two areas of cognitive functioning that are typically difficult for those with ADHD.

Good eating habits also require self-awareness – awareness of when one is hungry, awareness of when one is full.

Many individuals with (ADHD) report that they skip meals because they were busy and distracted; these same individuals often report that later their hunger becomes so intense that they swing in the opposite direction, overeating well beyond the point of reasonable intake because they don’t know when to stop until they feel “stuffed.”

Individuals eat for many reasons besides hunger – including boredom, self-stimulation, anger, sadness, reward, simple food availability, and stress relief. It is easy to understand how consistent self-regulation, which is a well-documented difficulty for those with ADD (ADHD), can lead to patterns of chronic over-eating.

ADHD and obesity

More Food For Thought: ADHD and Obesity

More recently, the literature is mounting on the relationship between ADHD and eating behaviors.

Consider two recent papers.

Paper #1. Attention-Deficit Disorder and Obesity: Update 2016

Here are some highlights from Attention-Deficit Disorder and Obesity: Update 2016, by Samuele Cortese and Luca Tessari.

  • We retained a total of 41 studies, providing information on the prevalence of obesity in individuals with ADHD, focusing on the rates of ADHD in individuals with obesity, or reporting data useful to gain insight into possible mechanisms underlying the putative association between ADHD and obesity.
  • Overall, over the past 4 years, an increasing number of studies have assessed the prevalence of obesity in individuals with ADHD or the rates of ADHD in patients with obesity.
  • Although findings are mixed across individual studies, meta-analytic evidence shows a significant association between ADHD and obesity, regardless of possible confounding factors such as psychiatric comorbidities.
  • An increasing number of studies have also addressed possible mechanisms underlying the link between ADHD and obesity, highlighting the role, among others, of abnormal eating patterns, sedentary lifestyle, and possible common genetic alterations. Importantly, recent longitudinal studies support a causal role of ADHD in contributing to weight gain.
  • The next generation of studies in the field should explore if and to which extent the treatment of comorbid ADHD in individuals with obesity may lead to long-term weight loss, ultimately improving their overall well-being and quality of life.

Paper #2. Association between ADHD and Obesity: A Systematic Review and Meta-Analysis.

Also from a team headed by  Samuele Cortese:  Association between ADHD and Obesity: A Systematic Review and Meta-Analysis.

Key results:

  • Forty-two studies that included a total of 728,136 individuals (48,161 ADHD subjects; 679,975 comparison subjects) were retained.
  • Researchers found a significant association between obesity and ADHD for both children (odds ratio=1.20, 95% CI=1.05-1.37) and adults (odds ratio=1.55, 95% CI=1.32-1.81).
  • The pooled prevalence of obesity was  70% higher in adults with ADHD (28.2%, 95% CI=22.8-34.4) compared with those without ADHD (16.4%, 95% CI=13.4-19.9), and by about 40% in children with ADHD (10.3%, 95% CI=7.9-13.3) compared with those without ADHD (7.4%, 95% CI=5.4-10.1).
  • The significant association between ADHD and obesity remained when limited to studies
    • 1) reporting odds ratios adjusted for possible confounding factors;
    • 2) diagnosing ADHD by direct interview;
    • and 3) using directly measured height and weight.
  • Gender, study setting, study country, and study quality did not moderate the association between obesity and ADHD.
  • ADHD was also significantly associated with overweight.
  • Individuals medicated for ADHD were not at higher risk of obesity.

This post originally appeared 4/27/09. Updated 8/9/18

___________

How about YOU? Do you suspect that ADHD has affected your or your partner’s ability to maintain a healthy weight?

And remember: some people with ADHD might be chronically underweight

for reasons similar to those who are overweight: lack of planning, not paying attention to internal phenomenon, and so forth.

I welcome your comments.

—Gina Pera

14 thoughts on “ADHD and Obesity: A Connection?”

  1. 58% of morbidly obese people are ADD according to research. Every time I talk in front of people who are severely overweight about ADD and weight, about 1/5 of the people come up to me afterwards asking for information on ADD and tests for ADD.

  2. Jacqueline Blue

    The information is very informative and has helped at least narrow down why, in layman’s terms, in the evening I have to stop reading my book, put it down and make a special effort to get a snack (and all the time not wanting one because I am not hungry and wish the urge wasn’t there). I do have ADHD and Tourettes Syndrome so it is unbelievably difficult. I only take Concerta on the weekends because my tics would be out of control at work during the week. I am 61 and nothing has slowed down with age. I do appreciate the fact that the medical profession is taking this seriously and involved with so much research.

    1. HI Jacqueline,

      I’m glad you found the post helpful. I know that some people are able to find solutions that don’t trigger the tics. I would encourage you to keep searching. Perhaps at Dr. Parker’s blog. http://www.corepsychblog.com
      In the meantime, I feel for you. It’s hard enough to find ADHD treatment that works well, without having to deal with tics. 🙁 Good luck!

  3. betsy davenport, phd

    One more thing: Paul Elliott, MD from Texas, a one-time luminary/maverick in the field of AD/HD treatment (since retired I believe), asserted at many national conferences that anytime there is substance abuse of any kind (inc. cigarettes, coffee) except for hallucinogenics, AD/HD should be presumed present until ruled out.

    Ten years ago this created a lot of discomfort and skepticism. I imagine it would do less of that, now.

  4. betsy davenport, phd

    Gina,
    I came on this post just now. I am reminded of the retrospective study conducted by my colleague and office mate Jules Altfas, MD (who I consider to be our local best-doc for AD/HD in adults).

    He looked at the records of a number of his weight management patients who he also diagnosed (very conservatively) with Ad/HD. The study was published in 1992 and so far as I know, did not receive wide attention.

    Here’s the URL (my skills stop short of inserting links).

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=130024

  5. Dr. Parker,

    Thank you very much for participating in this discussion. As I’ve learned more about ADHD over the years I’ve found that it wasn’t just as simple as adding a stimulant due to aggravation of anxiety issues I didn’t even initially realize I had. I’m trying to work my way through it and have made significant progress, but I hope to read your book and see if there is more in it that might apply to me. Thanks again…

    — Carl

  6. G,
    My current investigations are several in regards to the *PM drop* – and this is my current take, based on what works regularly in the office, and from the labs:

    1. *Office findings:* Yes comorbid diagnosis of depression is often present with the PM drop, but missed because ADHD ‘depression’ is often more cognitive and missed – just as is ADHD ‘anxiety’ – again more cognitive… and all of this is spelled out in my new book, thanks for asking.

    The unhappy result of the missed depressive diagnosis, because the ‘Clint Eastwood’ guy or gal hates depression and denies it, – is a big crash in the PM. Actually the stimulant aggravates the depression, and they go from cognitive: “I do not care, whatever.” to… affect: “You have really hurt my feelings! I am in so much pain with you!” – but they still say, I’m *not* depressed – I’m just mad!! Depression is seen as weakness.

    2. *Lab findings:* I have been impressed by the neurotransmitter findings we do on refractory and otherwise challenging cases with ADHD: comorbid conditions often don’t show in the office even with careful questioning, but the biomarkers from urine testing are helpful from http://ww.Neurorelief.com These findings often show 5HTP diminished as part of the ADHD picture. Evidence counts.

    Lab: Neurotransmitter findings are derided by some who see the findings as *not diagnostic* – a point that the company and I completely agree upon. They are not indeed diagnostic of DSM 4 process. 5HTP [serotonin precursor] deficiencies don’t always look like depression, the can result in OCD symptoms, trichotillomania, or many other problems like ODD. But, they do work as effective biomarkers, and we have seen correction of these imbalances result in some dramatic turnarounds – even with tic disorder.

    SPECT imaging gets the same heat because it is *not diagnostic* – and is, in fact, another, quite precise, biomarker. The problem with evolving evidence is simple: You can’t go from one cookie cutter diagnosis like ‘depression’ to another cookie cutter finding with a subsequent cookie cutter recommendation.

    Some of my SPECT colleagues aggravate the use of evidence as they leave the recommendation piece in ‘cookie cutter land’ rather than taking the investigation to the next important level: clinical outcome functioning.

    Understanding the limitations of SPECT will help with the consternation some have with neurotransmitter testing. – All of these activities are quite similar to lipid testing for coronary heart disease: not diagnostic but clearly useful.

    More in my blog soon,
    Thanks for your excellent work!
    Chuck

  7. Hi Otto,

    Good points about Health at Every Size. I am certainly starting to accept my own changed size from earlier years — what a relief!

    Good health is what’s important, and if people can’t get organized enough to shop/cook/eat-well or motivate themselves to exercise, it’s hard to be healthy.

    Given Dr. Parker’s example of the dopamine-serotonin teeter-totter, it perhaps follows that treating ADHD without treating a person’s depression, anxiety or other serotonin issue can have a similar effect, in that it could aggravate anxiety or depression. So, if the person with ADHD who is taking a stimulant still gets stressed out about food preparation and the like, then maybe anxiety is the bigger (or at least unaddressed) diet-related problem for this person.

    At any rate, here’s what the study says about the role of dietary intervention:

    “Subjects in both treated and control groups had an extensive
    history of dietary interventions and were judged by the
    clinic’s dietitian to be very familiar with diet concepts. Only
    50% of subjects had one meeting with the dietitian, and only
    five of these subjects, all from the treatment group, reported
    substantial adherence to the written menu plans after the
    first month. Records of dietary adherence were not kept after
    that time, as the data were too few to be significant.”

    And one more point that seems relevant:

    “III. Why weight loss occurred synchronously with the relief of
    ADHD symptoms.

    “The subject’s recollections of failed past efforts at weight loss
    highlighted how daily demands on their time and energy
    frustrated their weight loss plans. Typically new diet plans were
    launched with great intensity, and a lot of wishful thinking,
    about how they would fit everything in. To find time for new
    diet and activity requirements, most subjects put off some
    routine tasks and often went with less sleep. However, it was
    clear that within a few weeks they could not cope with
    competing demands and gave up, relapsing to old habits.
    Many individuals linked their failure to feelings of boredom
    and frustration with the mundane and repetitive demands of
    managing/deciding what to eat, shopping, cooking and paying
    attention to diet and activity plans. Every diet plan they tried
    ended in exactly the same way and for the same reasons.
    However, our analysis was that enduring problems with
    inattention, distractibility, impulsivity, restlessness, an inconsistent
    level of available energy, and poor working memory
    substantially interfered with time management and task
    completion. Subjects habitually suspended ‘boring’ weight loss
    related plans to gravitate toward tasks that were more urgent,
    more intrinsically stimulating or that had a greater likelihood
    of immediate success, as these were tasks that allowed them to
    function most effectively.

    “Once pharmacotherapy treatment was begun, we anticipated
    that improvements would occur in exactly those symptoms of
    ADHD that were most detrimental to successful weight loss.
    Careful inquiry was made as medication was titrated to
    determine the mechanism by which changes in symptoms of
    ADHD might have resulted in improved compliance with diet
    and physical activity plans over time. A distillation of our
    subject’s comments showed that improvements in daytime
    energy, restlessness, distractibility, working memory, impulsivity
    and mood were instrumental in their successful execution
    of weight loss plans. Most often, improvements occurred in the
    order in which they had been listed.

    “Fundamentally, drug treatment led to improvements in selfdirectedness,
    a reduction in novelty seeking, and an increased
    capacity for persistence. An improved ability to be selfdirected
    was noted first, and this is a trait that is important
    for attaining any goal. As daytime energy improved, and
    restlessness and distractibility diminished, subjects could more
    consistently initiate behaviors congruent with their ultimate
    goal of weight loss. For example, they did not use food as
    before to restore energy or to focus attention. They could stay
    on task and finish their work expeditiously so that tasks related
    to meal preparation or physical activity could be done reliably.
    Subjects reported being more able to pay attention while
    eating, so that they were aware of the signals of hunger and
    fullness much sooner than before, allowing for better control
    over the amount consumed.

    “The second change was that subjects showed improvement
    in control over novelty seeking and had a much greater
    ability to be persistent in a task. Control over both of these
    traits is highly important to success in a long-term project,
    such as weight loss.

    “As an example, subjects on medication reported that they
    felt calmer, less restless, and less impelled to seek intense,
    novel, and unplanned stimuli than ever before. Thus,
    feelings that earlier had led them to leave one task to begin
    a newer one, and generally one not congruent with a
    previously determined long-term goal, did not intrude and
    undermine their weight loss plans. Impulsive choices of food
    were curtailed, and exercise plans were not forgotten in favor
    of novel entertainment. With enhanced persistence, many
    felt they were able to continue with or elaborate new
    problem-solving strategies, as well as tolerate negative mood
    states, rather than using food or engaging in other impulsive
    actions to quickly relieve that distress.”

  8. Thanks for weighing in, Dr. Parker. “Downstream” is right — we definitely need more cross-disciplinary knowledge with ADHD.

    I’m so glad that you explain the serotonin-dopamine teeter-totter. (When I explain it to people in the ADHD support groups, they look a little skeptical — they’ve never heard such a thing from their physician — so it’s great to hear it from a medical expert!) I hope you’ll discuss this in your upcoming book on ADHD medication strategies.

    Do you think the PM crash is primarily caused by untreated “serotonin issues?”
    What do you think about B vitamin deficiency also being a culprit in the PM crash (or so-called rebound)?

  9. The 2009 Levy/Fleming study raises a couple of questions for me….

    1. Were these people given a diet to follow, or were they left to devise their own? (If the latter, then that’s a *hell* of an effective ADHD treatment they were given, and I’d like to know where to get some of that!)

    2. Was anything done to address “rebound hunger,” a fairly common problem associated with long-acting stimulants?

    And of course, I’d love to see a follow up. My suspicion is that the ADHD dieters will probably perform pretty much the same as non-ADHD dieters, i.e. 95% regain all the lost weight after 5 years.

    As a proponent of body acceptance and Health At Every Size, I believe that an individual’s weight or body size is not necessarily a good indicator of their current health or an accurate predictor of future disease. I wish that public health authorities, and the media, would stop focusing on weight loss and instead put the focus on good food choices and enjoyable, appropriate exercise. These are health-promoting habits in their own right, and beneficial for everyone to adopt, even if weight loss does not result. That said, permanent habit change of this nature can be tremendously difficult even for those of us with no deficits in PFC function, and from what I have seen it is an absolute nightmare for people with ADHD. Even when they are diagnosed and treated, they seem to need a lot of outside structure and support in order to effect and maintain positive lifestyle changes. That’s why I’m so curious about the dietary intervention used in this particular study.

    My partner has ADHD and has wished to lose weight since adolescence. She has dieted three times, each time eventually regaining the lost weight plus a bit more (just like most other people). She is nowhere near “severely obese” as described by Levy/Fleming, and AFAIK she has never been a severe junk food junkie as described by Nadeau. But despite her high intelligence, *and* ADHD medication, the executive demands of meal planning, food shopping and cooking are extremely stressful for her and take up an inordinate amount of time – or they don’t get done at all if she is the least bit busy. When I came to live with her I took on the food related duties, partly because I enjoy cooking and partly to relieve her of what was obviously a great burden in her life. She only seems able to stick to a structured eating program if someone else does all the planning, shopping and cooking for her. “Intuitive eating,” favored in the body acceptance community, does not seem possible for her – with intuitive eating, there is simply too much choice every day, and that is overwhelming.

    As far as exercise, again, she seems to need a very great deal of support and motivation from outside – otherwise she simply does not find the time, despite knowing that exercise is beneficial in myriad ways. I used to provide a lot of this support and motivation, but I have recently given up. I’m tired of trying to get somebody off the couch. I need to attend to my own body, and if she doesn’t want to leave the couch that is, in the end, her problem.

  10. Gina,
    Excellent piece, as usual, – so timely and so accurate as we move further down the path of identifying how ADHD can create destructive medical issues downstream from compromised executive function. Others include hormone dysregulation, downstream from high glycemic diets [seen with polycystic ovarian syndrome, even in adolescents], high blood pressure and diabetes [nutritionally related], and many others.

    One interesting additioinal insight, seen quite often in my office, on this same theme of weight gain and ADHD, may prove helpful for your readers:

    I have seen many who suffer with ADHD *gain weight* on medicatioins – as a consequence of the following interaction between neurotransmistters:
    With comorbid depression and ADHD some simply want the depression addressed, and just don’t want to treat with a stimulant – ADHD denial is firmly in place. They will take the SSRI or SNRI, but not the necessary stimulant for the ADHD.

    The outcome is predictable and happens often: They gain weight on the fact that the SSRI or SNRI appears to downregulate [lower] the effectiveness of the pre frontal dopamine, with a subsequent drop in executive function – simply stated their ADHD intensifies. Good judgement about food is lost, compulsive eating can intensify.

    Dopamine and serotonin appear to be sitting on both ends of a seesaw, when one goes up, the other can go significantly down – as is seen with children who have comorbid depression. Untreated, the depression almost always intensifies with stimulant meds – resulting in a big emotional crash in the PM.

    Said another way on the weight issue: The downregulation of the dopamine is associated with downregulation of executive function and they become: disinhibited. Not inhibited, – disinhibited… it just doesn’t matter. And on top of eating without reservation, they are forgetting the name of their best friend, and can’t remember the first part of the sentence – all related to this downregulatory phenomenon.

    The basic fix: Treat the ADHD simultaneously now or later, perferrably at the outset. Antidepressants just don’t fix ADHD, they aggravate it. Effective executive function is necessary for consistent self regulation… as you have so frequently pointed out.

    Great article, thanks again for your thoughts on this important challenge,
    Chuck

    1. Dear Dr. Parker,

      Your comment sheds light on a huge piece of my ADD history. Having just been diagnosed with ADD at 24, huge pieces of the puzzle of my life are falling into place. Your explanation of an SSRI’s effect on the ADD brain makes sense of an incredibly important period of my life that I have struggled to reconcile with for years.

      At 19, I was diagnosed with major clinical depression and prescribed an SSRI. However, it not only exacerbated my depression symptoms, it completely changed me. I went from an adventurous, (too) hard-working, and athletic college sophomore to a girl who rarely left her bed, binge ate uncontrollably, struggled with thoughts of suicide, and gave up on studying for an entire semester in college. It left me utterly shaken and stripped of any sense of self. Finally, I switched to an SNRI which, though it did not push me further into depression, did not address what I now know to be ADD concerns.

      Thank you so much for commenting on this article. Your expertise and insight have helped to fill a black hole in my life that has been dogging me for years.

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