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Thursday, December 30, 2010

Is It ADHD--Or Is It Anxiety--Or Is Depression?

In psychology and psychiatry, we are almost always presented with the issue referred to as differential diagnosis.  There is often more than one diagnosis which can explain a set of symptoms.

For example, with ADHD, there are deficits in attention and other aspects of executive functioning.  However, these deficits can be caused by many reasons.  Some of the most typical causes (besides ADHD) are depression and anxiety.

In depression, if it is severe enough, the brain is not working at maximum efficiency.  In fact, it is like a car trying to go up a hill when three out of six spark plugs are not working.  There just isn't the power to do what it needs to do.  Concentration and memory consolidation are affected.

For an example of a pet scan in depression, go to http://www.mayoclinic.com/health/medical/IM00356
(Pet scans are like an xray of the brain.  However, instead of revealing structure, they reveal activity levels.  They show the level of glucose utilization.  Red and orange areas show high levels of glucose utilization, hence indicating higher levels of brain activity.  Purples and blues indicate lower levels of brain activity.)  In the petscan at the Mayo Clinic link, you can see how the brain which has recovered from depression is more active than the brain in a state of depression.)

In anxiety, the person has a hard time concentrating.  They may feel fuzzy headed, or they may be distracted by their worries.  This interferes with attention, and when there is impaired attention, it is hard to learn.

Of course, it is quite possible that a person will have both depression and ADHD, or anxiety and ADHD.  Depression, at least in a mild form, is often a result of ADHD in children and teenagers because they are not doing well in school and perhaps not being accepted by their peers.  On the other hand, the more severe that the depression is, the less likely it is to be explained by depression, and the more we have to start looking at other causes.

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