While for some adults, attention-deficit/hyperactivity disorder (ADHD) is relatively mild and, with effective treatment, does not have a significant impact on overall functioning or quality of life.  However, it is noteworthy that the majority of adults with ADHD have a diagnosed or undiagnosed comorbid psychiatric disorder, which can make  diagnosis and treatment more difficult.

A new study from the Netherlands indicates that women with ADHD may be more vulnerable to hormonally mediated mood disorders, including premenstrual dysphoric disorder (PMDD), postpartum depression (PPD), and perimenopausal depression.  

In this study, 209 women (18–71 years) with the diagnosis of ADHD seen in an outpatient clinic for Adult ADHD were screened for  PMDD (using the PMDD chapter of the Neuropsychiatric Interview Plus version 5.0.0).  In this cohort, 95 of the 209 women (45%) reported symptoms suggestive of PMDD.  While they did not have a control group without ADHD for comparison, this prevalence is about 10-fold higher than what we observe in the general population.

While this is an interesting and relatively dramatic finding, it should be noted that premenstrual symptoms were not assessed prospectively in this population.  Previous studies have indicated that without prospective charting, PMDD tends to be over-reported. (Probably not by a factor of 10, but over-reported nonetheless.) 

The Edinburgh Postnatal Depression Scale was used to assess for PPD. This tool was also used retrospectively, as most of the women in this cohort were not screened during the postpartum period.  Of the 85 women who had at least one biological child, 49 (57.6%) had an EPDS score of 10 or greater, which is suggestive of at least mild  PPD.  The estimated prevalence of PPD in this cohort of women with ADHD is much higher than expected; previous studies in the general population report that 15% to 20% of women have elevated EPDS scores. 

Of the 37 women who were no longer of child-bearing age, 18 (48.6%) were perimenopausal and 19 (51.4%) were postmenopausal.  Using the Greene Climacteric Scale to assess for menopausal symptoms, the researchers found that women with ADHD, compared to clinical norms, reported higher total scores and higher levels on subscores of anxiety, depression, vasomotor symptoms, and sexual dysfunction.  

This is the first study to look at the prevalence of PMDD, PPD and menopausal symptoms in women with ADHD.  While this study suggests that women with ADHD are more likely to suffer from significant PMDD symptoms, PPD, and menopausal symptoms, this study is preliminary.  Future studies should use refined tools to accurately measure the prevalence of these disorders.  

Nonetheless, these findings are interesting and parallel what we see clinically, at least during pregnancy.  In a recent study from the CWMH, Dr. Allison Baker observed that women who discontinued psychostimulants were more likely to experience clinically significant depressive symptoms during pregnancy than women who continued treatment with stimulants.  Stay tuned, Dr. Baker will soon be publishing data on postpartum outcomes in this cohort of women with ADHD.  

Ruta Nonacs, MD PhD

Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res 2020.