Brief report
Seasonality of mood disorders in adults with lifetime attention-deficit/hyperactivity disorder (ADHD)

https://doi.org/10.1016/j.jad.2005.11.017Get rights and content

Abstract

Background

The objective of this study was to estimate the prevalence of Seasonal Affective Disorder (SAD) in adults with lifetime Attention-Deficit/Hyperactivity Disorder (ADHD).

Method

Patients eligible for this study had lifetime impairing symptoms of ADHD and a current and/or past co-morbid mood disorder according to their medical record. The Seasonal Pattern Assessment Questionnaire (SPAQ) was administered by a telephone interview to assess seasonality.

Results

The overall rate of SAD in this clinical population of adults with ADHD was estimated at 27%. Females were more at risk to develop SAD than men.

Limitations

The SPAQ is a screening, not a diagnostic instrument.

Conclusions

SAD symptoms are frequently comorbid with ADHD in adults. These results have clinical relevance for the recognition and treatment of SAD with bright light therapy in adults with ADHD.

Introduction

Attention-Deficit/Hyperactivity Disorder is a common psychiatric disorder with prevalence rates of 3–8% in children, and 1–5% in adults (Buitelaar and Kooij, 2000, Kooij et al., 2005, Murphy and Barkley, 1996, Kessler et al., 2005). Mood disorders are frequent co-morbid disorders with ADHD (Biederman et al., 2002, Biederman et al., 1993, Kooij et al., 2001, Kooij et al., 2004).

A new research area in adults with ADHD is the association of mood changes with seasonality. In a retrospective study in adults with ADHD the prevalence of Seasonal Affective Disorder (SAD) was estimated 19.1% using the Seasonal Pattern Assessment Questionnaire (SPAQ) (Levitan et al., 1999). SAD is a condition of regular recurring depressive episodes in autumn or winter with a spontaneous remission the following spring or summer (Rosenthal et al., 1984). SAD is often characterized by atypical symptoms like increased appetite, carbohydrate craving, weight gain and hypersomnia.

Symptoms of ADHD and SAD overlap. Both disorders include poor concentration, sleep problems, forgetfulness, irritability and impulsive eating behavior. This study aims to estimate the prevalence of SAD in adults with ADHD attending a specialized adult ADHD outpatient clinic.

Section snippets

Procedure

All medical records of outpatients attending the adult ADHD clinic between April 2003 and April 2004 were investigated for a DSM-IV classification of current or lifetime mood disorder at the time of diagnostic assessment. Patients were asked for written informed consent. The study was approved by an independent medical ethical commission. The interviews were administered in the summer of 2004, between May and July, to minimize possible confounding effects of mood changes in winter (Wirz-Justice

Results

The total number of patients attending the adult ADHD outpatient clinic was 415, aged 17 to 65 years (mean 34.6 ± 9.9). 66% of them were male.

A total of 259 patients were eligible for further selection (Fig. 1). The mean age was 35.3 years (SD 9.8), including 174 males (67%). After screening patient records, 110 patients without (a history of) mood disorders were excluded.

The study sample consisted of 149 patients (57.5%) with a diagnosis of ADHD and a current or lifetime mood disorder (Table 1).

Discussion

In this study, the prevalence of SAD in 259 adults patients suffering from ADHD was estimated at minimal 27%. In the subgroup of 115 patients with ADHD and lifetime comorbid mood disorders, the estimated prevalence of SAD was 61%.

Our study supports the findings of Levitan et al. (1999). Our prevalence rate is much higher, however, but might be explained by the prevalence of SAD in the Netherlands being higher than in Canada (3% resp. 1.7%) (Mersch et al., 1999, Levitt et al., 2000).

Another

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