From the Guidelines
SSRIs generally do not make ADHD worse, but they may not help ADHD symptoms either. SSRIs like fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro) primarily treat depression and anxiety, not ADHD. In some cases, when a person has both ADHD and depression or anxiety, treating the mood disorder with an SSRI might indirectly help overall functioning. However, for treating ADHD specifically, stimulant medications like methylphenidate (Ritalin, Concerta) or amphetamine-based medications (Adderall, Vyvanse) are typically first-line treatments because they target dopamine and norepinephrine systems involved in attention and executive function, as noted in a study published in Pediatrics in 2019 1.
Some individuals might experience increased restlessness or activation when taking SSRIs, which could potentially worsen certain ADHD-like symptoms, but this is not common. If you have ADHD and are considering medication, it's essential to work with a healthcare provider who can determine the appropriate treatment based on your specific symptoms and any co-occurring conditions. The healthcare provider should consider factors such as severity of symptoms, presence of comorbidities, and patient preferences when selecting a medication, as recommended in a study published in Pharmacology and Therapeutics in 2022 1.
Key points to consider when treating ADHD include:
- Stimulant medications are typically first-line treatments for ADHD
- Non-stimulant medications like atomoxetine may be used as second-line treatments
- SSRIs may be used to treat co-occurring depression or anxiety, but may not directly help ADHD symptoms
- Medication adherence is crucial for effective treatment, and healthcare providers should regularly assess and address potential issues, as noted in a study published in Pediatrics in 2019 1.
Overall, while SSRIs may not directly worsen ADHD symptoms, they may not provide significant benefits for ADHD treatment either. A comprehensive treatment plan that addresses both ADHD and any co-occurring conditions is essential for optimal outcomes, as recommended in a study published in Pediatrics in 2019 1.
From the Research
Studies on SSRIs and ADHD
- There are no direct studies on whether SSRIs make ADHD worse, but there are studies on the use of SSRIs in combination with other medications for ADHD treatment 2, 3.
- One study found that adjunctive treatment with atomoxetine to SSRIs or SNRIs improved symptoms of anxiety and ADHD in adult patients with comorbid partially responsive generalized anxiety 2.
- Another study compared the efficacy and safety of atomoxetine and OROS methylphenidate as adjunctive to SSRIs in adults with ADHD and comorbid partially responsive major depressive disorder, and found that both treatments were effective and well-tolerated 3.
Combination Therapies for ADHD
- Combination pharmacotherapy is a common practice among clinicians for treating ADHD, especially in cases where monotherapy is not effective or has dose-limiting side effects 4.
- Studies have shown that combining stimulants with non-stimulant medications like atomoxetine can be effective in reducing ADHD symptoms and improving treatment outcomes 5, 4.
SSRIs and Their Mechanism of Action
- SSRIs were designed to be safer and more tolerable than previous antidepressants, and work by increasing central serotonin agonism to produce an antidepressant effect 6.
- While SSRIs share many similarities, they differ in terms of pharmacokinetics and effects on CYP450 enzymes, which can impact their safety and efficacy 6.