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Comment by moth-fuzz | Hacker News Reader

I have a friend that's convinced that her ADHD 'causes depression' because her brain does not produce 'enough dopamine'. I'm noticing more and more among my peers a mythology around brain chemicals that's about as accurate as the four humors but with a scientific-sounding veneer. All brain function (and thus all bodily function, because the brain is the whole person /s) can be traced back to the presence or absence of a nominal amount of certain chemicals.

I wonder how the popular understanding of these processes will evolve as more and more is discovered and understood.

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> I have a friend that's convinced that her ADHD 'causes depression' because her brain does not produce 'enough dopamine'

Interesting, and she is somewhat right, but is wrong about the 'enough dopamine' part, if I understand correctly. I have heard that dopamine plays a role in ADHD (seems likely our neurotransmitters don't absorb enough, but even that is an overly simplistic explanation of the unknown and true reality).

But yea, I also have ADHD and yes, it can cause depression. Not due to dopamine, but because of the negative feedback-loop ADHD can create.

For example, let's pretend I have some big assignment I need to complete, and I am without access treatment (professional or self-medication). If can't muster the "powers" to work on/finish said assignment, I start to get extremely anxious and/or I get depressed that I failed to finish said assignment. Said anxiety/depression only makes my ADHD symptoms worse which makes the anxiety/depression worse. Thus I will struggle more to complete future work, which only fuels said anxiety/depression even more, and the loop keeps on iterating.

Though, sometimes the anxiety can be extremely helpful. I can muster some insane kind of hyperfocus due to the pressure of a looming deadline. I spent decades of my life relying on anxiety to complete tasks, that even with treatment, it's extremely hard to start and finish tasks without the anxiety.

It's an annoying and rough way to live, but oh well, I am just grateful I do not have something worse.

The Andrew Huberman podcast has a great episode on the dynamics of ADHD. The brain does not properly distribute dopamine to where it wants to send it, which challenges your planning/reward matrices.

As much as I love the Huberman podcast, I do feel he spoke outside of his domain a bit too much on that episode in certain sections.

Sure, he is far more credentialed than I am, but it's not like he conducted any of the research himself. He is merely spouting off what one could find on PubMed, APA, etc..

While I think mindfulness can be beneficial, the research he cited about just 17 minutes (or whatever arbitrary number) can have permeant changes in the brains of individuals both with and without ADHD to be ridiculous.

I also find any research relating to ADHD and fish oil supplementation to be extremely dubious. It appears research is starting to back-track on that one too.

That being said, I do really enjoy his podcast, but just because he repeats something does not mean it's true/untrue. I would have preferred him to have an interview with an expert in the field of neuropsychiatry or of equal qualification.

There are studies about magnesium supplementation helping with adhd

Star Slate Codex (Scott Alexander) wrote that the evidence for such is basically non-existent. Thus such claims remain dubious at best. Though this was many moons ago, and things change. Do you happen to know of any research that supports this?

SSC also wrote a long article mildly trashing "The Body Keeps The Score" (which is truly excellent and important), with some very poor logic. He's not infallible.

I go through this process regularly when I have to put away groceries. I get progressively anxious about just leaving them on the counter, and it devolves into me ignoring them until I have to use them, by which time some of them are no longer usable.

I think ADHD causes depression because you get constant negative feedback from (many) teachers & bosses.

It's true, and I alluded to this more in depth in a comment in this chain.

Growing up in the semi-rural South East, USA, where kids didn't get diagnosed with ADHD. (Fun fact -- I had 5 boys who were my childhood friends that grew up with. We all lived within 3 miles of each other, and all of us have ADHD -- something in the water maybe?)

I didn't know I had ADHD until I was in a dark dark place in my early 20s after 4 years of college (only took me 6 years lol).

I swear I have some kind of CPTSD from growing up with it. I developed all kinds of healthy and unhealthy coping mechanisms and a lot of anger and negative self-talk that I struggle with still to this day.

I mean, I was chewed up and spit out by the public education system, little league sports, other children's parents, my peers, and even my own parents from time to time. Constantly, day in and day out, being punished, ridiculed, and humiliated for something I could not control. I didn't want to be that way, and I still don't want to be that way, but I am what I am.

I would not consider myself to be anything but average intelligence, maybe even below average, but if it weren't for sheer luck and a determination to prove everyone wrong, then I do not think I would have survived.

There is a reason alcoholism (and drug addiction) and ADHD strongly correlate. Coping and self medication are a big deal when it feels there is no other tools available or the negative externalities just get to be too severe. Add in addictive personality traits common to ADHD folks and it is quite a thing to overcome for more significant ADHD sufferers.

Did the ADHD cause CPTSD or the CPTSD that you might already have from childhood neglect/trauma that you're not aware of/dismiss/paint as "not too bad" manifests itself as ADHD?

Distraction from pain is one of the most common ways we deal with pain when it's not possible to escape it (which is the case for children that suffer emotional abuse/neglect).

I should probably have said that I am self-diagnosed with (C)PTSD, and have never consulted a professional about it, then again I truly believe we will one day look at psychologist of today like they look at Freud and psychiatrist like blood-letters of the past.

This may sound wild and woo-woo snake-oil, but using cannabis products coupled with mindfulness/deep-thought, I am sometimes able to fire up my "mental debugger" and access parts of my subconsciousness that I cannot tap during normal sobriety. I can pull out memories that I had subconsciously blocked, but I am able to process them in a healthy, compassionate, and understandable manner.

> Distraction from pain is one of the most common ways we deal with pain when it's not possible to escape it

Probably explains my compulsive levels of video games and screen time as a youth, then again... I grew up on a small horse farm on the outskirts of society, so it's not like I had anything else to do lol.

I do sincerely believe that anyone that ever wronged me (especially my family) ever did anything intentionally. Parents aren't given a "Parenting an ADHD Child 101" course or anything. Hell, both my parents probably have it themselves, and my parents swear on their life that the school system never told them anything.

I do think my ADHD manifested first though, for a variety of reasons. A lot of signs and stories seemed to point that I was even symptomatic from infancy. If anything, I wouldn't be surprised if it were environmental. All my male childhood school friends that grew up in a <small distance> radius of me all received the same diagnosis at one time or another.

So, while I do think you are on to something, I do not think it applies to me directly.

IMO, this hypothesis doesn't pass the smell test. One of the defining qualities of clinical depression is that personal success in life does not obviate the symptoms; there are many widely know examples of beloved and successful people being unable to overcome the burden of crushing depression.

Being beloved and successful does not negate negative feedback. In fact, rhetoric such as this is invalidating the experience of those who must thereby insist that, contrary to the signs you're seeing, they're actually feeling down, else they must further internalize the negative feedback which nevertheless exists in plethora. The notion that anyone could claim precisely what reasonably should bring another stranger happiness or resolve their depression is pure hubris. The defining qualities of this situation are all internal, and the externalities used in your measurement are correllative and either irrellevant or after-the-fact. A "smell test" one might consider is of empathy: if your mind ran quickly through various things which caught its attention, yet couldn't follow through with focus until resolution, negative feedback surely just recurs and piles up - it is neither sufficiently affected nor undone by positive feedback. OP's hypothesis smells true to me, but I choose to sniff the roots rather than the flower when we're looking for a cause more than an effect.

Well, first of all, I didn't say it was the only cause for depression; it's a condition that comes in lots of different flavors and this is only one.

Second, to elaborate a bit more, having to constantly manage your brain in order to get it to do what you need can be exhausting. Any success you achieve feels like it's extremely tenuous, and I'd say most AD(H)D people have had an experience of doing well for a while and then everything falling apart. So nothing ever feels safe. The negative feedback you get will tend to reverberate much more loudly in that environment than the positives.

I co-sign everything written here as

I never invited you people into my head and I don't like it

I understand this, lol. But you can also take heart that you don't struggle alone. You might be surprised at how many places you can be open about this stuff and have positive things result.

Another complicating factor is that it is assumed that there are a few different subtypes of depression. For example with and without psychotic features. Another subtypes is the "atypical depression", which actually has, in contrast to classical major depression, "reactive mood" and a high degree of "rejection sensisitivity": https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990566/

RSD (Rejection Sensitive Dysphoria) is a factor in many cases. Overreaction to external stimuli makes rejection hit harder. So it doesn't need to be constant or even more negative feedback - the same will be worse even if you are coping and getting things done.

https://www.webmd.com/add-adhd/rejection-sensitive-dysphoria

I think a lot of this is about English (and probably most languages) being vary lacking in ways to describe both short-time and long-time mood effects. Talking about a dopamine rush from completing a difficult task or an endorphin rush from sport isn't very accurate, but despite everyone knowing the feeling we never made better words for them.

Similarly "I've low dopamine" is just a modern version of "I have the blues" or "I'm depressed". That's all good, as long as everyone involved knows that it's a short hand, or maybe a double-meaning of the word, not an actual medical description. Just like somebody who is "a little OCD" has none of the symptoms of actual OCD.

It’s more like she has quantitatively or qualitatively different dopamine receptors.

This is like the right/left brain generalization that everyone seems to still believe in.

The low-dopamine hypothesis for ADHD is a legitimate idea still being actively studied.

> legitimate idea still being actively studied.

Yes, but it is not conclusive.

I for one believe there are multiple types of ADHD. Be it lifestyle induced, lead-exposure induced, TBI induced, genetic, etc.. Us humans like to slap labels on things, but life is rarely so cut and dry.

And you forgot maybe the most important, common and often overlooked one: ADHD that is emotional trauma-induced.

Hmmm, I know (C)PTSD can have issues that seem similar to ADHD, but then again, all these disorders are just a collection of symptoms slapped together. Is cyan a hue of blue or a hue of green -- does it even matter?

The only issue I have with emotional trauma-induced ADHD, is that it's very easy to be a chicken vs. egg issue. I have ADHD, and I experienced what I would consider emotional trauma to some degree (often because of ADHD), but which came first? It seems very cyclical to me.

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