Back to Journals » Neuropsychiatric Disease and Treatment » Volume 14

Low hedonic tone and attention-deficit hyperactivity disorder: risk factors for treatment resistance in depressed adults

Authors Sternat T, Fotinos K, Fine A, Epstein I, Katzman MA

Received 10 April 2018

Accepted for publication 18 June 2018

Published 17 September 2018 Volume 2018:14 Pages 2379—2387


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Roger Pinder

Tia Sternat,1,2 Kathryn Fotinos,1 Alexa Fine,1 Irvin Epstein,1 Martin A Katzman1–4

1START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada; 2Department of Psychology, Adler Graduate Professional School, Toronto, ON, Canada; 3Division of Clinical Sciences, The Northern Ontario School of Medicine, Thunder Bay, ON, Canada; 4Department of Psychology, Lakehead University, Thunder Bay, ON, Canada

Background: The burdens imposed by treatment-resistant depression (TRD) necessitate the identification of predictive factors that may improve patient treatment and outcomes. Because depression and attention-deficit hyperactivity disorder (ADHD) are frequently comorbid and share a complex relationship, we hypothesized that ADHD may be a predictive factor for the diagnosis of TRD. This exploratory study aimed to determine the percentage of undetected ADHD in those with TRD and evaluate factors associated with treatment resistance and undetected ADHD in depressed patients.
Subjects and methods: Adults referred (n=160) for psychiatric consultation completed a structured interview (MINI Plus, Mini International Neuropsychiatric Interview Plus) to assess the presence of psychiatric disorders.
Results: TRD was significantly associated with the number of diagnoses (P<0.001), past (P<0.001) and present medications (P<0.001), chronic anhedonia (P=0.013), and suicide ideation (P=0.008). Undetected ADHD was present in 34% of TRD patients. The number of referral diagnoses (P<0.001), failed medications (P=0.002), and past selective serotonin reuptake inhibitor failures (P=0.035) were predictive of undetected ADHD in TRD.
Conclusion: Undetected ADHD may be more prevalent among TRD patients than previously thought. In addition, TRD patients are more likely to present with psychiatric comorbidity than non-TRD patients. Screening patients with depression for the presence of ADHD and chronic anhedonia/low hedonic tone may help identify patients with TRD and undetected ADHD and improve treatment outcomes.

Keywords: anhedonia, catecholamine, suicide, dopamine, attention, drug response

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]