ADHD Medication and Depressive Symptoms in Adolescents: A Retrospective Longitudinal Study

To examine whether higher attention-deficit/hyperactivity disorder (ADHD) medication coverage was associated with lower depressive symptoms among adolescents who live in underresourced neighborhoods and/or identify as a member of a minoritized group.

In this retrospective cohort study, adolescents aged 12 to 18 years with ADHD completed a depression screener at their annual well visit. Patients were seen at a primary care office that predominantly serves minoritized, Medicaid-insured youth from underresourced neighborhoods. We calculated ADHD medication coverage as the percentage of days in which medication was available in the prior 36 months based on prescriptions in the electronic health record (range 0%-100%). Zero-inflated negative binomial regression models assessed whether medication coverage was associated with differences in total depression scores, measured by the Patient Health Questionnaire.

We included 2569 adolescents (66.6% male, 70.9% Black, 86.6% Medicaid-insured) with 4145 well visits. Medication coverage was poor (mean = 18.5% days covered, standard deviation = 26.8%). Higher medication coverage was not associated with lower depression scores in the overall sample. However, after excluding patients with 0% medication coverage, there was a significant association between higher coverage and lower depression scores. Depression symptom scores were higher in patients with mental/behavioral health comorbidities, those of female sex, and those living in neighborhoods with lower opportunity scores.

Greater ADHD medication coverage was associated with a small, yet potentially clinically significant decrease in depression symptoms in our sample, underscoring the need to investigate the protective effect of ADHD medication on depression in more diverse populations.