Women With ADHD May Have More Severe Symptoms of Premenstrual Dysphoric Disorder, Postpartum Depression, and Menopause

Maternal Depression Highest at Four Years After Birth
Maternal Depression Highest at Four Years After Birth
Researchers assessed the prevalence of hormonal-related mood disorder symptoms in women with ADHD in the Netherlands.

Women with attention-deficit/hyperactivity disorder (ADHD) may be more vulnerable to hormone-related mood disorders such as premenstrual dysphoric disorder (PMDD), postpartum depression (PPD), and climacteric mood symptoms during their lifespan, researchers found in a study that was recently published in the Journal of Psychiatric Research.

The study included 209 adult female patients with ADHD (mean age of 34.5 years, standard deviation (SD) of 11.5 years) who were in care in April and May 2016 at the PsyQ outpatient clinic for Adult ADHD in The Hague, the Netherlands.

Of the participants, 174 were of reproductive age, 35 were peri-or-postmenopausal and 70 had irregular menstrual cycles. Of the 85 participants who had at least 1 biological child, 53 (62.4%) reported having complications antepartum, peripartum and/or postpartum after their first childbirth.

The researchers assessed the patients using the Diagnostic Interview for ADHD in adults 2.0 based on DSM-IV criteria, the Neuropsychiatric Interview Plus (the M.I.N.I. Plus), the Edinburgh Postnatal Depression Scale (EPDS), the Greene Climacteric Scale (GCS) and the Munich Chronotype Questionnaire (MCTQ).

More women with ADHD and PMDD used contraceptives (50.6%) than those who did not have PMDD (68.1%, χ2 (1) = 5.82; P =.016, odds ratio (OR) = 2.09). PMDD symptoms were associated with the use of antidepressants (t = −1.991, P =.048), contraceptives (t = 2.515, P =.013), complications during pregnancy (F = 5.385, P =.008) and a mood disorder in remission (t = −2.500, P =.013). Adjusting for covariates and correcting for age and education level, use of contraceptives was associated with lower PMDD symptoms, and using antidepressants was associated with higher PMDD symptoms.

The prevalence of PPD indications (49 of the 85 who had at least 1 biological child) after the first childbirth was higher among the women included in the study than groups included in 2 systemic reviews: 19.6% among low-to middle-income countries and 14.5% in high-income countries. PMDD symptoms were significantly higher in the PPD-group compared to the no-PPD-group, with a medium effect size, (M = 7.38, SD = 3.28 vs. M = 5.53, SD = 4.07; t (81) = −2.30, P =.024, d = 0.50). The PPD-group used significantly more antidepressants (49% of the patients) than the no-PPD-group (25%, χ2 = 6.330; P =.010).

The researchers found significant differences on GCS subscores for depression between the 11 women with PMDD and the 14 without PMDD (F (1) = 5.105, P =.030) and sexual dysfunction (F (1) = 5.191, P =.029) as well as a significant correlation between more PMDD symptoms and higher total GCS (r = 0.511, n = 38, P =.001) and the subscores psychosocial (r = 0.441, n = 38, P =.006), anxiety (r = 0.381, n = 38, P =.020), depression (r = 0.0418, n = 38, P =.010) and somatic (r = 0.425, n = 38, P =.009) complaints. The PPD group (n = 18) showed significantly higher GCS scores (vs. no PPD, n = 8) on the total score (F = 7.18 (1), P =.013), the subscores psychosocial (F = 6.01 (1), P =.021), anxiety (F = 5.84 (1), P =.023), depression (F = 4.51 (1), P =.043), vasomotor (F = 7.03 (1), P =.013) and sexual dysfunction (F = 4.56 (1), P =.043).

Limitations of the study include possible recall bias and the inability to find significant association between a broad spectrum of psychiatric disorders and PMDD.


Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res. Published online December 3, 2020. doi:10.1016/j.jpsychires.2020.12.005