June 21st, 2011
10:23 AM ET

Can depression cause inability to focus?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Asked by Rachel from Southern California

I am a college student, recently diagnosed with depression, and am taking steps to figure out if I have ADHD because of a tremendous inability to focus and retain information. It is almost like, when I'm trying to focus on something someone says, it slips right through me like water.

I am curious to know what prospects I have of gaining my cognitive abilities back if I start taking Lexapro or other antidepressants. If these are going to impair my ability to concentrate and focus even more, then I am not sure how to weigh the cost-benefits of taking them, because I am in school.

In short, are antidepressants more helpful or hurtful to my cognitive functions? Can I look forward to reversing the concentration and memory retention problems I am currently undergoing?

Expert answer

I am very sorry to hear about your situation. College is tough enough without having to struggle with depression.

When most people think of depression, the first things that come to mind are sadness, a loss of enjoyment in life, and perhaps that great dark sense of foreboding and fear that so often accompany the disorder.

And while these are all very painful, and central, parts of the condition, other symptoms of depression can be at least as damaging, and you are struggling with one of those: trouble concentrating.

So the first thing you should know is that the problems with focusing and remembering that you are experiencing are classic depressive symptoms and therefore may not be indicative of ADHD (attention deficit hyperactivity disorder).

It's pretty easy to figure this one out. Did you always have trouble concentrating and remembering things? If you can clearly answer yes to this, then you may have ADHD that preceded your depression. This would not be surprising - it appears that ADHD in childhood is a risk factor for a variety of psychiatric disorders in adulthood.

On the other hand, if your problems with concentration and memory only began with the start of your depression, then they are almost certainly depressive symptoms that will resolve when your depression is fully treated.

Let me answer your question about Lexapro (escitalopram) by assuming that your memory and focus problems are symptoms of your depression and not related to any pre-existing ADHD.

In this case the surest way to resolve these issues is to get rid of your depression, and to do so as quickly as possible. If you take Lexapro and it resolves the depression, it will also greatly improve your ability to focus and remember things.

Note that this does not appear to be a direct effect of the antidepressant, but rather results when the antidepressant resolves the depression.

Antidepressants don't improve memory or concentration, per se. But anything that makes your depression go away will fix your cognitive difficulties precisely because they are part of the depression.

A final comment: Don't forget that antidepressants are not your only option. Many studies show that certain types of psychotherapy (including cognitive behavioral therapy, behavioral activation and interpersonal psychotherapy) work as well as antidepressants.

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