The relationship between Attention Deficit Hyperactivity Disorder (ADHD) and Bipolar Disorder is a multifaceted and often misunderstood area within the mental health field. These two disorders share overlapping symptoms, such as impulsivity, distractibility, and mood instability, which can complicate the diagnostic process and lead to misdiagnoses or underdiagnoses. Accurately distinguishing between ADHD and Bipolar Disorder is critical for providing appropriate treatment and support.
As research continues to unveil the complexities of these conditions, mental health professionals are better equipped to tailor therapeutic interventions and offer targeted guidance, paving the way for a more comprehensive understanding of these intertwined disorders and fostering improved mental well-being for those affected.
Attention-deficit/hyperactivity disorder or ADHD is defined as showing persistent patterns of inattention and hyperactivity, and impulsivity, interfering with daily functioning. Symptoms often begin in childhood and can continue into adulthood. Symptoms may also contribute to interpersonal, relational, and social deficits. Individuals living with ADHD may experience low self-esteem, restlessness, impatience, difficulties focusing and prioritizing tasks, mood swings, and anger outbursts. (1)
ADHD symptoms can often present positively when high functioning and go unnoticed. As a child, you may have done well in school, or you may have experienced extra support as well as coping strategies were made more readily available that decreased symptoms. Individuals with high-functioning ADHD may have flourished in environments that supported or channeled distractibility as curiosity or impulsivity as creativity. These may be positive attributes. However, difficulties can persist in high-functioning ADHD with organization, time management, multi-tasking, restlessness, putting off or not completing projects, mood swings, being easily stressed, difficulty listening, and difficulties managing or following one’s own thoughts. (1)
According to the American Psychiatric Association, there are four major categories of bipolar disorder: (2)
- bipolar I disorder – is defined by manic episodes that last at least 7 days or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes also occur, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.
- bipolar II disorder – is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
- cyclothymic disorder – defined by periods of hypomanic symptoms and periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
- bipolar disorder due to another medical or substance abuse disorder – Prominent and persistent mood disturbance, a direct physiologic consequence of substance abuse or medical condition.
ADHD is often unrecognized due to overlapping with other diagnoses of mood disorders and personality disorders, particularly true with bipolar disorder. ADHD and Bipolar disorder share several symptoms. The comorbidities of this diagnosis are as high as 20%. Symptoms overlapping include mood changes, outbursts, restlessness, talkativeness, and impatience. bipolar disorder is primarily a mood disorder, and ADHD affects one’s attention and behavior. The restlessness and distractibility in ADHD overlap with bipolar disorder making the differential diagnosis a challenge.
ADHD and bipolar often coexist, and individuals with this comorbidity often experience severe symptoms that are burdensome, having a higher number of mood swings, a prevalence of substance abuse and dependence, and experiencing a lower quality of life. Treatment focus should have the first goal of treatment being mood stabilization. (3)
- A combination of medication, therapy, and psychoeducation, especially on the use of substance use, abuse, and dependence, since individuals with ADHD and bipolar disorder are at a higher risk.
- Roughly 65% of people with ADHD and bipolar disorder will experience an anxiety disorder, mental health treatment for anxiety may be recommended.
- Medications can be highly effective for the two mental health disorders though caution should be used with the use of stimulant medications. Researchers do not have a complete understanding of the effects of stimulant medications used for ADHD exacerbating bipolar symptoms. (4)
- The first goal of treatment is to stabilize mood. Considering mood stabilizers, antipsychotics, and antidepressants (depending on the antidepressant and depending on the type of bipolar disorder, some antidepressants may trigger mania, consult your physician.). Once bipolar symptoms are managed, treating the ADHD symptoms with appropriate medications may be considered by the healthcare provider. Non-stimulant medications are generally less harmful and present less of a risk for abuse or dependence: Atomoxetine, clonidine, and guanfacine. (5)
- Lifestyle changes that support self-care should be evaluated. Getting enough sleep, eating healthy and balanced, exercising, and healthy social support from friends and/or family. (5) Creating and sticking to a routine, managing distractions, and setting goals.
- Therapeutic treatment such as cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) in group and individual sessions help provide coping skills and insight and support in gaining independence in interpersonal relationships. (5)