Bipolar & ADHD: Connections, Diagnosis, & Treatment

What Is Bipolar?

Bipolar disorder is a mental health condition characterized by extreme mood, energy, and activity shifts. These mood swings typically alternate between episodes of mania and depression. During manic episodes, individuals may experience elevated mood, racing thoughts, impulsivity, and a decreased need for sleep. Depressive episodes involve feelings of sadness, low energy, difficulty concentrating, changes in appetite, and thoughts of self-harm or suicide.

There are several types of bipolar disorder, including bipolar I disorder, bipolar II disorder, cyclothymic disorder, and other specified and unspecified bipolar and related disorders. These types differ in the severity and duration of the mood episodes experienced.

Bipolar disorder can affect anyone, regardless of age, gender, or background. However, specific statistics suggest it tends to emerge in late adolescence or early adulthood.¹ Additionally, individuals with a family history of bipolar disorder are at a higher risk of developing the condition themselves. Other risk factors for bipolar disorder include high-stress levels, substance abuse, traumatic life events, and imbalances in brain chemicals.

Common depressive symptoms of bipolar include:²

• Significant fluctuations in weight and appetite
• Change in sleeping patterns (insomnia or excessive sleep)
• Persistent feelings of sadness
• Hopelessness
• Emptiness
• Loss of interest or pleasure in activities they once enjoyed
• Fatigue
• Decreased energy levels
• Difficulty concentrating
• Indecisiveness
• Feelings of worthlessness or guilt
• Restlessness or slowed movements
• Recurrent thoughts of death or suicide

Common manic symptoms of bipolar include:²

• Overly inflated self-esteem
• Increase in risky behaviors such as gambling
• Elevated or irritable mood
• Grandiosity and excessive self-confidence
• Racing thoughts
• Decreased need for sleep without feeling tired
• Impulsivity
• A heightened level of activity or agitation
• Rapid speech
• Difficulty focusing or being easily distracted
• Increased involvement in multiple activities or projects

What Is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning and development. It commonly emerges in childhood and can continue into adulthood. ADHD can affect individuals of all genders, but statistics suggest that boys are more likely than girls to be diagnosed with ADHD, with a ratio of about 4:1.³

ADHD symptoms can be classified into three subtypes: predominantly inattentive ADHD, predominantly hyperactive-impulsive ADHD, or combined ADHD. Inattentive symptoms of ADHD include difficulty sustaining attention, being easily distracted, forgetfulness, and struggling with organization and time management. Hyperactive-impulsive symptoms involve excessive fidgeting, restlessness, impulsivity, difficulty staying seated, talking excessively, and interrupting others.

The exact causes of ADHD are not fully understood, but research suggests a combination of genetic and environmental factors.⁴ A family history of ADHD increases the likelihood of an individual developing the disorder, indicating a genetic component to ADHD. Other risk factors contributing to ADHD include premature birth, low birth weight, exposure to environmental toxins (e.g., lead), maternal smoking during pregnancy, and certain prenatal and early childhood factors.

Common symptoms of inattentive ADHD include:²

• Easily distracted
• Poor short-term memory
• Difficulty sustaining attention or focus
• Making careless mistakes
• Having trouble organizing tasks or activities
• Frequently losing or misplacing items
• Forgetfulness in daily activities
• Struggling to follow through on instructions or finishing tasks

Common symptoms of hyperactive-impulsive ADHD include:²

• Increased impulsivity
• Difficulty focusing
• Excessive physical restlessness
• Fidgeting
• Difficulty staying seated
• A constant need to be on the move
• Talking excessively
• Interrupting or intruding on others’ conversations or activities
• Have difficulty waiting their turn
• Have difficulty regulating their emotions

Similarities Between Bipolar & ADHD

During bipolar manic episodes, individuals may exhibit symptoms that resemble ADHD, such as increased energy levels, racing thoughts, impulsivity, and heightened activity. These manic symptoms can lead to difficulties with attention and focus, similar to the inattentive symptoms of ADHD. However, it is important to note that bipolar manic episodes also involve distinct features like inflated self-esteem and grandiosity, which are not characteristic of ADHD.

Similarly, during bipolar depressive episodes, individuals may display symptoms resembling ADHD. Symptoms such as decreased energy, difficulty concentrating, and a sense of apathy can overlap with the inattention and lack of focus in ADHD. However, bipolar depressive episodes also involve persistent sadness, feelings of worthlessness or guilt, changes in appetite and sleep patterns, and thoughts of self-harm or suicide, distinguishing them from pure ADHD symptoms.

Overlapping symptoms in ADHD and bipolar include:

• Insomnia
• Mood swings
• Impulsivity
• Difficulties with attention and concentration
• Restlessness
• Being easily distracted
• Difficulty completing tasks

Differences Between Bipolar & ADHD

The main differences between ADHD and bipolar disorder lie in their underlying nature and the patterns of symptoms. ADHD primarily involves attention and impulse control challenges, whereas bipolar disorder primarily revolves around mood dysregulation. Bipolar cycles are a key differentiator. Individuals with ADHD experience chronic symptoms, and while they may experience fluctuations in mood, these fluctuations are not as cyclical as in bipolar disorder.

Can You Have Both Bipolar & ADHD?

Individuals can be diagnosed with both bipolar disorder and ADHD. Research suggests a higher likelihood of comorbidity between the two conditions than the general population.⁵ According to one study, ADHD was three times more likely in those struggling with mood disorders and 1.7x more likely in those with bipolar disorder than major depressive disorder.⁶

Why are Bipolar & ADHD So Often Co-occurring?

The exact reasons for the high co-occurrence of bipolar disorder and ADHD are not fully understood. However, research suggests that shared underlying factors may contribute to the overlap between the two conditions.⁷ For instance, both disorders are believed to have genetic components, and specific genes and biological mechanisms may predispose individuals to develop both disorders. Additionally, common risk factors such as early-life stress, neurodevelopmental abnormalities, and neurotransmitter imbalances may contribute to the comorbidity.

What it is Like to Have Both Bipolar & ADHD

The co-occurrence of the two disorders may present unique challenges and complexities regarding diagnosis and treatment. The presence of both conditions can impact the severity and course of symptoms and treatment outcomes. Therefore, it is essential for individuals who exhibit symptoms of both bipolar disorder and ADHD to consult with a qualified healthcare professional for an accurate diagnosis and appropriate management strategies.

The co-occurrence of these conditions does not necessarily mean a person will experience double the symptoms or severity. Instead, the interaction between bipolar disorder and ADHD can vary from person to person. One study found that individuals with bipolar disorder and ADHD had higher rates of comorbid psychiatric conditions, including substance use disorders and anxiety disorders, suggesting additional challenges in managing their mental health.⁸

Diagnosing Comorbid Bipolar & ADHD

The diagnosis process typically involves a thorough assessment that includes a detailed medical history, a comprehensive clinical interview, and the use of standardized diagnostic criteria, such as the DSM-5. It may also involve rating scales or questionnaires to gather additional information. The length of the diagnosis process can vary depending on the individual’s specific circumstances and the availability of healthcare resources.

If an individual believes they may have both disorders, it is recommended to seek a comprehensive evaluation from a qualified healthcare professional, such as a psychiatrist or psychologist specializing in assessing and treating mental health disorders.

Treatment for Comorbid Bipolar & ADHD

While treatment approaches for bipolar disorder and ADHD may overlap to some extent, managing these disorders often requires a tailored approach. The specific treatment plan and the order in which each disorder is addressed may depend on factors such as the severity of symptoms and individual response to treatment. Treatment for comorbid bipolar and ADHD can involve a combination of medication and therapy.

Therapy for Comorbid Bipolar & ADHD

For bipolar disorder, therapy options commonly include psychoeducation, cognitive-behavioral therapy (CBT), and interpersonal and social rhythm therapy (IPSRT). For ADHD, therapy options often involve behavioral interventions, such as behavioral therapy and parent training. These interventions improve organizational skills, time management, and attention regulation.

Therapy options for bipolar and ADHD include:

• Cognitive behavioral therapy (CBT): CBT can benefit individuals with ADHD and bipolar disorder. CBT aims to identify and modify negative thought patterns, behaviors, and coping strategies. It can help individuals develop effective strategies for managing symptoms, enhancing mood stability, and improving overall functioning.
• Family therapy: Family therapy can be valuable in supporting individuals with ADHD and bipolar disorder. The involvement of family members in therapy can provide a supportive and understanding environment that promotes effective communication, problem-solving, and healthy coping strategies for everyone involved.
• Psychoeducation: Psychoeducation involves providing information and education about the conditions, their symptoms, and their impact on daily life. Psychoeducation aims to empower individuals by increasing their understanding and awareness of their conditions and providing them with tools to effectively manage symptoms and improve overall well-being.
• Interpersonal and social rhythm therapy (IPSRT): IPSRT is a treatment approach that can benefit individuals with ADHD and bipolar disorder. IPSRT focuses on stabilizing daily routines and interpersonal relationships to help manage mood symptoms and enhance overall functioning.
• Behavioral therapy: Behavior therapy can be a valuable treatment approach for individuals with ADHD and bipolar disorder. It focuses on identifying and modifying specific behaviors associated with the conditions, helping individuals develop adaptive strategies and skills to manage their symptoms.
• Executive functioning coaching: Executive functioning coaching can be a helpful intervention for individuals with ADHD and bipolar disorder. Executive functions are cognitive processes that regulate and manage various mental tasks, including attention, planning, organization, problem-solving, and self-regulation. Difficulties in executive functioning are commonly seen in both ADHD and bipolar disorder.

Medication for Comorbid Bipolar & ADHD

When an individual has comorbid bipolar and ADHD, the medication approach requires careful consideration. It is possible to be prescribed both ADHD medication and bipolar medication to target the symptoms of each disorder. However, some stimulants used for ADHD may trigger manic or hypomanic episodes in individuals with bipolar disorder. Therefore, close monitoring by a healthcare professional is necessary.

Medication options for bipolar disorder include:

• Mood stabilizers: Mood stabilizers help to regulate mood swings. Commonly prescribed mood stabilizers include Lithium, Valproate, and Lamotrigine.
• Antipsychotics: Antipsychotics may also be prescribed to manage manic or psychotic symptoms. Commonly prescribed antipsychotics include Abilify, Saphris, Clozaril, and Zyprexa

Medication options for ADHD include:

• Stimulant medications: Stimulant medications, like methylphenidate and amphetamines, are commonly used to improve attention and impulse control.
• Non-stimulant medications: Non-stimulant medications, like atomoxetine and bupropion, may be considered as an alternative for individuals who do not respond to stimulants or struggle with their side effects.

In My Experience

In my experience, I have had several clients with ADHD and Bipolar Disorder. From what I’ve seen, the most challenging aspects of these disorders are managing impulsivity and emotional reactivity. While initially finding relief for the various symptoms can be challenging, there is hope that individuals can lead a satisfying life with the proper treatment and medication.