Bipolar Disorder and ADHD
Bipolar disorder and ADHD have similar symptoms. And because these symptoms look so much like a presentation of either bipolar disorder or ADHD, they’re often misdiagnosed. But when there are such strong similarities, how are they different disorders? And if they’re different, do they ever occur together?
Statistics by the National Institute of Health indicate that anywhere between 3 and 6 percent of the US adult population has ADHD. On the other hand, the lifetime prevalence rate of bipolar disorder among US adults is 4.4 percent. When a notable chunk of the population experiences the two disorders, is it possible for them to co-occur? Let’s discuss what co-occurring bipolar disorder and ADHD looks like, how it’s treated, and how to differentiate between them.
Comorbidity of Bipolar Disorder and ADHD
Bipolar disorder, a mood disorder, and ADHD, a neurodevelopmental disorder, are commonly recognized as conditions with a high degree of comorbidity. That means they often co-occur. One study shows that people with bipolar disorder have a 6.7 times higher risk of developing ADHD as well.
It’s possible that the same environmental stressors can trigger the development of both disorders. Similarly, some studies indicate that the collective genetic risk factors for ADHD during childhood are also associated with hypomanic symptoms. Therefore, there’s a biological link between the two conditions.
Other Symptoms of Co-occurring Bipolar Disorder and ADHD
When you develop co-occurring bipolar disorder and ADHD, you experience manic episodes as part of bipolar disorder. It includes symptoms like elevated mood and an inflated sense of self. You’ll also exhibit symptoms of a major depressive episode, such as low mood, lack of interest in activities you previously enjoyed, fatigue, feelings of hopelessness, and thoughts of death.
With ADHD, you show symptoms of inattention, hyperactivity-impulsivity, or both. Inattention is characterized by failing to notice important details, poor ability to organize tasks, and forgetfulness. Meanwhile, hyperactivity can include symptoms like fidgeting, poor planning and execution, and feelings of restlessness.
Treatment For Bipolar Disorder and ADHD
There’s no defined method to treat co-occurring bipolar disorder and ADHD. Therefore, mental health practitioners must carefully implement aspects of treatments for both conditions. ADHD is a consistently present disorder that doesn’t fluctuate in intensity, while bipolar disorder is characterized by different mood episodes. Therefore, the best course of action is to stabilize the client by addressing the manic episode.
Treating Bipolar Disorder
For bipolar disorder, treatment involves a combination of medication, psychotherapy, and wellness therapies commonly known as holistic treatment.
Medication prescribed for manic episodes includes mood stabilizers, which can help prevent mood imbalances. In cases of severe mania that leads to psychotic features, antipsychotics are prescribed as well.
Once manic symptoms have been managed, practitioners may prescribe medication to address ADHD symptoms. Because medication includes both stimulant and non-stimulant formulations, practitioners should prescribe whichever drug is best for current circumstances.
Since stimulant medications can potentially trigger a manic episode, the type of drug and dosage should be considered on a case-by-case basis. Moreover, psychotherapy can help address certain ADHD symptoms by teaching the client new skills that help with maintaining concentration, emotional regulation, and more.
In addition to taking medication and attending therapy sessions, making meaningful changes to your lifestyle can have a big impact. This includes getting regular exercise, eating a balanced diet comprising whole foods, and setting a specific sleep schedule. Additionally, engaging in holistic therapies like meditation, animal-assisted therapy, and therapeutic massage can help alleviate stress, which is a common trigger for symptoms.
Differential Diagnosis for Bipolar Disorder and ADHD
As mentioned above, it’s common for clinicians to mistake ADHD and bipolar disorder for each other. This is due to overlapping symptoms like impulsivity, distractibility, and little need for sleep. In this case, psychiatrists should determine whether these overlapping symptoms occur episodically or consistently throughout the course of the condition. An episodic occurrence means that the symptoms occur several days at a time.
And in bipolar disorder, symptoms of impulsivity and distractibility are accompanied by feelings of grandiosity and elevated mood. Meanwhile, a person with ADHD may show major changes in mood over the course of one day, which is distinct from a manic episode.
ADHD Vs. Bipolar Disorder in Adults
The major difference is that symptoms of ADHD are situational and contextual, but in bipolar disorder, your symptoms don’t occur as the result of external factors. When people with ADHD are in a positive and stimulating environment, they can maintain a better mood. And when the environment fails to provide adequate stimulation, they can end up feeling agitated and bored. People with ADHD will see the world around them in the same manner, even as their mood changes. Similarly, they can control their feelings by changing the environment and stimuli around them.
On the other hand, a bipolar depressive episode occurs as a result of an internal emotional state. It’s not triggered by situational reasons – you just wake up and feel different when you’re depressed versus when you’re not.
ADHD Vs. Bipolar Disorder in Children
Manic episodes in children can look different from how they appear in adults. Rather than euphoria, children experience mania in the form of aggression and increased irritability. This is known as emotional dysregulation, and it can include behaviors like outbursts and tantrums as well. In children, emotional dysregulation is a symptom of other disorders as well, including ADHD. This makes it inappropriate to diagnose a child with bipolar disorder based on irritability alone.
Mental health practitioners can differentiate between the two conditions in children by looking at the duration of symptoms. Children with bipolar disorder only show emotional dysregulation for weeks or months at a time, while those with ADHD show these symptoms most of the time.
Treatment In Case of Unclear Diagnosis
When it’s unclear whether the child has bipolar disorder, ADHD, or both, clinicians prefer to start with ADHD treatment. Because ADHD is a lifelong condition, caregivers start noticing symptoms in childhood, which is when symptoms affect school performance. It’s why many people get diagnosed with ADHD around the age of 12.
Meanwhile, the average age of diagnosis in bipolar disorder is 25. That’s because it often develops after adolescence. So, even though it’s possible for children and adolescents to develop bipolar disorder, it’s a rare occurrence. This makes ADHD the likelier diagnosis compared to bipolar disorder. Another reason to proceed with ADHD treatment is that stimulant medication tends to work quickly. If the symptoms subside after taking stimulant medication, then ADHD is the likely diagnosis. But if symptoms persist, then it’s possible that bipolar disorder is what’s causing them.
Co-Occurring Bipolar Disorder and ADHD
How Common is Comorbid Bipolar Disorder and ADHD?
People with a diagnosis of ADHD are eleven times more likely to receive a diagnosis of bipolar disorder. The likelihood of developing bipolar disorder is 30 times greater for those who have a diagnosis of ADHD and anxiety. Research also indicates that up to 1 in 6 people with bipolar disorder have comorbid ADHD.
Due to the similarities between symptoms, people with comorbid ADHD and bipolar disorder may only receive a diagnosis for one of the conditions, which can affect treatment outcomes. Therefore, appropriate diagnosis and treatment are essential for positive outcomes and long-term management of symptoms.
Telling The Difference Between a Manic Episode and Hyperactivity
You can experience a manic episode when you have bipolar disorder, but it’s not indicative of ADHD. Similarly, people with a diagnosis of ADHD may show manic-like symptoms during bursts of hyperactivity. This can also include symptoms like being unable to focus on the task at hand or fidgeting in your seat. The difference, however, is that the burst of energy associated with ADHD is consistent and may briefly disappear because of external circumstances.
These bursts of hyperactivity associated with ADHD are different from manic episodes, where you feel a decreased need for sleep and an inflated sense of self-confidence. This can last for weeks but eventually results in a depressive episode. Moreover, the transition from mania to a depressive episode can happen independently, without any influence from external circumstances. So, while there are some triggers that can cause periods of low hyperactivity in ADHD, there’s no need for a triggering event to cause the shift from a manic to a depressive episode.
Diagnosing Comorbid Bipolar Disorder and ADHD
Getting a diagnosis of ADHD or bipolar disorder can take time. And if you present with symptoms of both conditions, it can take even longer to get an accurate diagnosis. Due to the overlapping symptoms and similarities between the disorders, your mental health practitioner will need to perform an extensive evaluation.
This can include checking your medical history to see if you have any other health conditions that could be causing symptoms. A treatment facility may also conduct a physical exam and blood tests to determine if your symptoms are the result of substance use. After they’ve ruled out the possibility of your symptoms being the result of a medical condition, they’ll perform a psychological assessment and see if you meet the diagnostic criteria for both conditions.
Treating ADHD With Bipolar Disorder: Medication
When ADHD and bipolar disorder co-occur, diagnosing and addressing both of them is the best route to a positive prognosis. Let’s look at the different forms of treatment used to help people manage ADHD, bipolar disorder, or both.
In mental disorders like ADHD, which can negatively impact your ability to perform different social, occupational, and important functions, medication is a core component of the treatment plan. Most mental health practitioners recommend a combination of both medication and therapy. Common medication for ADHD includes:
Stimulants like Adderall and Dexedrine work by stimulating your central nervous system, causing the production of dopamine and norepinephrine. At the same time, stimulants prevent the neurotransmitters from degrading so that they’re present in the nervous system for a longer time. This medication is effective because ADHD can lead to low levels of dopamine, an important neurotransmitter that controls concentration, sleep, and mood. Stimulant medication is available in immediate and slow-release formulations.
These also affect neurotransmitters like dopamine, serotonin, and norepinephrine in the central nervous system. The only difference is that they work by reducing the degradation of neurotransmitters in the brain rather than stimulating the increase of serotonin as well. Mental health practitioners may prescribe non-stimulants in conjunction with stimulants to increase their efficacy. They’re also preferred when you experience side effects due to stimulant medication.
Bipolar Disorder Medication
When you’re struggling with bipolar disorder, medication is an important part of your treatment plan. Although they don’t completely cure your condition, they make you much more responsive to therapy by alleviating symptoms.
Mood stabilizers prevent excessively high and low moods that can cause manic or depressive episodes, respectively. In contrast, antidepressants only address the low mood of a depressive episode. Medications like lithium and valproic acid can reduce the frequency and intensity of mood changes. Keep in mind that not all mood stabilizers have the same formulations and effects. Therefore, some are better at treating a manic episode, while others are effective at treating a depressive episode.
When needed, clinicians prescribe antipsychotics to address symptoms like hallucinations and delusions, which typically occur during acute mania or severe depression. Your mental health practitioner may also prescribe them to address other symptoms such as agitation, anxiety, or insomnia. In cases of intense manic symptoms, taking antipsychotics with mood stabilizers can help reduce symptoms until the mood-stabilizing medication takes effect.
You’ll work closely with your practitioner to find the right combination of medications for you. Do remember that it can take some time to start experiencing the effects of certain medications, such as those used to address bipolar disorder. If you have comorbid ADHD and bipolar disorder, a suitable method involves stabilizing your mood (treating bipolar disorder) before taking medications for ADHD.
Since ADHD medication can include stimulants like Adderall, it can end up intensifying mood fluctuations, causing you to cycle through manic and depressive episodes. This, in turn, doesn’t just impact overall well-being but increases the risk of self-harm behavior and suicidal ideation.
Treating ADHD With Bipolar Disorder: Therapy
The other component of an effective treatment plan for bipolar disorder or ADHD is almost always therapy. Studies show that therapy is as effective as medication for the treatment of certain disorders. It also helps with long-term recovery by reducing the likelihood of a relapse.
This form of psychotherapy involves meeting one-on-one with a licensed mental health clinician to discuss your concerns. For ADHD, psychotherapy can potentially have a greater effect on symptoms than medication alone. You’ll work with your therapist to build study, attention, and emotion skills that improve.
A major benefit of seeking individual psychotherapy is that your clinician can provide tailored support based on your current struggles. In bipolar disorder treatment, therapy serves an important function in changing how you view a situation. Consequently, you’re able to change how you respond to a situation.
Another mode of therapy that’s often employed to address the symptoms of ADHD and bipolar disorder is family therapy. In the case of bipolar disorder, family-focused therapy is an evidence-based intervention. It comprises three modules, namely psychoeducation, communication enhancement, and problem-solving.
In psychoeducation, the clinician informs your family members about the symptoms of bipolar disorder. As part of this module, your clinician will also teach them coping skills for whenever you experience symptoms, as well as develop a relapse prevention plan. In communication enhancement training, you work on maladaptive communication patterns to practice healthy patterns of interactions. The problem-solving skills module involves building skills to address issues causing conflict at home.
Similarly, family therapy for ADHD helps strengthen relationships by giving your family insights into your symptoms. It also gives them the space to build skills, allowing them to provide the support they need.
Group therapy sessions increase exposure to activities that reduce ADHD behaviors and increase social skills. In the long term, this can help improve your self-esteem and problem-solving skills as you learn to manage symptoms and achieve your goals. The same applies when you struggle with bipolar disorder since you learn how to solve problems and get a supportive environment to practice your coping skills.
Despite the similarities in bipolar disorder and ADHD, both of them are distinct disorders. Even so, there’s a high comorbidity rate, which means that it often co-occurs. People with both disorders will show symptoms like restlessness, poor concentration, and impulsivity all the time rather than in specific episodes. At the same time, you’ll experience manic and depressive episodes that are distinct from common mood fluctuations. With the right diagnosis and treatment, you can alleviate symptoms, improve your quality of life, and perform everyday functions without any trouble.
Here are some commonly asked questions regarding bipolar disorder and ADHD.
Having a diagnosis of ADHD can increase the risk of early-onset bipolar disorder and a higher frequency of mood episodes. If you have ADHD, it will not turn into bipolar disorder, but you may develop comorbid ADHD and bipolar disorder.
The primary differentiator between ADHD and bipolar disorder is time. The hyperactivity associated with ADHD is constant, while the manic symptoms of bipolar disorder are episodic, so they last for weeks before a depressive episode begins. In ADHD, your mood is affected by your environment and external factors, while manic and depressive episodes in bipolar disorder don’t occur as a result of external triggers.
Yes, it’s possible to have co-occurring ADHD and bipolar disorder. The rate of comorbidity between both conditions is high: around 1 out of 13 people with ADHD have comorbid bipolar disorder, while 1 in 6 people with bipolar disorder have ADHD as well.
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