Bipolar disorder and attention deficit hyperactivity disorder (ADHD) can occur together. They can also share similarities and differences in symptoms.This article provides an overview of the relationship between bipolar disorder and attention deficit hyperactivity disorder (ADHD). It also explains their similarities and differences.
The relationship between bipolar disorder and ADHDPhotography by Marija Anicic/Stocky United
Bipolar disorder and ADHD are two mental health conditions that can occur together but often present with different symptoms.
People with bipolar disorder experience periods of elevated mood (mania or hypomania) and low mood (depression). Bipolar disorder typically presents in young adulthood.
ADHD is a neurodevelopmental disorder that affects concentration. People living with the condition experience hyperactivity and impulsive behavior. ADHD typically starts in childhood. Many children are diagnosed after experiencing difficulties in school.
Bipolar disorder and ADHD are similar in that both conditions can cause a person to feel increased energy and talking. However, the two conditions are diagnosed and treated differently.
Also, ADHD affects more people than bipolar disorder — 4.4% of people in the United States have ADHD compared to 1.4% who have bipolar disorder.
How often do bipolar disorder and ADHD co-occur?
Bipolar disorder and ADHD co-occur in about 20% of cases. People with both disorders often experience difficulty in school performance, work, and relationships and a greater risk of substance misuse.
Both disorders can place individuals at an increased risk for suicide attempts. Bipolar disorder and ADHD increase the prevalence of disruptive behaviors and impulsivity, making attempted and completed suicide more likely.
Bipolar disorder, formerly called manic depression, involves changes in mood, energy, and activity levels. Individuals with bipolar disorder generally experience periods of elevated and depressed moods, typically cycling between the two. Periods of elevated mood are called manic episodes. People experiencing a manic episode can feel:
- extremely “up”
Less severe periods of mania are called hypomania.
Periods of low mood are called depressive episodes. People experiencing depressive episodes often feel sad, indifferent, or hopeless.
There are three types of bipolar disorder:
- Bipolar 1: This is defined as manic episodes that last at least 7 days for most of the day, nearly every day, or manic symptoms that are severe enough that the person needs to be hospitalized. Some individuals with bipolar 1 also experience psychosis, with symptoms such as delusions and hallucinations.
- Bipolar 2: This is defined as periods of depression and hypomania. Episodes are not as severe as those in bipolar 1.
- Cyclothymia: This is defined as recurrent hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.
Signs that a person with bipolar disorder is experiencing a manic or depressive episode include:
- feeling elated, jumpy, or wired
- decreased need for sleep
- talking fast or racing thoughts
- excessive appetite for drinking, sex, or other pleasurable activities
- feeling unusually important, talented, or powerful
- delusions or hallucinations
- feeling hopeless or worthless
- thoughts of suicide
- lack of interest in activities
- trouble concentrating
- talking very slowly
- feeling down or sad
Read more about bipolar disorder.
ADHD is characterized by inattention or hyperactivity-impulsivity, which interferes with daily functioning.
Inattention means difficulty concentrating, sustaining focus, and staying organized. However, this is not due to defiance or lack of comprehension.
Hyperactivity means the person is restless and seems to move about constantly, even in situations where it is not appropriate. Impulsivity means the person has difficulty with self-control and cannot delay gratification.
Signs that a person is experiencing inattention, hyperactivity, or impulsivity with ADHD are:
- not listening when being spoken to
- having difficulty organizing tasks and activities
- overlooking details or making careless mistakes
- difficulty following through on instructions
- losing things necessary for tasks and activities
- forgetting appointments, chores, or errands
- fidgeting or squirming
- talking excessively
- having difficulty waiting for one’s turn
- interrupting others in conversation, games, or activities
- being constantly in motion or on the go
Bipolar disorder vs. ADHD
Bipolar disorder and ADHD differ because one is a mood disorder, and the other is an attention disorder. While both can occur simultaneously, they often present with different characteristics. Here are some examples:
|Onset in young adulthood||Onset in childhood|
|Cyclical symptoms||Chronic and pervasive symptoms|
|Decreased need for sleep||Sleep not affected|
|Hypersexuality in mania or hypomania||Sexuality not affected|
|Psychosis possible||Psychosis absent|
|Increased self-esteem or grandiosity||Decreased self-esteem|
|Increased goal-related activity||Trouble achieving goals|
Diagnosing bipolar disorder and ADHD
Diagnosis of both conditions is based on symptoms, history, and family history. Diagnosis typically begins with your doctor. They may perform lab tests to rule out any medical conditions causing symptoms.
To diagnose bipolar disorder, your doctor will typically recommend you contact a mental health professional to evaluate manic or depressive symptoms and how they impact daily functioning.
They will determine the severity of symptoms to assess the type of bipolar disorder. They will also rule out other conditions, such as anxiety or major depressive disorder.
To diagnose ADHD, your doctor will typically determine whether the core symptoms — inattention, hyperactivity, and impulsivity — are present. They will also assess how much these symptoms interfere with work or school. Like bipolar disorder, they will rule out other mental health conditions that might be causing your symptoms.
Treatment for bipolar disorder and ADHD
Bipolar disorder and ADHD are typically treated with medications. However, the medications for each disorder are different.
The first goal of treatment for symptoms of bipolar disorder is mood stabilization. Symptoms are typically treated with mood stabilizers, such as:
A doctor may prescribe antipsychotics, which can also be used for people who experience psychosis in manic episodes.
For people with ADHD, in addition to bipolar disorder, your doctor may add a stimulant, such as methylphenidate, atomoxetine, or amphetamine salts. This helps with the core symptoms of ADHD.
More research is needed to determine whether the stimulant medications used for ADHD can cause a manic episode in people with comorbid bipolar disorder.
People with bipolar and ADHD can also benefit from psychotherapy by a mental health professional. Cognitive behavioral therapy (CBT) is the most common and well-studied form and is often used to help treat bipolar disorder and ADHD.
CBT involves changing thoughts to help improve how a person feels and behaves. CBT is often used in conjunction with medications.
Bipolar disorder and ADHD are two mental health conditions that sometimes occur together. While the two conditions share some of the same symptoms, they typically present at different times and are treated with different medications.
Symptoms also present differently. Bipolar disorder symptoms are more cyclical. ADHD symptoms are more chronic. Medications and psychotherapy can help individuals with both bipolar disorder and ADHD.
If you experience symptoms of either condition, contact your doctor for evaluation and a referral to a mental health professional.