Understanding ADHD and Bipolar Disorder: Key Similarities and Differences

Untangling the Web Of ADHD & Bipolar Disorder

Do you ever find yourself caught between the rapid mood swings of bipolar disorder and the relentless distractions of ADHD? What a rollercoaster! 🎢 If so, you’ll know how difficult it can be to navigate both disorders on a bad day (or even an average day), and to find a balance that works with your mental health. 

Today, we’ll explore together how the two can coexist and share personal experiences from our community that may help.

This includes:

• The distinct and overlapping symptoms of ADHD and bipolar disorder.
• The dopamine connection between ADHD and bipolar.
• Strategies for telling the difference between the two conditions.
• How to approach treatment and management of symptoms of coexisting ADHD and bipolar disorder.
• Personal insights and tips for navigating daily life with both conditions.

Ready to get a better understanding of the two conditions and find real strategies that work?

Let’s jump in. 🥰

Yes, ADHD and Bipolar Disorder Can Overlap

At the heart of Attention Deficit Hyperactivity Disorder (ADHD) lies a constant struggle with either inattention, hyperactivity, or both, depending on which of the three types you’re diagnosed with. It’s a neurodevelopmental disorder. 

Bipolar disorder is characterized by severe mood swings, ranging from manic highs to depressive lows. It’s considered a mood disorder.

The two disorders may not seem similar at first glance, but it’s in their impulsivity and mood instability that the two conditions blur. This can present challenges in distinguishing one disorder from the other without a thorough assessment. 💭

ADHD is known to have several comorbid conditions, including anxiety disorders, depression, and learning disabilities like dyslexia and dyspraxia. It’s also associated with earlier onset bipolar disorder.

Recently, a systematic review and meta-analysis by researchers has highlighted the prevalence of comorbid ADHD and bipolar disorder in individuals with up to 35% of patients with bipolar disorders also meeting the criteria for ADHD.‍

This co-occurrence is exactly why a nuanced approach to diagnosis and treatment is so essential to helping people live a life of health and happiness. ☀️

Before we can explore why this overlap can happen, we need to first understand what makes these comorbid disorders different.

You Asked Us…

Can you have ADHD and bipolar disorder?

Yes, it's possible to have both Attention Deficit Hyperactivity Disorder (ADHD) and Bipolar Disorder (BD), conditions known for their distinct diagnostic challenges. Co-occurrence requires careful differential diagnosis for effective treatment.

Bipolar Disorder vs ADHD: What's The Difference?‍

To distinguish between bipolar disorders and ADHD, we have to look at individual symptoms. 

Here's a breakdown that highlights how they’re different, and how they’re similar. 👇

Common Symptoms of ADHD

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes Attention Deficit Hyperactivity Disorder into three types: predominately hyperactive-impulsive, predominantly inattentive, and combined type. 

When being assessed for an ADHD diagnosis, your ADHD symptoms must meet the criteria for one of these types. The number needed depends on whether you’re being tested for adult ADHD (five or more) or childhood ADHD (six or more).

These symptoms include:

• Being Easily Distracted: Struggling to focus is a big part of all ADHD presentations, whether it be because of hyperactive racing thoughts bouncing around while you’re trying to focus, or inattentiveness meaning you have difficulty sustaining attention (often leading to careless mistakes). 
• Interrupting Conversations: Interrupting or blurting things out uncontrollably is an impulsive ADHD symptom that can often be seen as disruptive in certain environments, and lead to misunderstandings and difficulty maintaining relationships. It’s particularly noticeable in those with childhood ADHD or young adults due to the expectations of school settings.
• Struggling With Organization & Time Management: Organization can be a real challenge with ADHD. Not just our homes and environments, but our thoughts, ideas, and emotions too. 😵‍💫People with ADHD also typically experience time blindness, where they have difficulty noticing the passing of time in the same way as everyone else. 
• Losing Things: Working memory is an executive functioning skill that’s impacted by ADHD. That’s why if you’ve ever spent time with someone with ADHD, you’ll know we misplace things constantly. We can also have issues with object permanence, which means we can forget objects exist if we can’t see them. 
• Avoiding Difficult Tasks: tasks that require sustained mental effort can be a real challenge for many reasons: distractibility, lack of focus, difficulties organizing thoughts, and prioritization. These obstacles can often be overwhelming, even before starting, leading to procrastination.‍
• Restlessness: hyperactivity can manifest both as physical restlessness and mental restlessness. It can look like fidgeting, tapping, squirming, or racing thoughts, which can lead to sleep disorders. 

Common Symptoms of Bipolar‍

Bipolar is characterized by extreme mood episodes, switching from periods of extreme highs to periods of extreme lows, usually lasting for several days or longer. You may generally experience more of one than the other. While bipolar can be diagnosed at any age, the average age of bipolar disorder onset is 25, according to the American Psychiatric Association. When assessing bipolar disorder, psychiatrists will look at the patterns and frequency of your mood episodes, genetic factors, and symptoms to diagnose bipolar patients. 📋

When we talk about ‘episodes’, we mean distinct periods of manic/hypomanic episodes and depressive episodes.For people with bipolar disorder, these episodes tend to fluctuate between:

• Manic or hypomanic episodes: Individuals may become more talkative than usual, need less sleep and show increased self-esteem and grandiosity. Additionally, they might experience racing thoughts, become easily distracted, engage in goal-directed activities or physical restlessness, and show excessive involvement in activities with a high potential for negative consequences.
  
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• Episodes of depression: In depressive episodes of bipolar disorder, individuals may experience persistent sadness, significant loss of interest in activities they once enjoyed, feelings of worthlessness or excessive guilt, changes in appetite or weight, sleep disturbances (either insomnia or oversleeping), physical sluggishness or restlessness, difficulty concentrating, and thoughts of death or suicide. When following a manic episode, bipolar depression can feel and appear more extreme than a usual depressive episode seen in major depression, due to the rapid shift in mood.
  

It’s also important to note that, like ADHD, there are three types of bipolar disorder.

These include:

1. Bipolar I Disorder: Characterized by severe manic episodes lasting at least 7 days, or manic symptoms so intense immediate medical care is needed. Depressive episodes usually occur as well, typically lasting at least 2 weeks.
   
2. Bipolar II Disorder: Defined by a pattern of depressive episodes and hypomanic episodes, which are less severe than the manic episodes of Bipolar I Disorder.
   
3. Cyclothymic Disorder (Cyclothymia): Involves recurring hypomanic and depressive symptoms that are not intense enough to qualify as full hypomanic or depressive episodes.

Overlapping Symptoms of ADHD and BD

Now that you understand these two conditions a little better, you may already see some similarities, especially in impulsivity and mood instability.  🧐

Here are a few of the common shared symptoms. 👇

Impulsivity

Impulsivity is a key symptom of those with hyperactive-impulsive and combined types of ADHD. This impulsivity can lead to risky behaviors and increased risk of substance abuse, especially in young adults.

For those with bipolar, increased impulsivity is also a symptom of a manic episode, which can present similar risky behaviors. 

Manic episodes can often be accompanied by feelings of ‘euphoria’, which can impact the type of impulsive behaviors that manifest, whereas ADHD impulsivity can come from a place of low mood and result in behaviors like self-harm.

Impulsivity can present similarly in both bipolar disorder and ADHD, often manifesting as a relentless need for stimulation and boredom with routine or 'normal' life. This shared symptom can lead to sudden, impulsive decisions - like booking a last-minute trip without considering financial or practical consequences. However, these impulsive behaviors' root causes can offer insights into which disorder is in the driver's seat.

For example, during manic episodes, impulsivity is frequently driven by an exaggerated sense of self-confidence or grandiosity. Individuals might find themselves taking huge risks under the belief that they are invincible or exempt from the rules that govern others. Extravagant spending, grand business ventures, or dangerous activities often stem from this distorted self-perception.

Contrastingly, in the depressive phases of bipolar disorder, impulsivity emerges not from euphoria but from a desperate attempt to feel anything amidst emotional numbness. The impulsiveness here is an escape route from despair, worthlessness, or a pervasive emptiness, leading to potentially harmful actions like substance abuse, disappearing/running away, or reckless spending as forms of self-medication or temporary relief.

On the other hand, impulsivity in ADHD doesn't typically arise from emotional highs or lows but as a core feature of the disorder itself. Impulsive behavior in this context is due to difficulty regulating responses to internal urges without considering consequences. This form of impulsivity might manifest in social contexts as inappropriate interruptions or quick actions without considering the consequences.

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Biologically, ADHD is due to problems with executive functions, such as planning and controlling impulses, and (usually)not because of emotional instability - although the consequences can undoubtedly contribute towards emotional dysregulation and comorbid conditions such as depression.

Mood Instability

With ADHD, we typically refer to mood instability as emotional dysregulation. This is also a result of a deficit of executive functioning. This describes how people with ADHD can struggle to regulate their emotions and lack emotional control. This can lead to more intense feelings and emotional episodes. 

These emotional episodes can be triggered incredibly quickly, especially in response to rejection, as those with ADHD are particularly sensitive to actual or perceived rejection. 

Switching from hyperactivity to an emotional outburst or low mood can often seem to mimic that of bipolar, but it’s usually shorter term. These mood swings can happen over the space of minutes or hours, rather than days at a time. 🕒

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The mood symptoms and episodes of bipolar are typically more severe and prolonged, putting them at increased risk of depression and suicidal tendencies, but that doesn’t mean the depressive symptoms experienced by those with ADHD can’t be just as dangerous. 

A 2015 study in the Journal of Affective Disorders on the comorbidity of ADHD and suicide attempts among adolescents and young adult bipolar disorder patients found that there was increased risk among those who had both conditions, rather than bipolar alone.

Fluctuating Energy Levels

While ADHD often involves hyperactivity, leading to cycles of high energy followed by extreme fatigue, bipolar disorder intensifies this pattern through its manic and depressive episodes. 

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In the manic phase, individuals might experience an overwhelming surge in energy and a decreased need for sleep, engaging in a flurry of activities. This is starkly contrasted by the depressive phase, where even minimal tasks become daunting due to severe fatigue. 

Both conditions present challenges in daily functioning and planning, with unpredictable energy levels making it difficult to foresee one's capabilities from one day to the next.

Hyperfocus

Hyperfocus, often observed in ADHD, is where an individual becomes deeply engrossed in an activity of interest, sometimes to the exclusion of other responsibilities. 

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This intense concentration can resemble the obsessive focus seen in bipolar mania, where individuals may also exhibit an extreme dedication to specific tasks or projects. 

However, the context differs; in ADHD, hyperfocus is more constant across various states, while in bipolar disorder, this fixation is typically seen only during manic episodes, marked by heightened energy and reduced need for sleep, making activities or interests more intense and consuming.

You Asked Us…

What symptoms overlap between bipolar and ADHD?

ADHD and Bipolar Disorder share overlapping symptoms like impulsivity, restlessness, and difficulty focusing. Accurate diagnosis is crucial, as these similarities can complicate identification and treatment strategies.

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The Importance of Accurate Diagnosis

If you enjoy a puzzle, you’re in luck, because this is exactly what this can feel like. 🧩

The symptoms of ADHD, including the constant buzz of activity and difficulty focusing, can often look a lot like hypomanic symptoms. And the mood swings of bipolar can be mistaken for ADHD. This overlap means the conditions can mask each other.‍

With comorbid mental disorders, it’s actually fairly common to receive diagnosis and treatment for the masking condition, leaving the less visible one unmanaged. This is common with ADHD, where many are first diagnosed with depression and generalized anxiety disorder or social anxiety, sometimes even years before ADHD is suspected. 

‍If you suspect both ADHD and bipolar, please speak up and tell a medical professional. Only when both are diagnosed, can you fully get the tailored treatments that will make a real difference in your life. Pushing for a comprehensive evaluation and being open to exploring all possibilities can be transformative. 🦋

If you’ve ever felt like you couldn’t see the whole picture of your mental health, or that you weren’t in control of your own mind or life, then a diagnosis (or two) may be the answer.   

‍Accurate diagnosis matters. It's not just about getting the right label. 🏷️ It's about gaining access to the treatments that truly work. It means getting a clearer understanding of your experiences and finding strategies that help improve your daily life.

The Dopamine Connection

The link between ADHD and bipolar disorder extends deep into the brain's chemistry, particularly involving dopamine, a key neurotransmitter responsible for regulating mood, focus, and motivation. 🧠 Both ADHD and bipolar disorder are associated with dysregulation in dopamine pathways, but they manifest differently.

In ADHD, the core issue often lies in dopamine deficiency, leading to problems with attention, impulsivity, and the brain's reward system. This deficiency can make it hard for individuals with ADHD to find motivation and maintain focus on tasks that do not provide immediate rewards or stimulation.

Unlike ADHD, bipolar disorder might be characterized by periods of dopamine imbalance, where manic episodes can result from an overload of dopamine, leading to heightened energy, euphoria, and sometimes risky behavior. Conversely, during depressive episodes, reduced dopamine activity can contribute to feelings of sadness, lethargy, and a lack of interest in activities once found enjoyable.

Interestingly, both conditions are associated with differences in the dopamine transporter gene (DAT1/SLC6A3), which may help explain why both ADHD and bipolar disorder share genetic factors.

This dopamine connection is why treatments that focus on stabilizing dopamine levels can be effective for managing ADHD and bipolar symptoms.

However, it also underscores the complexity of treating individuals with both ADHD and bipolar disorder, as interventions must carefully balance the dopamine system to address the diverse and sometimes opposing symptoms presented by each condition. 😕

Understanding this dopamine connection is crucial for developing treatment strategies that support overall brain health and emotional regulation. 

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You Asked Us…

What is the co-occurrence of ADHD and bipolar disorder?

The co-occurrence of ADHD and Bipolar Disorder is recognized, with systematic reviews indicating a significant overlap in symptoms and treatment considerations. Recent data indicates that up to 35% of people with ADHD also have bipolar disorder.

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How Do You Treat Bipolar Disorder and ADHD Together?

Effectively treating a complex coexistence like ADHD and bipolar disorder requires a carefully tailored treatment strategy that combines medication and therapy. It may also take a bit of trial and error to find a treatment combination that works for your mind, body, and lifestyle. 

Here’s what a plan to treat bipolar disorder and ADHD may include. 👇

Mood Stabilizers and Stimulant Medications

Medication is an option for both ADHD and bipolar disorders, but they often don’t mix. 

Mood stabilizers are designed to level out the bipolar rollercoaster of emotions, while stimulants typically calm the hyperactivity of an ADHD brain. Mixing the two? That calls for a steady, expert hand. 🩺

See, while stimulants help with ADHD symptoms, they can also trigger a manic episode for those with bipolar if not managed correctly.

Because of this risk, doctors might choose to treat ADHD symptoms with non-stimulant medication, especially if you're already taking a cocktail of mood stabilizers or antidepressants for bipolar disorder. On the other hand, some psychiatrists will use mood stabilizers to reduce the risk of mania if you find that only stimulants work for your ADHD symptoms.

Psychotherapy

Think of psychotherapy as your mental health gym, where you work out emotional kinks and build resilience. Therapy is crucial for managing both ADHD and bipolar, offering a space to wrestle with emotional challenges and learn healthy behavioral patterns. 

‍Cognitive-behavioral therapy (CBT) is the main recommendation here, as it teaches you to identify and change or work through negative thought loops and actions. This is an incredibly helpful tool for anyone, especially when dealing with emotional dysregulation, and it can also help you track your mood cycles.

The Benefits of a Combined Approach

Pairing medication with therapy offers a more rounded approach to managing these complex conditions. Medication tackles the brain’s wiring, helping mellow mood swings or sharpen focus, while therapy equips you with strategies to navigate life’s hurdles and make lasting changes.

‍Tweaking treatment plans is pretty much par for the course, reflecting your growing insights into your mental health needs. By continuously revisiting and adapting treatment considerations you ensure your treatment evolves with you.

Everyday Lifestyle Changes

If you’re diagnosed with ADHD and bipolar, you’ll find yourself on a lifelong journey of finding what works for your brain. What works in childhood or even early adulthood may not be how you choose to manage your adult bipolar disorder or adult ADHD.  

People change, and the way you treat and manage your comorbid bipolar disorder and ADHD should, too. 

That being said, several everyday habits will benefit you throughout your life, so the sooner you start building these habits, the higher your quality of life will be.

These three practices may seem obvious, but the positive impact is huge:

1. Exercise serves as a natural mood stabilizer, crucial for navigating the mood regulation challenges posed by both ADHD and bipolar disorder. It not only helps smooth out mood fluctuations but also boosts cognitive function, making it easier to manage inattentive symptoms like maintaining focus and clarity amidst attentional difficulties and cognitive disruptions. 🏃
2. Mindfulness and meditation are key in managing stress, a common trigger for both ADHD-related impulsivity and the onset of bipolar mood episodes. These practices aid in reducing the frequency and intensity of symptom flare-ups by fostering a sense of calm and resilience. While it may be tough for those of us with a hyperactive mind, it is possible with practice. 🧘
3. Good sleep hygiene plays a pivotal role in emotional stability and cognitive performance. Given that poor sleep can make you extremely irritable, diminish focus, and intensify mood swings, ensuring adequate rest is essential for those with ADHD and bipolar disorder. 🛏️

By weaving these holistic practices into daily routines, individuals with ADHD and bipolar disorder can address some of the core challenges of their conditions beyond traditional medication and therapy approaches (which can be difficult to access in certain situations and countries). These practices not only offer immediate benefits but also contribute to building durable coping mechanisms, enabling individuals to navigate their diagnoses with greater ease and confidence.

Andria’s Story

Here at The Mini ADHD, we’ve personally experienced just how inspiring and comforting it is to share the stories of others living with ADHD, all across the globe. That’s why we've put together a wide range of interviews that explore the real challenges and nuances of managing ADHD.

We wanted to share Andria’s story here because it offers a valuable perspective on the complicated relationship between ADHD and bipolar disorder.‍

‍Andria was initially diagnosed with bipolar type 2, which is characterized by hypomanic episodes, a less intense mood than mania. 

She started taking strong medication designed to treat her ‘bipolar’, but the diagnosis didn’t sit right with her. She had no family history of bipolar but did have family members who displayed ADHD symptoms, which led her to seek a new diagnosis. 

‍After nearly four years with an adult bipolar disorder misdiagnosis, she was diagnosed with combined ADHD and immediately knew she finally had the right diagnosis. Now she’ll be able to treat ADHD specifically. 🎉

Andria’s path to correctly identifying her ADHD sheds light on the importance of recognizing symptom overlaps for an accurate diagnosis and effective management.

Her experience is a powerful reminder of how crucial it is to dig deep into our symptoms and listen to our own instincts to ensure we're on the right track toward wellness. No one knows you like you do. 

Key Takeaways

• ADHD and bipolar disorder can coexist with overlapping symptoms such as impulsivity and mood instability, which complicates differentiation.
  
• ADHD symptoms include inattention, impulsivity, organization difficulties, and restlessness, while bipolar disorder involves extreme mood swings between manic/hypomanic and depressive episodes.
  
• Shared symptoms such as impulsivity, mood instability, emotional dysregulation, and fluctuating energy levels can lead to misdiagnosis or delayed diagnosis.
  
• Mood stabilizers and stimulant medications must be carefully managed to avoid exacerbating symptoms.
  
• Psychotherapy, particularly cognitive-behavioral therapy (CBT), is essential for managing emotional challenges.
  
• Lifestyle changes, including regular exercise, mindfulness, and good sleep hygiene, complement traditional treatments. These practices offer immediate benefits and build long-term coping mechanisms.‍
• Accurate diagnosis is essential for effective management and access to appropriate treatments. If you doubt your diagnosis, don’t be afraid to speak up.

Remember, you're not alone in navigating the complexities of ADHD and bipolar disorder. Seek support, advocate for accurate diagnosis, and explore tailored treatment options to reclaim control over your mental health journey. 💕