Relationship Between Bipolar and ADHD

Bipolar disorder is a mental health condition characterized by changes in thoughts, mood, and behavior. A person with bipolar disorder may experience periods of mania, hypomania, and depressive episodes

Attention deficit hyperactivity disorder (ADHD) is characterized by inattention and/or hyperactivity and impulsivity. Onset happens during childhood and includes three main presentations: predominantly inattentive, predominantly hyperactive-impulsive, or a combination.

This article explores the relationship between bipolar disorder and ADHD, and why they can occur together.

Relationship Between Bipolar Disorder and ADHD

Bipolar disorder and ADHD can be comorbid, meaning a person can have both conditions at the same time. Determining whether someone has bipolar disorder, ADHD, or both can be challenging, as some symptoms are similar.

Symptoms of ADHD, such as impulsivity, inattention, or distractibility, may also be observed in individuals with bipolar disorder, specifically during an elevated mood state.

Everyone’s experience with bipolar disorder and/or ADHD is different. It's important to accurately diagnose both disorders, if present, as research indicates the comorbidity of these conditions can significantly affect daily functioning.

Why Do Bipolar and ADHD Occur Together?

Because the exact causes of both bipolar disorder and ADHD are unclear, it's challenging to determine why they co-occur.

However, one study found that individuals with first-degree relatives of people with ADHD (parents, offspring, and siblings) were more likely to develop bipolar disorder. This may suggest a potential genetic connection.

How Often Does ADHD Co-Occur With Bipolar Disorder?

One study of individuals with ADHD found co-occurring bipolar disorder in 4.9% of participants, and other research has found a higher incidence. The risk of someone with ADHD developing bipolar disorder is significantly higher than those without ADHD.

Signs and Symptoms of Bipolar and ADHD

Bipolar disorder is characterized by symptoms of mania, hypomania, and depression. Mania may include:

• Inflated sense of self
• Elevated mood
• Decreased need for sleep
• Racing thoughts
• Pressured speech
• Distractibility
• Impulsivity

Symptoms of hypomania are similar but less disruptive. 

Symptoms of depression include:

• Low and depressed mood
• Difficulty concentrating
• Disturbances to sleeping patterns
• Lack of interest in activities that previously brought pleasure
• Fatigue or lethargy
• Feelings of worthlessness, helplessness, hopelessness
• Thoughts of death or suicide

ADHD is defined by symptoms of inattention, hyperactivity-impulsivity, or both. 

Inattention presentation can look like:

• Missing important details
• Difficulty maintaining attention or focus
• Distractibility
• Challenges with organization and follow-through 
• Forgetfulness regarding daily activities

Hyperactivity and impulsivity can look like:

• Inner restlessness
• Interrupting or intruding
• Difficulty with planning and execution 
• Trouble sitting still (fidgeting, tapping) 

A person with ADHD can experience symptoms of both inattention and hyperactivity-impulsivity. 

Treatment for People With Both

Treatment for co-occurring bipolar disorder and ADHD is not straightforward. More research is needed to determine best practices.

Currently, healthcare providers may approach each case on an individual basis to identify the patient's needs. However, treating symptoms to stabilize patients is generally considered the first step of treatment.

Treatment strategies for bipolar disorder include medication, psychotherapy, and lifestyle changes. Medication options may include:

• Mood stabilizers
• Antipsychotics 
• Antidepressants (depending on the type of bipolar disorder, as they may trigger mania)
  

Once bipolar symptoms are managed in patients with comorbid bipolar disorder and ADHD, a healthcare provider may add stimulant or non-stimulant medications to target symptoms of inattention.

Some non-stimulant medications used to treat ADHD include:

• Atomoxetine
• Clonidine
• Guanfacine
  

Stimulants can trigger manic symptoms in some cases, so regular check-ins with a healthcare provider are essential. Medication management with bipolar disorder and ADHD may involve some trial and error.

Lifestyle changes such as getting regular sleep, eating healthy and balanced meals, and exercise can support people with bipolar disorder and ADHD.

Therapeutic interventions for bipolar disorder such as cognitive behavioral therapy (CBT) and dialectical behavior therapy can teach individuals how to challenge distorted thinking, improve how they regulate their emotions, and increase coping skills. Additional strategies and behavioral interventions, such as establishing routines and creating systems to support symptoms, may also be helpful.

Ultimately, collaboration with a healthcare provider can determine the best treatment plan.

Summary

Bipolar disorder is a condition characterized by mood episodes. A person may experience low and elevated mood states with a host of symptoms affecting thoughts, emotions, and behavior. ADHD is a neurodevelopmental condition characterized by inattention and/or hyperactivity-impulsivity. These conditions can co-occur and have overlapping symptoms, which complicates diagnosis. However, treatment strategies such as therapy, medication, and lifestyle changes can improve symptoms.

A Word From Verywell

Managing bipolar disorder or ADHD can be challenging. When these conditions occur together and symptoms overlap, it can be overwhelming. However, having a clear diagnosis and understanding of your symptoms can help you develop an effective treatment plan with your healthcare provider.