Link Between ADHD and Bipolar Disorder

What Is Bipolar Disorder?

Formerly known as manic depression, bipolar disorder is a mental health condition that causes extreme mood swings that range from depressive lows to manic highs, otherwise referred to as episodes of mania and depression. When people with bipolar disorder experience depression, they may have symptoms like sadness or hopelessness and lose interest in pleasurable activities. 

When the person’s mood shifts to mania or hypomania (a less severe version of mania), they may feel euphoric, energetic, talkative, full of energy, and unusually irritable. These mood swings are severe enough to affect sleep, energy, activity, judgment, behavior, and the person’s ability to think clearly and fulfill their responsibilities. 

These bipolar disorder mood swings can occur rarely or multiple times a year, depending on the nature of the person’s diagnosis. There are also several kinds of bipolar disorder, such as bipolar I disorder, bipolar II disorder, and cyclothymic disorder, each of which produces mood swings at different rates and levels of severity. 

Bipolar and ADHD Relationship

Because of their similarities, we wanted to look into the link between ADHD and bipolar disorder to determine why they co-occur and how common their comorbidity is. 

How Are ADHD and Bipolar Disorder Related?

As difficult as it can be to manage one of these disorders, imagine how challenging it is to be diagnosed with both. However, you can have ADHD and bipolar disorder simultaneously.

In a 2018 study on the comorbidity of bipolar and ADHD in adults, researchers sought to examine the prevalence of bipolar disorder among a group of 2.8 million people in Denmark. They found that bipolar disorder was almost 11 times more likely to occur in people with an underlying diagnosis of ADHD compared with people who had no prior diagnosis of the condition. 

Although the specific connection is unclear, it's possible for ADHD and bipolar disorder to share genetic factors, as well. One 2015 study that examined data from 13,532 twins found that genetics linked to mania played a role in the development of ADHD in people with bipolar disorder.⁴ 

Another way to view this relationship is by their symptoms. It's understandable why people with ADHD (a condition associated with hyperactivity and impulsive behavior) may also struggle with manic episodes or symptoms of mania associated with bipolar disorder, including increased talkativeness, increased activity, reduced appetite, and reduced need for sleep.

Those who take ADHD medications may also be more likely to experience severe depressive moods when their medications wear off. It's common for people to experience a comedown or crash after the effects of stimulants wear off, which may play a factor in this relationship.

How often do ADHD and bipolar disorder occur? Research suggests that ADHD and bipolar disorder often co-occur together. One 2021 study found that 1 in 13 adults with ADHD will also be diagnosed with bipolar disorder, and 1 in 6 adults with bipolar disorder had ADHD.⁵

How Are They Diagnosed?

Like other mental health disorders, ADHD and bipolar disorder are both diagnosed by physicians or psychiatrists according to the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders(DSM-5). The diagnosis criteria for ADHD is:⁶ 

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities 
• Often has difficulty paying attention to tasks or activities 
• Often does not seem to listen when spoken to directly (their mind seems elsewhere, even in the absence of any obvious distraction)
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (they start tasks but quickly lose focus and are easily sidetracked)
• Often has difficulty organizing tasks and activities 
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (schoolwork or homework, preparing reports, completing forms, reviewing lengthy papers)
• Often loses things necessary for tasks or activities (including school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
• Is often easily distracted by irrelevant stimuli 
• Is often forgetful in daily activities (including doing chores, running errands, returning calls, paying bills, keeping appointments)

Six or more of these symptoms need to persist for at least six months to the degree that is not consistent with the individual’s developmental level and negatively impacts their social, academic, or occupational activities. For bipolar disorder, the DSM-5 diagnostic criteria include symptoms of both mania and depression, such as:⁷

• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Increased talkativeness and energy
• Racing thoughts
• Distracted easily
• Unusual irritability 
• Increased goal-directed activity 
• Engaging in activities that hold the potential for painful consequences, like unrestrained buying sprees
• Depressed mood most of the day, nearly every day
• Loss of interest or pleasure in all, or almost all, activities
• Significant weight loss or decrease or increase in appetite
• Engaging in purposeless movements, such as pacing the room
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Diminished ability to think or concentrate, or indecisiveness
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt

What Is the Difference Between ADHD and Bipolar Disorder?

Despite their relationship, ADHD and bipolar disorder are not the same things. While bipolar disorder is primarily a mood disorder, ADHD affects attention and behavior, causing symptoms like inattention, hyperactivity, and impulsivity. 

While ADHD is chronic and ongoing, bipolar disorder symptoms are episodic and interrupted by periods of normal mood interjected by depression, mania, and hypomania. Additionally, while a person with bipolar disorder may experience ADHD-like symptoms, they would not occur as persistently as they would in someone with ADHD. 

Can ADHD Be Misdiagnosed As Bipolar Disorder?

ADHD) and bipolar disorder share certain symptoms, such as impulsivity, distractibility, and mood fluctuations, which can sometimes lead to instances of ADHD misdiagnosed as bipolar disorder or confusion between the two conditions. The fact that these illnesses may present differently in different people and may even coexist in some circumstances makes diagnosing them more difficult. The symptomatology of ADHD and Bipolar Disorder overlap, and the latter’s mood fluctuations may be misdiagnosed as ADHD due to their similarities to inattention or hyperactivity.

Treatment options may be significantly impacted by misdiagnosis of either condition. Stimulant drugs, which are frequently recommended for ADHD, could potentially worsen symptoms in those with undiagnosed or incorrectly diagnosed bipolar disorder, as these drugs could cause or exacerbate manic episodes. To effectively distinguish between various diseases, a complete and in-depth evaluation by a qualified mental health practitioner is essential. In cases when ADHD and Bipolar Disorder co-occur, it is crucial to consider a person's entire clinical history, family history, and a thorough assessment of their symptoms throughout time. A correct diagnosis not only ensures the right course of treatment but also lessens the danger of using the incorrect course of treatment.

Is ADHD a Precursor to Bipolar Disorder?

It's crucial to understand that having ADHD does not automatically predispose someone to bipolar disorder. However, there is evidence to show that compared to the overall population, those with ADHD may have a slightly increased chance of developing bipolar disorder. According to some research, having ADHD as a child may make you more likely to develop bipolar disorder later in life, especially if your symptoms are more severe or continue until puberty.⁸ Nevertheless, the connection between the two disorders is intricate and probably involves a number of yet-to-be-examined genetic, environmental, and neurological factors.

Approaching this topic with caution and avoiding assumptions is key. Because the diagnostic criteria for ADHD and bipolar are different, a thorough evaluation by a licensed mental health professional is required for an accurate diagnosis. Even though they have distinct behavioral patterns and underlying causes, these disorders may show certain symptoms, such as impulsivity and mood swings. More research is required as our understanding of the brain and mental health develops in order to better comprehend the complex relationship between ADHD and Bipolar Disorder and to identify any potential causal or associative factors that may contribute to the emergence of one condition in people with a history of the other.