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Bipolar Disorder?  ADHD?  It Might be Both.

Speed goes up.  Emotions go down.  Up, up, up.  Down, down, down.  Bipolar disorder and ADHD look a lot alike.  You need strategies to tell them apart.  Here’s how.

Bipolar disorder moves from feelings of euphoria down to depression.  The challenge is that it’s also characterized by impulsivity, physical over-activity, and mood reactivity.  These also mirror the symptoms of ADHD.

Being able to tell the differences between bipolar disorder and ADHD is confusing.  What happens when they look the same?  Almost 60% of children with ADHD have been found to have an affective illness.  Research studies show that more than 70% of the people with bipolar disorder also have ADHD.  It is important to receive the right diagnosis to treat the conditions efficiently.


  • Depressive Episodes (One side of bipolar disorder)


      • Persistent, sad, or irritable mood.
      • Loss of interest in previously enjoyable activities.
      • Significant changes in appetite, body weight, sleep patterns.
      • Low energy and concentration.
      • Feelings of worthlessness and recurrent thoughts of death and suicide.


  • Manic Episodes (The other side of bipolar disorder)


    • Severe changes in mood.
    • Inflated self-esteem and grandiosity.
    • Increased, revved-up energy.
    • Impulsive or self-destructive behaviors.
    • Psychosis (detached from reality).

Bipolar disorder and ADHD are a bad combination that cannot be overestimated.  In fact, it is often debilitating and tormenting in nature.  

The challenge in diagnosing a person with ADHD who is bipolar as well is creating an appropriate perspective.  The team should include a psychiatrist, psychologist, teachers, and parents.  All should remember that while ADHD affects attention and behavior, bipolar disorder is primarily impacts mood.

One consideration is whether a person has both bipolar and ADHD is determining if depression is present.  This is especially challenging as depression is less common in younger cases.  Extra care must be taken as there is rapid cycling between pleasure-seeking, anger, and relative calm.


  • Age of Onset


      • ADHD:  Symptoms apparent at 12
      • BD:  First episode 18 (26 mean)


  • Consistency of Impairment


      • ADHD:  Persistent
      • BD:  Cycling episodes


  • Mood Triggers


      • ADHD:  Strong emotional reactions
      • BD:  No seeming connection with events


  • Rapidity of Mood Shift


      • ADHD:  Sudden onset, instantaneous
      • BD:  Hours, days


  • Family History


    • Common throughout family tree
    • Fewer genetic connection

Research shows that there is more effective if bipolar disorder is treated first.  Mood stabilizers may not resolve ADHD symptoms.  If ADHD symptoms continue, it is recommended to titrate ADHD meds.  However, little information exists on combining stimulants with mood stabilizers or antipsychotics.  Stimulants may be acceptable if bipolar symptoms respond well to mood-stabilizing agents.  This use requires ongoing monitoring.

Discussion continues on the efficacy of a combination of medications for comorbid bipolar disorder/ADHD.  However, the great majority of people with ADHD and depression respond with treatment.

Some forms of counseling or psychotherapy can be effective.  Therapy benefits through a combination of individual and family treatments.

  • Recognize pleasure-seeking risks.
  • Monitor consequences of non-compliance.
  • Alter incentives based on circumstances.
  • Lead to more balanced behavior.
  • Create systems in meeting personal and academic needs.

Bipolar disorder and ADHD share symptoms.  ADHD is more common, leaving bipolar disorder to be missed or misdiagnosed.  Physicians should avoid assessing in isolation.  Parents using observational checklists can better become involved in the process.

What characteristics of bipolar disorder have you seen (self, child)?

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