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Comorbidities: ADHD & Bipolar Disorder

What is Bipolar Disorder?

Bipolar disorder is a serious mental illness that causes dramatic shifts in a person's mood, energy, activity, concentration, and decision-making. There are three types:

  • Bipolar I disorder - Involves manic episodes that last for at least 7 days (nearly every day for most of the day) or manic symptoms severe enough to require immediate medical care. These usually include depressive episodes, typically lasting at least 2 weeks. There may also be episodes of depression with mixed features (both depressive and manic symptoms simultaneously.

  • Bipolar II disorder -Involves a pattern of depressive episodes and hypomanic episodes which are less severe than the manic episodes in bipolar I disorder.

  • Cyclothymic disorder (also called cyclothymia) - Involves recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.

How are Bipolar Disorder and ADHD related?

The differential diagnosis between ADHD and Bipolar Disorder (BD) is considered the most difficult one to make since they share many symptoms. It’s estimated that 20% of those diagnosed with ADHD also suffer from BD. Although they share a majority of symptoms (mood changes, hyper behavior, distractibility, genetic component, etc.), there are nuances in those symptoms that set them apart.


ADHD is persistent and BD is more episodic in nature. ADHD is chronic and pervasive, so a person might be more distracted doing one thing versus another, but the symptoms are present all the time. Those with BD do have a baseline where they feel normal, but they experience depressive and manic episodes that last for several days at a time. During that period, they will have more difficulties with distractibility or racing thoughts.

Onset & Family History

Even though ADHD is sometimes not diagnosed until adulthood, it develops during childhood and persists throughout a person's life. The severity may vary depending on how well the structure they have in place works for them. Typically, when adults are diagnosed with ADHD, it tends to explain many of the issues experienced throughout childhood and adolescence. In contrast, the average age of BD onset is 25, according to the American Psychiatric Association.

Both disorders run in families, but people with BD usually have a family history of it while individuals with ADHD have a family tree with multiple cases of it.

Depression's Manifestation

Although depression and anxiety are common in ADHD and BD, the biggest difference is in how they manifest. In ADHD, these symptoms are secondary, meaning they are a result of the frustration and challenge that comes from dealing with it. Feelings of inadequacy and hopelessness can easily develop when executive dysfunction affects performance at school, work, or home. It can make life miserable. With BD, these depressive states are a core component, not typically tied to or the result of anything else.

Mood Shift's Speed & Duration

ADHD mood shifts are triggered and often instantaneous shifts from one state to another. They are typically described as "crashes" or "snaps” emphasizing how sudden they can be. These mood shifts are also short and usually measured in hours. On the other hand, BD mood shifts are often untriggered and take hours or days to move from one state to another. They are also typically sustained. A person can experience four shifts of mood from high to low or vice versa in a 12-month period of time. Many people with ADHD experience the same number of mood shifts in a single day.


If both ADHD and BD coexist in a person, treatment requires a careful assessment and often a delicate balance of medication. For ADHD, you might be prescribed a stimulant to improve attention and executive function and control impulsive behavior. These medications, however, may trigger mania or hypomania associated with BD. For BD, you may be prescribed a combination of mood stabilizers and antipsychotics. These can help with depressive episodes but may also trigger hypomanic episodes. Some do well with stimulants, others do not. Some feel good initially, but then quickly deteriorate. This is why managing ADHD and BD simultaneously must be highly individualized as it depends on several variables. Finding the most effective treatment plan can be exhausting and frustrating due to all the medication changes and parsing through symptoms that may be required.

Cognitive behavioral therapy (CBT) can also greatly benefit because it helps change negative thought patterns and manage emotional dysregulation.

The bottom line is, these mental disorders, individually or together, can be extremely disruptive. But with the right medication/treatment, you can be happy, successful, and productive.



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