Bipolar disorder and Attention-Deficit/Hyperactivity Disorder (ADHD) are two common psychological conditions experienced among children and adults alike. Since ADHD symptoms are pretty similar to bipolar disorder, they are often mistaken for each other. Moreover, they are also comorbid, meaning both conditions may occur together. There is a high chance one of the conditions being overlooked due to the similarity in ADHD symptoms and bipolar disorder symptoms.
Understanding when ADHD and bipolar disorder are comorbid can have important implications for treatment decisions. However, it is difficult to diagnose both the conditions together since ADHD is a neurodevelopmental disorder that starts in childhood. In contrast, bipolar disorder may be diagnosed later in adulthood. Knowing when and how often both these disorders occur is essential to create awareness and implement adequate treatment options. Such measures are necessary because co-morbidity has a more severe course than either diagnosis alone and is also linked to higher suicide attempts.
Keep reading to find out the differences between ADHD and bipolar disorder, why these conditions are comorbid in some scenarios, how often both conditions occur together, and the different options for bipolar disorder and ADHD diagnosis and treatment.
ADHD and Bipolar Disorder – What’s the Difference?
ADHD is a neurodevelopmental disorder that most commonly affects children. However, there is also a high prevalence of ADHD in adults. Symptoms of ADHD include a lack of focus or attention, forgetfulness, excessive fidgeting and talking, impulsive behavior, difficulty in forming relationships, and a tendency to take risks among others. It is most often identified when individuals attempt to disrupt the college or work environment and have trouble getting along with peers or colleagues.
In contrast, bipolar disorder is a mental health condition that may result in extreme mood swings. Patients often oscillate between episodes of emotional highs such as mania or hypomania to lows like depression. Shifting between both ends of the emotional spectrum can affect the patient’s day-to-day functioning, energy, sleep, judgment, and clarity. These episodes can span the patient’s entire lifetime, however, they are mostly free of any symptoms in between these episodes.
Why Do ADHD and Bipolar Disorder Occur Together?
Researchers are still studying why ADHD and bipolar disorder occur together in some patients. One hypothesis is that there may be some common underlying biological and genetic factors. A study conducted in 2015 set out to test the robustness of this hypothesis. Researchers used data from 13,532 twins to get a deeper understanding of the genetic underpinnings in ADHD and bipolar disorder co-morbidities. They found that genetic factors connected to mania had a 25 – 42% association with ADHD symptoms.
Follow-up studies will be helpful in further understanding the association between ADHD and bipolar disorder for efficient treatment options.
How Often Do They Occur Together?
Many studies have set out to determine the frequency of ADHD and bipolar disorder co-morbidity. One such review aimed to analyze rates of ADHD and bipolar disorders in a sample of 646,000 participants. They found that ADHD was comorbid with bipolar disorder in roughly 1 in 13 adults. Conversely, the ratio was 1 in 6 adults for bipolar disorder comorbid with ADHD.
Hence, as research suggests, ADHD and bipolar disorder occur together in a large proportion of individuals. Thus, clinicians and healthcare providers must be cognizant of these statistics while diagnosing patients with either of these conditions.
Due to similarities between bipolar disorder and ADHD symptoms like inattention and hyperactivity, clinicians are presented with a challenging task. While there are no set guidelines available, clinicians can employ the American Psychiatric Association’s Diagnostic and Statistical Manual criteria to diagnose bipolar disorder in patients with ADHD.
There are also cases where clinicians and sometimes patients are more inclined towards an ADHD diagnosis than bipolar disorder if symptoms overlap. Bipolar disorder is more complex and challenging to treat than ADHD in adults. There is also a more significant social stigma attached to it. The stigma can be further deteriorating for the patient’s health; hence the diagnosis of bipolar disorder is ignored in some cases even if the symptoms are blatant.
Despite their similarities, there are still some distinguishing factors between ADHD and bipolar disorder. ADHD symptoms are more or less a regular part of the patient’s life. Hence, if the patient is experiencing a lack of focus and hyperactivity as a regular part of their routine, their condition is most likely diagnosed as ADHD. In contrast, bipolar disorders occur in episodes. The patient may face a manic or depressive episode for around 4 – 7 days, and then the symptoms subside. Thus, if the symptoms occur only over a specific time period and are absent otherwise, it is bipolar disorder.
What Strategy Do Clinicians Adopt?
There is a scarcity of research on treatment options for patients with both ADHD and bipolar disorder. Hence, clinicians decide the best course of action keeping the severity of the patient’s symptoms in mind as there are no definitive criteria set in place so far.
One strategy that healthcare providers adopt is to treat bipolar disorder initially. Once those symptoms are under control, they move towards the ADHD symptoms.
Medications for ADHD and Bipolar Disorder
Different drugs and therapies are available for both ADHD and bipolar disorder. The most commonly used medications for bipolar disorder include antidepressants, antipsychotics, mood stabilizers, and benzodiazepines. ADHD in adults and children is usually treated with nervous system stimulants like methylphenidate or as it is commonly known as Ritalin.
Treating both ADHD and Bipolar Disorder Together
While each condition has its own set of medications for treatment, it is not as straightforward treating both together. For example, there have been issues in the stimulant treatment of ADHD when the bipolar disorder was a comorbid condition. A 2016 study found that patients on Ritalin for ADHD treatment who also had bipolar disorders and were not placed on mood stabilizers had nearly a 7-fold chance of a manic episode in 3 months. But if these patients were also treated with a mood stabilizer for bipolar disorder and Ritalin, then the medications worked effectively to control the symptoms.
The Final Word
ADHD diagnosis and treatment may become challenging if the patient also has bipolar disorder as a comorbid condition. Given the lack of research on this topic, it is highly dependent on the expertise and prior knowledge of the healthcare providers in understanding the symptoms and administrating the best treatment option. With an increasing interest in the intersection of both these conditions, there is greater awareness on how to manage ADHD symptoms in patients with bipolar disorder. If you are looking for ADHD treatment in Austin, be sure to get in touch with our ADHD specialist at the Family Medicine Austin where we are offering a broad spectrum of treatment options.