ADHD and Bipolar Disorder - Can You Have Both?

Is it possible for someone to have both ADHD and bipolar disorder?

Let us first start by talking about ADHD. According to the DSM-5 Diagnostic criteria, some characteristics of Attention Deficit Hyperactivity Disorder include, but are not limited to: difficulty paying attention, decreased attention span, easily distracted, is often “on the go” or appears to be “driven by a motor,” and/or lack of self-control. Symptoms usually present prior to 12 years of age; however, it is not uncommon for ADHD to be diagnosed at a later age. Diagnosis is usually based on symptoms and objective screening tools.

So, what exactly causes ADHD? We know there is a strong link with genetics. According to the CDC (2020), some other factors that might contribute to the symptoms of ADHD include brain injury, exposure to environmental toxins (such as lead) during pregnancy or at a young age, alcohol and/or tobacco use during pregnancy, premature delivery, and low birth weight.

Treatment for ADHD includes a variety of medications and behavioral therapy.

Now let us switch to bipolar disorder. You might be asking yourself "what does bipolar really mean?". In bipolar disorder, one can have times of being energized, going without sleep, and being impulsive, but also have other times when one is depressed and cannot get out of bed. There are 2 types of bipolar disorder. Bipolar type I is defined by a manic stage having sustained and abnormally elevated or irritable moods for at least one week. Some other symptoms may include impulsivity, being easily distracted, racing thoughts, and talking rapidly and loudly. The depressive stage of bipolar type I may include feelings of hopelessness, difficulty concentrating, fatigue, and problems sleeping. Type I bipolar disorder is generally more common than type II (Teh et al.,2020). Type II bipolar disorder is defined by depressive episodes and hypomanic episodes. Hypomanic episodes are having irritability and more energy than usual but is not full-blown manic like in Type I. Diagnosis is made based on symptoms as well as diagnostic questionnaires. The National Institute of Mental Health (NIMH, 2021) notes that bipolar disorder is usually diagnosed during late teen years or early adulthood. Manic episodes are more seen in men; however, depressive and mixed episodes are more seen in women (Pillai et al., 2020).

So, what causes bipolar disorder? As with ADHD, there is also a strong genetic link. According to the NIMH (2021), brain structure and functioning play an important role in bipolar disorder. However, more research is being done how that will translate to better treatment options in the future. Some other risk factors for bipolar disorder include prenatal and perinatal infections, childhood maltreatment, psychological stressors, and substance misuse (Rowland and Marwaha, 2018). While bipolar disorder can sound intimidating, rest assure that there are treatment options. This can include medications and various forms of therapy.

As you can see, many of the symptoms of ADHD and bipolar can overlap. This overlap can lead to underdiagnosis and undertreatment of these disorders. Getting the right diagnosis is important to help attain the correct treatment and a remission of symptoms. A research article published by Hegerl et al (2010) states, “Symptomatology of ADHD is more or less stable over many years, mania typically occurs in episodes…Images of the brain noted similar abnormalities in both ADHD and bipolar disorder.” Because there are similar abnormalities in both ADHD and bipolar disorders on brain images, this can explain the similarity of symptoms. This also can explain why someone can have both ADHD and bipolar disorder.

Another study estimated that nearly twenty percent of the population who have bipolar disorder also have ADHD (Viktorin et al., 2017). This study also notes that it is important for the provider to rule out a bipolar disorder before starting a stimulant. If a patient has bipolar disorder and ADHD, a stimulant may be prescribed provided a mood stabilizer is given as well. Another research article published by Pataki and Carlson (2013) found that stimulant treatment did not worsen mood symptoms in children being treated for ADHD with bipolar disorder. In the research article, the bipolar was also being managed with mood stabilizing medications. Girard and Joober (2017) also recommend that bipolar symptoms be under control first and then suggest medications that could improve attention problems.

In conclusion, bipolar and ADHD can occur together. With the possibility of these disorders co-occurring, discussing the symptoms with one’s healthcare provider ensures getting the right diagnosis and treatment thus giving the greatest quality of life.

Written by Peter Rambo (BSN, RN; AGNP-BC Student) and Kimberly Parker (FNP-BC)

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Girard, R., & Joober, R. (2017). Treatment of ADHD in patients with bipolar disorder. Journal of psychiatry & neuroscience: JPN, 42(6), E11–E12. https://doi.org/10.1503/jpn.170097

Hegerl, Ulrich; Himmerich, Hubertus; Engmann, Birk; Hensch, Tilman Mania and attention-deficit/hyperactivity disorder: common symptomatology, common pathophysiology and common treatment?, Current Opinion in Psychiatry: January 2010 - Volume 23 - Issue 1 - p 1-7. doi:10.1097/YCO.0b013e328331f694

NIMH» Bipolar Disorder. (2021, January 28). National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Pataki, C., Carlson, G.A. The Comorbidity of ADHD and Bipolar Disorder: Any Less Confusion?. Curr Psychiatry Rep 15, 372 (2013). https://doi-org.pallas2.tcl.sc.edu/10.1007/s11920-013-0372-5

Pillai, M., Munoli, R.N., Praharaj, S.K. et al. Gender Differences in Clinical Characteristics and Comorbidities in Bipolar Disorder: a Study from South India. Psychiatr Q (2020). https://doi.org/10.1007/s11126-020-09838-y

Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic advances in psychopharmacology, 8(9), 251–269. https://doi.org/10.1177/2045125318769235

Teh, W. L., Abdin, E., Vaingankar, J., Shafie, S., Yiang Chua, B., Sambasivam, R., Zhang, Y., Shahwan, S., Chang, S., Mok, Y. M., Verma, S., Heng, D., Subramaniam, M., & Chong, S. A. (2020). Prevalence and correlates of bipolar spectrum disorders in Singapore: Results from the 2016 Singapore Mental Health Study (SMHS 2016). Journal of Affective Disorders, 274, 339–346. https://doi.org/10.1016/j.jad.2020.05.032

Viktorin, A., Rydén, E., Thase, M. E., Chang, Z., Lundholm, C., D'Onofrio, B. M., Almqvist, C., Magnusson, P. K., Lichtenstein, P., Larsson, H., & Landén, M. (2017). The Risk of Treatment-Emergent Mania with Methylphenidate in Bipolar Disorder. The American journal of psychiatry, 174(4), 341–348. https://doi.org/10.1176/appi.ajp.2016.16040467

What is ADHD? (2020, October 23). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/facts.html