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ADHD and Bipolar 1 Disorder: The Connection You Should Know About

Posted on April 11, 2023
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Medically reviewed by
Paul Ballas, D.O.
Medically reviewed by
Remi A. Kessler, M.D.

  • Bipolar disorder and attention deficit/hyperactivity disorder (ADHD) have several overlapping symptoms, which sometimes makes diagnosis challenging.
  • Between 10 percent and 20 percent of adults with bipolar disorder also have ADHD.
  • If you have both conditions, treatment can involve both mood stabilizing and stimulant medications.

It’s important for anyone living with bipolar 1 disorder or ADHD to be aware of the links between these two conditions. They have several symptoms in common, which can make getting the right diagnosis difficult. It’s also possible to have both ADHD and bipolar 1 disorder at once.

Understanding how these mental health conditions are similar and different can help you and your doctor reach an accurate diagnosis and decide on the best treatment options.

What Are the Symptoms of ADHD?

ADHD has a variety of symptoms, including difficulty focusing and hyperactive motor movement (like fidgeting). It can lead to significant challenges at school or work, or in social settings.

ADHD is most often diagnosed in kids, but adults can also have it. Studies show adult ADHD is still present for between 15 percent and 65 percent of people who were diagnosed with ADHD before they became adults. Adult ADHD can include additional problems with controlling emotions, impulsivity, disorganized thinking, restlessness, and difficulty functioning in work or personal relationships.

Several conditions can coexist with ADHD, especially mood and personality disorders. In particular, bipolar disorder has some overlapping symptoms with ADHD. This can cause bipolar disorder to be underdiagnosed and undertreated.

What Are the Symptoms of Bipolar 1 Disorder?

Bipolar 1 disorder is a mood disorder characterized by intense, shifting mood swings that include manic episodes interspersed with periods of normal emotion or depression. These serious shifts in mood often lead to difficulties in daily life.

Distinguishing between bipolar and ADHD can be difficult, given that the conditions share similarities, including:

  • Inattention
  • Impulsivity
  • Distractibility
  • Irritable mood
  • Sleep disturbances

One difference is that ADHD symptoms are typically stable over time, whereas bipolar disorder symptoms fluctuate over time. Additionally, the symptoms of ADHD often become clear by age 12, whereas bipolar disorder usually appears in young adulthood at an average age of 25.

Is It Common To Have ADHD and Bipolar Disorder?

Many studies show that ADHD and bipolar disorder often co-occur. The National Comorbidity Survey-Replication, considered to be the largest mental health survey available in the United States, estimated that about 21 percent of people with an ADHD diagnosis also had bipolar disorder. Two studies on 40,000 people with ADHD in Norway and 61,000 in Sweden found that 13 percent to 18 percent of women and around 9 percent of men with ADHD also had bipolar disorder.

Another study in the U.S. found that people living with bipolar disorder had a 6.7 higher odds of also having ADHD as compared to the general population in the United State.

Increased Mental Health Risks

If you have ADHD, bipolar 1 disorder, or both, it’s important to be aware of additional health risks. One study showed that people with bipolar disorder who also had ADHD tended to be younger when bipolar disorder began, and had a higher risk of substance abuse and anxiety, as compared to those with bipolar disorder only.

In 2019, a study of 703 people with bipolar disorder found that those in the study with ADHD had more challenges with school performance and relationship stability, as well as a higher risk of suicide attempts and substance use. This increased risk of suicidal behavior is a known symptom of both bipolar disorder and ADHD. While strong research is lacking on having both conditions and the risk of suicidality, one study with 500 subjects found people with both conditions were nearly twice as likely to attempt suicide.

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

Diagnoses May Change With Age

More than half of kids who receive a diagnosis of ADHD continue to have adult ADHD, but for many, the diagnosis changes with age.

Similar rates of ADHD are reported among those with all types of bipolar disorder. Studies have looked at the risk for juveniles with ADHD to develop bipolar disorder, but results have been mixed. One study followed boys with ADHD for 10 years and found they were more likely to develop bipolar disorder by the time they reached 21 years old. A similar study found that girls with ADHD were more likely to develop bipolar disorder by age 22.

However, a larger study with 14 years of follow-up concluded having ADHD in the first or second decade of life is not a risk factor for developing bipolar disorder. However, people with ADHD may have higher rates of bipolar symptoms than the general population. More research is needed to truly understand the way these two conditions influence each other.

A diagnosis of major depression or a series of depressive episodes can be changed to a diagnosis of bipolar disorder in early adulthood, if new symptoms arise. Because symptoms of several mental health conditions can change throughout early life and adulthood, it’s important to keep in mind that nothing is set in stone. Always communicate symptom changes to your doctor.

The Goal of Treatment is Mood Stabilization

For people living with both bipolar disorder and ADHD, the most important goal of treatment is mood stabilization. Many young people with ADHD may not go on to have adult ADHD, even if they have bipolar disorder. Nevertheless, symptoms of difficulty with concentration and memory can persist and are thought to be due to ADHD.

In these cases, treatment can include ADHD medications such as methylphenidate (Ritalin), atomoxetine (Strattera), or amphetamine salts. However, the combination of a stimulant medication for ADHD treatment with a mood stabilizer is not well-studied. There is a risk of stimulant medications for ADHD inducing a manic episode in a person with bipolar disorder. This is especially possible when a person is not already consistently taking a mood stabilizing medication.

Always let your health care provider know about all medications you might be taking, and whether you regularly take them according to prescribed doses.

Getting the Right Diagnosis

Research from the journal Medicina estimates that 10 percent to 20 percent of adults with bipolar disorder also have ADHD. A younger age at the diagnosis of bipolar disorder seems to be linked with a higher likelihood of having both.

If you have any concerns about whether you have the right diagnosis or treatment, speak to your primary care doctor or a mental health professional, such as a psychiatrist, as soon as possible. Ask specific questions about how your doctor came to a diagnosis of bipolar disorder or ADHD. Before deciding on treatment, you may decide to seek a second opinion.

Once you’ve found a doctor you trust, it’s important to do your best to follow up with that same doctor on a regular basis. Being consistent with your treatment gives doctors the best chance to track your mood changes and progress with different medications and dosages. Be sure to ask all the questions you may have about living with your condition, and always take your medication as prescribed.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression or bipolar 1 disorder and their loved ones. On MyDepressionTeam, more than 143,000 members come together to ask questions, give advice, and share their stories with others who understand life with mental health conditions.

Are you living with bipolar disorder and ADHD? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. What Is ADHD? — Centers for Disease Control and Prevention
  2. The Age-Dependent Decline of Attention Deficit Hyperactivity Disorder: A Meta-Analysis of Follow-Up Studies — Psychological Medicine
  3. Bipolar Disorder — Mayo Clinic
  4. Attention-Deficit/Hyperactivity Disorder in Children and Teens: What You Need To Know — National Institute of Mental Health
  5. Bipolar Disorder — National Alliance on Mental Illness
  6. The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication — The American Journal of Psychiatry
  7. ADHD and Bipolar Disorder in Adulthood: Clinical and Treatment Implications — Medicina
  8. Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication — Archives of General Psychiatry
  9. Comorbidity Between Attention Deficit Hyperactivity Disorder (ADHD) and Bipolar Disorder in a Specialized Mood Disorders Outpatient Clinic — Journal of Affective Disorders
  10. Attention Deficit-Hyperactivity Disorder in Adult Bipolar Disorder Patients — Journal of Affective Disorders
  11. Young Adult Outcome of Attention Deficit Hyperactivity Disorder: A Controlled 10-Year Follow-Up Study — Psychological Medicine
  12. Adult Psychiatric Outcomes of Girls With Attention Deficit Hyperactivity Disorder: 11-Year Follow-Up in a Longitudinal Case-Control Study — The American Journal of Psychiatry
  13. Risk for Emerging Bipolar Disorder Variants, and Symptoms in Children With Attention Deficit Hyperactivity Disorder Now Grown Up — World Journal of Psychiatry
  14. Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative — Archives of General Psychiatry
  15. The Relationship Between ADHD Symptomatology and Self-Harm, Suicidal Ideation, and Suicidal Behaviours in Adults: A Pilot Study — Attention Deficit and Hyperactivity Disorders
  16. Comorbidity of ADHD and Suicide Attempts Among Adolescents and Young Adults With Bipolar Disorder: A Nationwide Longitudinal Study — Journal of Affective Disorders
  17. Adult ADHD and its Comorbidities, With a Focus on Bipolar Disorder — Journal of Affective Disorders
  18. The Risk of Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder — The American Journal of Psychiatry
  19. A Systematic Review of Rates and Diagnostic Validity of Comorbid Adult Attention-Deficit/Hyperactivity Disorder and Bipolar Disorder — Journal of Clinical Psychiatry
    Posted on April 11, 2023
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    Paul Ballas, D.O. is an attending psychiatrist at Friends Hospital in Philadelphia, Pennsylvania. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Remi A. Kessler, M.D. received her medical degree from the Icahn School of Medicine at Mount Sinai in New York City. Learn more about her here.

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