It’s normal for everyone to have periods of feeling up and periods of feeling down, but when the highs get too high and the lows are too low, and when you’re feeling constantly distracted, irritable or otherwise unable to engage in daily activities, there may be a mental health issue at work such as bipolar disorder or ADHD.
These two conditions, bipolar vs. ADHD, have some overlap in symptoms but are actually quite different. Getting the right diagnosis isn’t always easy, but it’s critically important for receiving the appropriate treatment.
What Is Bipolar Disorder?
“Bipolar disorder is a mood disorder formerly called manic depression,” says Stephanie G. Thompson, director of clinical operation for Lightfully Behavioral Health, a Thousand Oaks, California–based mental health treatment provider.
“It’s characterized by extreme mood swings, AKA polar opposites, in that an individual will experience periods of extreme highs or excitement known as mania followed by periods of severe sadness known as depression.” There may also be periods of a “normal,” or balanced, mood that are not extreme.
Despite the common misconception, manic episodes are not necessarily “happy” times for the patient. Instead, they’re periods of extreme energy that can be frightening at times for the patient. These episodes can last for weeks or months if they’re not treated, and during one of these episodes, the patient may experience three or more of the symptoms below:
— Euphoria, being abnormally upbeat, hyperarousal (being on high alert), feeling jumpy or wired.
— Increased activity, energy or agitation.
— An exaggerated sense of well-being and self-confidence.
— Too energetic to sleep or insomnia.
— Excessive talkativeness or rapid speech.
— Racing thoughts.
— Poor decision-making, such as overspending, taking sexual risks, making foolish investments or using or abusing substances.
A depressive mood episode includes five or more of the following bipolar symptoms:
— Depressed mood, such as feeling sad, empty, hopeless or tearful. “In children and teens, depressed mood can appear as irritability,” Thompson says.
— A marked loss of interest or taking no pleasure in all, or almost all, activities.
— Significant weight loss when not dieting, weight gain, or either a decrease or increase in appetite. Thompson notes that failure to gain weight as expected can be a sign of depression in children.
— Either insomnia or sleeping too much.
— Either restlessness or slowed behavior.
— Fatigue or loss of energy.
— Feelings of worthlessness or excessive or inappropriate guilt.
— Difficulty concentrating or making decisions.
— Thinking about, planning or attempting suicide.
There are actually a few different types of bipolar disorder, including:
— Bipolar 1. In bipolar 1, patients have periods of mania and depression that can be quite intense and may require hospitalization.
— Bipolar 2. Bipolar 2 has similar swings in mood as bipolar 1, but is typically somewhat less severe. Periods of mania are often referred to as hypomania in bipolar 2 because they tend to be less intense. Depressive episodes tend to be more similar across the two disorders, and how often or frequently they cycle through is highly variable from patient to patient.
— Cyclothymic disorder. This rare mental health disorder shares some similarities to bipolar disorder in that patients cycle in and out of periods of depression and mania, but while these symptoms are cyclical, they may not be severe enough to meet the criteria for bipolar 1 or bipolar 2.
There’s no cure for bipolar disorders, but they can be managed. Treatment for bipolar disorder can include:
— Changes to lifestyle choices, such as exercising and eating healthy foods.
— Social support, such as a peer support group.
Thompson notes that for many people with bipolar disorder, “it can be tempting to stop taking medication when symptoms resolve or you begin to feel better, but without medication adherence, the symptoms can worsen and negatively impact all areas of your life.”
What Is ADHD?
Attention deficit hyperactivity disorder, also sometimes called attention deficit disorder, or ADD, “is a neurodevelopmental disorder resulting in problems with attention/concentration and/or hyperactivity/impulsivity,” says Justin Barterian, a licensed psychologist and assistant professors of psychiatry and behavioral health at the Ohio State University Wexner Medical Center in Columbus.
ADHD symptoms can include:
— Difficulty focusing on work or schoolwork.
— Difficulty following instructions.
— Difficulty staying organized.
— Difficulty completing tasks.
— Losing things.
— Difficult social interactions.
— Talking too much, being loud and interrupting others.
Often, such behaviors are blamed on an overconsumption of sugar, especially in children, but Thompson says that’s not what causes ADHD. “Quite the contrary, the brain in individuals with this condition is looking for a stimulant that it’s not making enough of on its own, which causes a desperate response in the brain leading to distractibility and hyperactivity. Once the stimulant is provided to the brain, it is able to refocus on tasks at hand.”
ADHD isn’t something that just shows up one day, Barterian says. “ADHD is a lifelong disorder,” meaning that evidence of ADHD symptoms will be apparent since childhood. Still, many adults with ADHD were not diagnosed as children.
ADHD is typically treated with stimulant medications, such as Adderall and Ritalin, psychotherapy and behavior therapy.
“In addition to medication, cognitive behavioral therapy is also an evidence-based approach for helping individuals with ADHD monitor their mood and intervene behaviorally,” Barterian says. “Cognitive behavioral therapy can help individuals with ADHD identify challenges and modify their environment and behaviors to increase the likelihood of task completion.”
Thompson adds that not every patient with ADHD needs medication, but for those who do, it’s really important to understand how and when to take medications. Some are to be taken daily while others are only taken at specific periods of time.
ADHD vs. Bipolar: Symptoms Can Overlap
While ADHD and bipolar disorder are two distinct conditions, they do have some overlap in the symptoms they can cause. Specifically, these overlapping symptoms include:
— Emotional dysregulation.
— Sleep problems.
— Racing thoughts.
— Loss of social functioning.
— Problems maintaining attention.
— Difficulty focusing and concentrating.
— Engaging in risky or impulsive behaviors.
“One way to help differentiate between the two is to explore whether these symptoms occur only within the context of a manic/depressive episode or if these symptoms have been apparent and consistent since childhood,” Barterian says.
He adds that it’s also entirely possible to have both ADHD and bipolar disorder at the same time. “Research shows that up to 1 in 13 patients with ADHD has bipolar disorder and 1 in 6 patients with bipolar disorder has ADHD.”
Getting the Right Diagnosis
Arriving at the right diagnosis isn’t always simple, but it’s best to start by visiting with a psychiatrist and asking whether they have experience diagnosing or treating either condition, Thompson says. If they don’t, ask for a referral to a provider who can make the diagnosis and help you find treatment.
Accurate diagnosis is important, Barterian says, because stimulant medications, typically the go-to for ADHD medication, can actually worsen symptoms of bipolar disorder.
When seeing a doctor for symptoms that could be related to ADHD or bipolar disorder, your provider will ask a lot of questions, so it’s best if you can come armed with details of what’s been happening. “It’s important to track frequency and duration of episodes,” Thompson says.
She also says you should note which symptoms occur during each episode and the situations in which the symptoms occur. Your provider will also ask:
— How old you were you when these specific symptoms started?
— Whether you have a family history of mental health conditions.
— Whether you use any substances, such as alcohol and illicit drugs,. If so, how much and how often?
— Any other medical conditions you may have.
Thompson says that once you have a diagnosis and a treatment protocol, “it’s imperative that you follow the treatment plan established by you and your providers.”
She also notes that “research suggests that individuals with ADHD are at a higher risk of abusing stimulant drugs such as cocaine and methamphetamine as a means of self-medicating, which is why it’s important to speak to a doctor about symptoms and establish a treatment plan that works for you.”
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What’s the Difference Between ADHD and Bipolar Disorder? originally appeared on usnews.com
Update 11/22/22: This story was previously published at an earlier date and has been updated with new information.