Comorbid conditions can be challenging to diagnose and treat due to overlapping symptoms, so it is important for patients and doctors to understand where these overlaps could occur and how to identify them. Here, we are exploring both bipolar disorder and ADHD as comorbid conditions, the signs and symptoms, the differences in symptoms, how both are diagnosed and treated, and where to seek help if you think you may have both ADHD and bipolar disorder. 

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about ADHD and bipolar disorder, we can help. 

What is ADHD?

ADHD stands for attention deficit hyperactivity disorder, which is a type of neurodivergence that means a person with ADHD is hard-wired differently to a neurotypical person. There are three types of ADHD, each characterised by their symptoms; hyperactive-impulsive ADHD, inattentive ADHD, and combined ADHD. Keep in mind ADHD tends to affect women differently to men, as inattentive ADHD is thought to be more common in women, and hyperactive ADHD is thought to be more common in men. 

The most common symptoms of ADHD are: 

Inattention symptoms

• Struggling to maintain attention during long tasks, and missing details
• Regularly making what seem to be careless mistakes
• Struggling to organise tasks and activities, and to manage time
• Often losing items like keys or phones
• Forgetting important things, such as paying household bills or attending appointments

Hyperactive symptoms

• Fidgeting or squirming a lot
• Prolonged restlessness and difficulty sitting still for long periods of time
• Being unable to engage in fun activities in a quiet manner 
• Excessive talking, interrupting, or answering questions before they are finished
• Difficulty waiting, such as in a line or for their turn to speak 
• Becoming easily distracted by unrelated things and external stimuli 

These symptoms can cause issues in various areas of life, potentially impacting the person’s career, relationships, finances, achievements and more. You can learn more in our guide to the main symptoms of ADHD.

What is bipolar disorder?

You may have heard bipolar disorder called manic depression, as it was previously known, but it is now exclusively referred to as bipolar disorder. This condition leads to extreme mood swings that can cause mania (a euphoric high) or severe depression. 

In most cases of bipolar disorder, these mood swings happen rarely (a few times a year for some people) and could last for several days. Between the highs and lows, people could experience long stretches of emotional stability, and doctors can recommend a treatment plan to help manage any mood swings when they arise.  

The symptoms of bipolar disorder when a person is having a manic episode include:  

• Feeling extremely elevated, or high
• Feeling very irritable
• Feeling wired or jittery, and more active than usual
• Having thoughts racing through their mind 
• A decreased need for sleep
• Talking rapidly about many different subjects 
• Having an excessive desire for enjoyable activities like eating, drinking, sex and more
• Believing they can achieve many things at once without tiring 
• Feeling uncharacteristically powerful or talented

The symptoms of bipolar disorder when a person is having a depressive episode include:  

• Feeling extremely low or sad 
• Feeling anxious or restless 
• Having trouble focusing 
• Finding it difficult to make decisions
• Finding it difficult to fall asleep, waking too early or sleeping excessively 
• Talking slowly and forgetting things 
• Having a lack of interest in activities they once enjoyed 
• Finding it hard to do simple tasks 
• Feelings of hopelessness, worthlessness, or suicidal thoughts 

You may find more useful information in our guide to understanding how a person with bipolar disorder thinks.

Can someone have both bipolar disorder and ADHD? 

Yes, a person can have comorbid bipolar disorder and ADHD. It is estimated that up to 1 in 13 patients with ADHD also have comorbid bipolar disorder, while up to 1 in 6 patients with bipolar disorder also have comorbid ADHD. One study suggested children and teenagers with ADHD may have up to a 10-fold increased risk for also having bipolar disorder, which most commonly develops between the ages of 15 and 19.

The causes of both bipolar disorder and ADHD as individual conditions are not known, so it is also difficult to know why they co-occur. Research has identified 33 chromosomal gene locations occurring in both disorders, and those who have first-degree relatives with ADHD (such as a parent or a sibling) could be more likely to develop bipolar disorder. 

In what ways are bipolar disorder and ADHD similar?

There are a number of symptoms occurring in both bipolar disorder and ADHD that can make diagnosing the separate conditions more difficult. Some of these symptoms include: 

Hyperactivity 

Both those with ADHD and those with bipolar disorder may experience hyperactivity and restlessness. However, according to a 2021 study, people with ADHD may experience this symptom as a constant throughout their life, whereas people with bipolar disorder will likely find hyperactivity fluctuates depending on whether they are in a manic state or not. 

People with bipolar disorder experience cycles of mania (or hypomania, which is a milder form) that cause them to have a lot of energy, become very excited, and possibly become agitated. They may experience this one or two times a year, however people with ADHD tend to experience hyperactivity symptoms consistently throughout the year. 

Focus Issues 

One of the main features of ADHD is distractibility, as many people with ADHD struggle to focus on things for a long time and may move from one task to the other, leaving things unfinished. One 2023 study identified spontaneous mind-wandering, external distraction and unwanted intrusive thoughts as sources of their distraction. 

Similarly, research has found those with bipolar disorder often have trouble focusing during a manic episode. 

Impulsivity

Impulsivity is a key symptom in some types of ADHD, and this is usually caused by an imbalance in dopamine and serotonin, meaning a person with ADHD lacks enough of the serotonin responsible for managing impulses. This can lead to impulsive decisions, impulsive purchases, risk-taking behaviour and more. 

Impulsivity is also a feature of bipolar disorder, with a 2022 study finding significantly higher levels of self-reported impulsivity in bipolar disorder subjects than the control group. 

Racing Thoughts

Both ADHD and bipolar disorder can cause the mind to feel like it is racing, with thoughts coming and going quickly, mental restlessness, or “manic thinking”, according to a 2021 study. 

The study researched racing thoughts and acknowledged them as a feature of both ADHD and bipolar disorder, while also identifying them as a potential contributor to the common sleep issues faced by those with both ADHD and bipolar disorder. 

Sleep Problems 

According to Bipolar UK, 25-65% of those with bipolar disorder who experience manic episodes may also experience a “social rhythm disruption” before the episode, which causes sleep issues. Reduced or interrupted sleep can be a symptom of mania in those with bipolar disorder, but it can also lead to further manic and hypomanic episodes, so this is an important symptom to understand and treat if possible. 

For those with ADHD, sleep is a common problem as the condition can impair the brain activity regulation which leads to disrupted sleep patterns. Around 25-50% of those with ADHD experience sleep problems, including insomnia.

Mood Instability and Emotional Regulation Issues 

Mood instability is the defining feature of bipolar disorder, but this can also impact those with ADHD. While people with bipolar disorder may experience fluctuations in their mood a few times a year, people with ADHD may find their energy levels, focus abilities and emotions fluctuate several times a day, causing emotional regulation issues. 

One study on the comorbidity of ADHD and bipolar disorder found those with both conditions experienced significantly more depression, an earlier onset of mood disorders, more severe and chronic mood disorders, and could also be more irritable than those who only had one of these conditions. 

Substance Use Disorders

According to a 2022 study, those with bipolar disorder are more at risk of developing an addiction, such as gambling or a substance use disorder, and the rate of comorbid alcohol and substance-related disorders in people with bipolar disorder is disproportionately high. 

One study on 150 patients with bipolar disorder found 70.7% also had ADHD, 59.3% had a substance use disorder, and 38.7% had both, so those with ADHD and bipolar disorder may have a higher likelihood of developing a substance use disorder. 

Other Symptoms 

Unlike those who live only with bipolar disorder or ADHD, those with comorbid ADHD and bipolar disorder tend to experience shorter periods of wellness and stability, more frequent and severe mood episodes, more severe ADHD symptoms, more emotional reactivity, and more rule-breaking behaviours. 

As a result, people with this comorbidity may need treatment from an earlier age, be less successful in school and work, become unemployed more often, and experience further general issues in daily life. 

What differences are there between bipolar disorder and ADHD?

Although ADHD and bipolar disorder have similar and overlapping symptoms, the frequency or symptoms and how long they last offers further insight into which condition may be at play. The episodic nature of bipolar disorder mood fluctuations can be a tell-tale sign of this condition, so if someone is experiencing symptoms in a continuous manner, ADHD could be the underlying problem. 

Some of the main differences between ADHD and bipolar disorder are:

• ADHD is thought to be more common in males, while bipolar disorder is more common in females
• In ADHD, symptoms start before age 12, while in bipolar disorder, symptoms start in early adulthood
• In ADHD, features such as motor impulsivity and lack of organisation are key, whereas in bipolar disorder, features such as emotional instability and reactivity are more common
• ADHD tends to cause more consistent symptoms, while bipolar disorder causes symptoms to appear periodically and could become worse during stressful times
• ADHD symptoms stay mostly consistent and stable throughout a person’s life, while bipolar disorder symptoms are thought to decrease with age

What are the challenges in diagnosing comorbid bipolar disorder and ADHD? 

Due to the overlapping symptoms, diagnosing either ADHD or bipolar disorder may be challenging. If one of these conditions is present, symptoms may indicate the other, which could lead to misdiagnosis, delays in receiving the correct diagnosis, and inappropriate treatment methods. 

Receiving a comprehensive assessment from a mental health professional is the only way to differentiate between the two conditions, or diagnose comorbid ADHD and bipolar disorder. Some key features, such as the above differences, the age of onset, and the frequency and consistency of symptoms can help to distinguish between the two. 

Stigma is also a significant challenge in diagnosing comorbid ADHD and bipolar disorder, as often patients prefer an ADHD diagnosis and the treatment methods available for this, and hope to avoid a diagnosis of bipolar disorder and its associated treatments. 

Studies suggest those with comorbid ADHD and bipolar disorder are often under-diagnosed and under-treated. For this reason, it is vital to understand both conditions, where they intersect and how they might interact with each other to ensure this does not happen, especially as this comorbidity has been associated with significant functional impairment.

How is comorbid bipolar disorder and ADHD treated? 

As above, treating comorbid ADHD and bipolar disorder can be challenging, but it is possible to achieve a balance with the appropriate bipolar disorder treatment options combined with the recommendations for managing ADHD symptoms. 

Some of the recommended treatment options for this comorbidity include: 

Medications 

Identifying either ADHD, bipolar disorder or a comorbidity is crucial in order to get the correct balance of medications. One 2022 study suggests patients should be treated hierarchically, with bipolar disorder being treated in the first instance to achieve mood stabilisation.

Treatments for bipolar disorder usually involve mood stabilising medications, antipsychotics or antidepressants, and once a balance has been achieved to effectively treat this condition, a doctor can prescribe stimulant or non-stimulant ADHD medications to manage the symptoms of inattention that tend to affect those with ADHD. 

Studies have found symptoms of ADHD (such as irritability, inattention and hyperactivity) tend to improve with certain medications – the most common are stimulant medications – however some research has suggested a possibility of inducing manic episodes through the use of stimulant ADHD medications, so further research is needed to confirm their efficacy and safety.   

Ultimately, medications are typically used in the treatment of comorbid ADHD and bipolar disorder, and the best way to achieve a balance over time is to speak to a doctor about options.  

Therapy

There are a number of therapeutic approaches that can help to treat comorbid ADHD and bipolar disorder, such as cognitive-behavioural therapy (CBT), dialectical behaviour therapy, and more. Family therapy is sometimes recommended for those with bipolar disorder, so this can also help in understanding the needs of a loved one with this comorbidity. 

Talking therapies can offer a way to learn more about personal emotions and triggers, to recognise when ADHD symptoms become an issue, and the warning signs of an approaching episode of mania or depression. 

Lifestyle Changes 

As well as medications and therapy options, lifestyle changes could also help, which can be done at home with the support of a medical professional for guidance. These include: 

• Getting enough sleep – Adequate sleep has been found to help improve both ADHD symptoms and bipolar disorder symptoms. 
• Eating a healthy, balanced diet – For those with ADHD, it can help to ensure you have no nutritional deficiencies, avoid foods you may be intolerant to, and avoid too much sugar or caffeine in order to manage ADHD symptoms. For those with bipolar disorder, a diet with plenty of wholegrains, omega-3 fatty acids and probiotics is recommended, and limited caffeine, alcohol and highly processed foods could minimise symptoms. You may find some useful information in our article: The Relationship Between ADHD And Gut Health
• Getting regular exercise – Studies have shown the potential benefits of both acute and long-term exercise routines for those with ADHD, as well as those with bipolar disorder. 
• Creating more structure and using organisation techniques – Putting in place more structure in the home environment can help to alleviate ADHD overwhelm. This could include limiting distractions, or using visual reminders so you do not forget important tasks. Those with bipolar disorder can also benefit from these interventions. 

Where can someone with comorbid bipolar disorder and ADHD seek support? 

If you suspect you may have comorbid ADHD and bipolar disorder, it is important to seek a diagnosis, tailored treatment, and support from a medical professional with experience treating both conditions. You can find helpful advice through the NHS on ADHD and bipolar disorder, as well as through Mind.org.uk. Remember, everyone will experience a different combination of symptoms, particularly if they have comorbid ADHD and bipolar disorder, so getting a personalised treatment plan is the best way to feel a real difference in your life. 

You can read more about ADHD medications that may be recommended for you in our guide to ADHD Medication in the UK.

If you would like to explore therapy treatment options for this comorbidity, you can speak to your GP about this while discussing medications, or if you would like to access support without being stuck on a long NHS waiting list, you can speak to a private provider like Augmentive. We can help you with your comorbid ADHD and bipolar disorder, and support you on your journey to obtain a diagnosis and treatment from your doctor, if needed. 

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from a private adult ADHD assessment or bipolar assessment, to help finding a psychiatrist or ADHD specialist near you.

We believe all advice and support for those with comorbid ADHD and bipolar disorder should be personalised to each person’s individual situation, and our free 15 minute consultation can help match you with an appropriate professional who can help you.