The ADHD and Bipolar Disorder Connection

ADHD and Bipolar Disorder Connection

This question comes up a lot: “How do you know if it’s ADHD or bipolar disorder?” And “Is there an ADHD and bipolar disorder connection?”

My friend and fellow journalist-advocate John McManamy writes an excellent blog on bipolar disorder: Knowledge Is Necessity. He started that blog in 2008, the same year I started this blog, ADHD Roller Coaster. We were “early adopters,” you might say.

In his regular blog posts on Knowledge Is Necessity, John often reminds his readers to also consider any possible indicators of ADHD:

Because unrecognized ADHD could be what is holding you or your loved one back. Perhaps it’s not bi-polar but actually ADHD. Or the two are co-existing: bipolar with some attention-impulse issues; ADHD with some mood-emotions issues.

Likewise, if you’ve been diagnosed with ADHD (or suspect you have it), it’s also important to watch for bipolar and mood-disorder symptoms. Stimulants alone can exacerbate those issues.

As John says:

Either way, in bipolar disorder, if co-existing ADHD is not addressed, treatment is problematic frustration with meds, with no recovery.

In ADHD, if co-existing bipolar is not addressed, same thing: treatment is problematic, frustration with meds, with no recovery.

I encourage you to learn about the importance of second opinions when it comes to psychiatric diagnosis: Frank South, author and Hollywood screenwriter, joined the PBS Second Opinion team to talk about ADHD and proper diagnosis.

Update to This Post: March 2020

For many years, John also wrote about bipolar disorder at Health Central. This post originally shared excerpts from a blog series he wrote there on the ADHD and bipolar disorder connection, along with links to each post. Unfortunately, those posts have disappeared.  I have left the excerpts below, to give an idea of the questions we ask about the ADHD and bipolar connection.

Recently, he has devoted a series of posts addressing this very topic. I share handy links to each post below.

Diagnostic Labels: What Are They Good For?

Rarely, if ever, do we “just have bipolar.” Something else is invariably going on. Perhaps not full-blown, often “a little bit of this” and “a little bit of that.” For instance, Ellen Frank of the University of Pittsburgh has done work in the overlap between mood disorders and anxiety. I recall hearing her in a talk telling people that just two symptoms of another condition can significantly complicate the course and treatment of the mood disorder.

You are probably reading this page because you know in your bones that you have bipolar [or in this blog’s case, ADHD]. If you are like me, you may have welcomed the diagnosis. It explained your whole crazy life. It offered you the hope of getting your life back on track, once you figured out the nature of this beast.

But, if you are like me, you also found that there were more obstacles to your recovery than you bargained on. Once you had a handle on controlling your depressions and manias, you may have noticed some quirks in your thinking and emotions and behaviors. What was going on?

A little bit of this and that? Another full-blown diagnosis?

Paying Attention to Attention

You know how it goes down. It’s late evening, you’re starting to droop, big day tomorrow, time to hit the hay. But first, five minutes to check out Facebook. Someone’s just posted “Ten Reasons Why Rednecks Make Bad Astrophysicists.” You decide you need a good laugh. You click to the full piece. It’s hilarious. You’re laughing your ass off. You can’t stop now, of course. You click on the link to “Seven Great Disasters in History Caused By Men Who Didn’t Ask for Directions.”

Inside your brain, your dopamine circuits are firing. The thinking parts of your brain lock in. You are alert and hyper-focused, but at the expense of any awareness of your immediate world and what you need to be doing to negotiate your way through it. All sense of time vanishes.

Lack of Impulse Control or Hypomania?

According to data from the International Mood Disorders Collaborative Project, nearly one in five individuals with bipolar experience ADHD.

What we really need to be aware of, though, is that we don’t have to have a full-blown ADHD diagnosis to complicate our lives. Virtually all of us (“normal” people included) have attention problems of some sort. Thus, we all need to be paying attention – to attention.

Another element of ADHD concerns the lack of ability to rein in impulses.

It works something like this: Attention is a function of the thinking parts of the brain. If you’re not thinking right, the front end of your brain is perpetually engaged in a losing battle with the back end of the brain.

The back of your brain may tell you that now would be a good time to belt out “There’s No Business Like Show Business” in your best Ethel Merman voice. The front end of your brain neglects to remind you that you happen to be in the middle of a business meeting right now.

Lack of Focus or Depression or Fatigue?

Is it hypomania or is it ADHD? This common question begs the obvious follow-up: Is it depression or is it ADHD? For starters, check out this DSM-IV symptom for depression:

Diminished ability to think or concentrate, or indecisiveness …

Now compare that to this symptom for ADHD:

Often has difficulty sustaining attention in tasks …

“Fighting through the fog” is how those with ADHD describe their attempts to achieve some form of mental clarity.  All of us (even those considered “normal”) know what this is like. We experience it every morning, prior to our coffee, which I jokingly refer to as my “neuro-cognitive starter.”

Gulp-gulp-ahh! The fog lifts. But what if it doesn’t? What if, in effect, you don’t fully awaken? Is this depression or is this ADHD? Maybe chronic fatigue?  Perhaps all of the above?


Previously, we looked at the confusion between hypomania and ADHD and depression (and fatigue).

By way of example: If you are dancing on a table during a business meeting, oblivious to those around you, is it hypomania or ADHD?

What if you are:

  • Over-absorbed in a project or activity?
  • Jumping from one thing to the other?
  • Failing to rein in your impulses?
  • Getting high on doing something totally crazy or risky?

Is it hypomania or ADHD?


77 thoughts on “The ADHD and Bipolar Disorder Connection”

  1. well call me “wren” its not my real name because i am a veteran and i think my current doctor might read this and I hope that he does. Perhaps he will pick up a copy of your book? It’s part of my “crazy life”. I have enjoyed your sight very much thank you. Well have i got a good one for you all . Diagnosed at age 10, A.D.H.D and a 170 I.Q . so they tried to give me stimulants but i was really against pills and really most factory made foods . I said no to all medications or any pills till the military . Oh another thing is i refused to believe something was wrong with me. But i was hyper capital “h” but not in the same way i am now and neither is my depression or anxiety. Its different now ,so at one time for a long time i would be depressed for months at a time . almost a whole year in high school , as soon as i got out of college and traveled before the towers came down and i joined up . i did not get depressed even once and took zero medications . so depression happened again and again in 2007 .it was being taken off the benzos that were prescribed but i didnt know that at the time . so i became suicidal trying to drown myself and i almost suceeded but the sand bar in the river had moved so i stood up and all the animals in the forest just stopped for a long time . it was loud when the commotion returned but instead of chatter and wisehels .. it was laughter the birds and creatures were giggeling at my mistake and i looked stupid in my metal suit made of chains from a motor pulley system . so the depression stopped but the comfort from “valium” never stopped and only when traveling to every other country in the world would i get a small tree months of relief. i’m now in my forties and still act and kinda still look like i did back then . only as i get older and different models of what good treatment looks like come and go. I still feel like a guinia pig only i know what works but my good doctor who had me stable for over four years . He is amazing and many article’s that he had published at at “Duke” , “Harvard” turned up later in national magazines and in a “us weekly” a Full article was written about the man him self . He took care of me a little over four years all “pro bono” So i am telling my story but i really respect his commitment to those of us who need it most . often its the least among us that live to tell the story and i feel like i am “one of the lucky ones .However because i did have some substance abuse issues in the past. He is a Trail blazer maybe? You make up your mind? His method of treatment is progressive but its not hard to wrap ones mind around the reasons so he would prescribe low doses of “benzo” on PRN and switching them every six months. Then in my case because of my size and tolerance he did prescribe somewhat higher doses of a.d.h.d medication? Im a “big boy” can get really big so the two typical medications that come to mind would be given and if i got past 90 mg. on the one kind like
    ” adderall ” i would go to 70 mg. of ” vyvanse ” on the other longer acting and all brand name; from the pharmacy of my choice and trust! Also he gave me these very strong albeit short weekly commands . Like ; “Just keep your job and do something for the community . He still takes meals to a local non profit . He retired and my life fell apart for a number of years until a smart addiction specialist believed in me and it had been a hard go of it! Because my retired good psychiatrist was amazing! He even had me opiate free, so when i showed up at her office for “m.a.t” treatment. i was more of a mental health patient, so after about two years . I went to the veterans admin. Where in the military in 2004 i was first given “Valium” .For the first time. Fast forward and v.a psychiatrist / doctor promised to not take me off the med’s and diagnosed me with bipolar, i just assumed that i was giving him the diagnosis in exchange for the possibility that he isnt the only person who can read the d.s.m -is disabled veteran can earn his trust? Mostly because the Lithium carbonate lithium carbonate only makes me manic and “lithium” makes me hungry! so i eat . So i’m fat so my tolerance goes up and i get depressed. I just wish i had a good doctor. its about listening to us and not just acting like our trauma doesn’t count! like we can’t tell the difference between manufactures. or generic brand names. Well thank you so much! I do feel better . With respect to all and love to all.

    1. Hi Wren,

      Thanks for sharing your story.

      I imagine the number of people with undiagnosed/mis-diagnosed ADHD on benzos is just staggering.

      Maybe even more than the number diagnosed with “depression” and treated with anti-depressants.

      I admire your determination.

      take care,

  2. Good morning Gina.
    My name is Araceli and I had wrote you a few months back, I had mentioned I had been diagnosed with ADHD when I was 12 years old. Never got treatment for it. Since then I always known I’ve had a problem but because of the lack of information, the ingnorance and also not having health insurance can be extremely frustrating.
    Finally last month after struggling with being a recovering addict and having adhd I finally started going to a psychiatrist who is trying to help me find the right medication I also got diagnosed with biopolar disorder so know is a little bit harder to find the balance.
    I’m still not taking any medication at this time I had an allergic reaction to the first medication he prescribed me so we are looking for something that will work for me. Thank you so much for being a awesome woman God blees

    1. Dear Araceli,

      I’m so glad to hear from you! And I’m so pleased that you succeeded at long last in finding a psychiatrist to help you.

      Sometimes all folks need is validation that they deserve help. With that, they can keep pushing to the finish line. I’ve seen that so many times.

      So, congratulations to you and well done. I know it’s not easy!

      If you had an allergic reaction, it might have been a generic medication. They have different colorants and binders than with the brand medications, and some people are sensitive to them.

      Maybe you have bipolar as well as ADHD, but make sure your physician knows that ADHD can sometimes “look like” bipolar disorder. Due to the emotional dysregulation component.

      Good luck and keep me posted!!


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