Co-occurrence of ADHD and Bipolar Disorder
Attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) are two common and complex psychiatric conditions that often co-occur in adults. The prevalence of comorbid ADHD and BD ranges from 5.1% to 47.1% in different studies, depending on the diagnostic criteria and methods used . This comorbidity poses significant challenges for diagnosis and treatment, as the symptoms of ADHD and BD can overlap and interact with each other.
ADHD is a neurodevelopmental disorder characterized by persistent and impairing patterns of inattention, hyperactivity, and impulsivity that usually manifest in childhood . BD is a mood disorder marked by recurrent episodes of mania or hypomania (elevated or irritable mood, increased energy, decreased need for sleep, etc.) and depression (low mood, loss of interest, hopelessness, etc.) . Both ADHD and BD can affect various aspects of functioning, such as academic performance, work productivity, interpersonal relationships, and self-esteem.
The relationship between ADHD and BD is not fully understood, but some possible explanations include shared genetic and biological factors, environmental influences, developmental trajectories, and diagnostic biases . Some studies have suggested that there are structural and functional differences in the brain regions involved in attention, emotion regulation, executive functioning, language, memory, and motor function among people with ADHD, BD, or both . Additionally, some environmental factors, such as stress, trauma, substance use, or sleep deprivation, may trigger or worsen the symptoms of both conditions .
Diagnosing ADHD and BD can be challenging, especially when they co-occur. The main difference between the two conditions is that ADHD causes more consistent patterns of behavior across different situations and over time, while BD occurs in cycles or episodes that vary in duration, frequency, and severity . However, some symptoms of ADHD and BD can mimic each other or coexist. For example, both ADHD and mania or hypomania can cause increased energy, distractibility, impulsivity, talkativeness, or risk-taking behaviors. Similarly, both ADHD and depression can cause difficulty concentrating, low motivation, poor organization, or forgetfulness .
To receive a diagnosis of ADHD or BD or both, a mental health professional will conduct a comprehensive assessment that includes a detailed history of symptoms (onset, duration, frequency), family medical history (genetic predisposition), personal medical history (other physical or mental health conditions), psychosocial factors (stressors, coping strategies), and functional impairment (impact on daily life) . The diagnosis will be based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which specifies the number and type of symptoms required for each condition .
Treatment for comorbid ADHD and BD requires a multimodal approach that involves medication, psychotherapy, psychoeducation,
and lifestyle modifications. Medication can help reduce the severity and frequency of mood episodes in BD and improve attention and impulsivity in ADHD. However, medication choice and dosage need to be carefully monitored to avoid potential interactions or adverse effects. For example, stimulants (commonly used for ADHD) may trigger or exacerbate mania or hypomania in some people with BD . Psychotherapy can help people with comorbid ADHD and BD learn coping skills,
manage stress,
enhance self-esteem,
and improve interpersonal relationships. Psychoeducation can help people with comorbid ADHD and BD understand their conditions,
recognize their triggers and early warning signs,
and adhere to their treatment plan. Lifestyle modifications can help people with comorbid ADHD and BD optimize their physical and mental health by adopting healthy habits such as regular exercise,
balanced diet,
adequate sleep,
and avoiding substance use .
Comorbid ADHD and BD is a complex condition that requires careful diagnosis and treatment. People with this condition can benefit from seeking professional help
and following evidence-based interventions that address both conditions simultaneously. With appropriate support
and self-care,
people with comorbid ADHD
and BD can achieve better outcomes
and quality of life.
References:
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: Kolar D., et al. (2021). Prevalence of bipolar disorder and attention-deficit/hyperactivity disorder comorbidity: A systematic review and meta-analysis. Journal of Affective Disorders 282: 1238-1247. https://doi.org/10.1016/j.jad.2020.12.144
: American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Publishing.
: American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Publishing.
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: Nierenberg A.A., et al. (2005). Bipolar disorder with comorbid attention-deficit/hyperactivity disorder: a distinct clinical phenotype? CNS Spectrums 10(7): 530-534. https://doi.org/10.1017/S1092852900010209
: Perani S., et al. (2019). Shared and distinct structural and functional abnormalities in attention-deficit/hyperactivity disorder and bipolar disorder: a combined voxel-based morphometry and resting-state functional magnetic resonance imaging study in medication-naïve adolescents. Psychological Medicine 49(15): 2548-2558. https://doi.org/10.1017/S0033291718003720
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: American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Publishing.
: Wingo A.P., et al. (2014). The role of gene-environment interactions in the comorbidity between mood, anxiety, and impulse-control disorders: review and recommendations. Journal of Psychiatric Research 57: 29-39.
: Nierenberg A.A., et al. (2005). Bipolar disorder with comorbid attention-deficit/hyperactivity disorder: a distinct clinical phenotype? CNS Spectrums 10(7): 530-534.
: National Institute of Mental Health (2020). Attention-deficit/hyperactivity disorder (ADHD): The basics.
https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics/index.shtml
: National Institute of Mental Health (2020). Bipolar disorder.
https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
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Archives of General Psychiatry 64(4
