ADHD vs. Bipolar Disorder: What Are the Differences?

Attention deficit hyperactivity disorder (ADHD) and bipolar disorder share some of the same symptoms, including hyperactive or restless behaviors, being easily distracted, and having poor concentration, impulsivity, and racing thoughts. 

It is more common for someone to have ADHD, and as these disorders share many symptoms, this can mean that bipolar disorder is misdiagnosed or is missed altogether. It is also common for those with one of these disorders to also have the other, meaning that differential diagnosis can be challenging.

A meta-analysis published in 2021 found that up to 1 in 6 patients with bipolar disorder also had ADHD and up to 1 in 13 patients with ADHD also had bipolar disorder.

In this article, you will learn about the differences between ADHD and bipolar disorder. Bipolar disorder is a serious condition whose symptoms will worsen if not diagnosed, so it is important to see a healthcare professional for a diagnosis so that you can receive the proper treatment.

Symptoms 

ADHD and bipolar disorder share many of the same symptoms. Both can cause problems with concentration, energy, and activity levels, and both can affect someone’s ability to carry out everyday tasks. 

However, ADHD causes symptoms on an ongoing basis, whereas bipolar disorder is characterized by episodic shifts—meaning that symptoms come and go in cycles.

ADHD

Some people with ADHD mainly have symptoms of inattention, while others mostly have symptoms of hyperactivity-impulsivity. Some will experience both types of symptoms.

Symptoms of inattention include:

• Overlooking or missing details and making seemingly careless mistakes in schoolwork, at work, or during other activities
• Having difficulty sustaining attention
• Not seeming to listen when spoken to directly
• Finding it hard to follow through on instructions or finish tasks
• Having difficulty organizing and managing tasks and activities
• Avoiding tasks that require sustained mental effort, such as homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
• Being easily distracted by unrelated thoughts or stimuli
• Being forgetful in daily activities

Symptoms of hyperactivity-impulsivity include:

• Fidgeting and squirming while seated
• Leaving seat in situations when staying seated is expected, such as in the classroom or the office
• Running around, or climbing at inappropriate times, or, in teens and adults, often feeling restless
• Being unable to play or engage in hobbies quietly
• Being constantly in motion or on the go, or acting as if driven by a motor
• Talking excessively
• Answering questions before they are fully asked, finishing other people’s sentences, or speaking without waiting for a turn in a conversation
• Having difficulty waiting one’s turn
• Interrupting others

Bipolar Disorder

There are different types of bipolar disorder, but all involve clear changes in mood, energy, and activity levels. These range from periods where someone will feel extremely up and energized, known as manic periods, to periods where they will feel very down, known as depressive episodes.

These cycles may be irregular and not follow a clear pattern. Episodes can last for weeks, months, or longer.

Manic episodes can involve the following symptoms:

• Exaggerated self-esteem or grandiosity (feeling unusually important, powerful, or talented)
• Decreased need for sleep
• Talking more than usual, and talking loudly and quickly
• Being easily distracted
• Doing many activities at once, scheduling more events in a day than can be accomplished
• Risky behavior, for example, sexual indiscretions, spending or giving away a lot of money
• Uncontrollable racing thoughts or quickly changing ideas or topics

Major depressive episodes can involve the following symptoms:

• Intense sadness or despair, including feelings of helplessness, hopelessness, or worthlessness
• Loss of interest in activities once enjoyed
• Feeling worthless or guilty
• Sleep problems, sleeping too little or too much
• Feeling restless or agitated, or having slowed speech or movements
• Increase or decrease in appetite
• Loss of energy, fatigue
• Difficulty concentrating, remembering, or making decisions
• Frequent thoughts of death or suicide

Causes 

While ADHD and bipolar disorder share many similar symptoms, they will have different causes, though what these causes are is unknown. However, it is thought that a number of different risk factors can increase the chance that someone develops these disorders.

ADHD

The cause of ADHD is not well understood, but many studies do suggest that genetics play an important role. Environmental factors, such as brain injuries, nutrition, and social environments, are also thought to be involved. 

While it was thought in the past that eating a lot of sugar, watching too much television, or turmoil in the family might cause ADHD, these theories have now been debunked. Though, it is thought that such factors may exacerbate symptoms.

Bipolar Disorder

As with ADHD, genetics are thought to also play a role in the development of bipolar disorder.

Research shows that it is highly hereditary, meaning that having a close family relative, such as a parent, with bipolar disorder increases the risk of someone having the disorder themselves. However, no one gene can cause the disorder, and it is thought that many genes are involved. 

It is also thought that differences in brain structure and functioning may be linked to bipolar disorder. Some studies indicate that those with bipolar disorder have an underlying problem with how nerve signals are transmitted in the brain and in the balance of the chemicals that deliver the nerve signals. 

Diagnosis 

Both ADHD and bipolar disorder are diagnosed using the specific criteria listed in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5.

ADHD

Most children with ADHD will receive a diagnosis between the ages of 5 and 11. When the diagnosis is made in adolescents or adults, the symptoms need to have been present before the age of 12.

A diagnosis of ADHD will be made based on symptoms and an interview with a mental health professional such as a psychologist, psychiatrist, neurologist, or a primary care provider—often a pediatrician.

Bipolar Disorder

Bipolar disorder is typically diagnosed during late adolescence or early adulthood. Each type of bipolar disorder has its own specific set of diagnostic criteria in the DSM-5.

During the diagnosis, your doctor may also perform tests to rule out other causes of your symptoms, which can be the result of physical illness rather than mental illness. These include hypothyroidism, certain inflammatory disorders, and some types of substance use.

Treatment 

It is important to properly diagnose both ADHD and bipolar disorder, as the treatments for each vary. Early diagnosis increases the chance of a good treatment outcome, which is especially important with bipolar disorder because without treatment symptoms can get worse.

ADHD

ADHD is treated with behavioral therapy, medication, and in some cases by a combination of both. For 4- and 5-year-olds, the first line of treatment is behavioral therapy with parental involvement.

For many, medications can help to reduce symptoms such as hyperactivity and impulsivity and improve the ability to focus, work, and learn. Stimulants are the most common type of medication used. These work by increasing the chemicals in the brain that play a role in thinking and attention.

A few other ADHD medications are non-stimulants. These may be prescribed if someone has side effects from stimulants or may be prescribed in combination with stimulants. 

Several specific psychosocial interventions, such as cognitive behavioral therapy (CBT) and family therapy, have been shown to help individuals with ADHD and their families manage symptoms and improve everyday functioning. 

Bipolar Disorder

Bipolar disorder is a lifelong illness that requires long-term management. Appropriate treatment options vary from person to person depending on the severity of symptoms, but an effective treatment plan usually involves a combination of medication and psychotherapy. 

Medications generally used include mood stabilizers and second-generation atypical antipsychotics. Treatment plans may also include medications that target sleep or anxiety. 

Psychotherapy uses a variety of techniques to better equip someone with bipolar disorder with the skills and coping mechanisms necessary to recognize and better manage their illness. 

Summary

ADHD and bipolar disorder share some symptoms, including hyperactive or restless behaviors, being easily distracted, and having poor concentration, impulsivity, and racing thoughts. The causes of both are unclear, but there may be genetic risk factors.

Each condition is diagnosed by a healthcare professional applying the criteria from the DSM-5. Each can be treated by medications, but they differ as to the specific drugs used. Each can also be treated by talk therapy. ADHD may also be treated with behavioral interventions.

A Word From Verywell

We understand that the symptoms of both ADHD and bipolar disorder can be difficult to experience. However, with treatment, both disorders can be effectively managed.

Make sure you speak to your doctor if you are experiencing any of the symptoms highlighted above. Early diagnosis greatly increases the chance of a successful outcome.