Manic ADHD: Can ADHD Cause Mania?
While attention-deficit hyperactivity disorder (ADHD) cannot cause mania on its own, individuals living with ADHD and bipolar disorder simultaneously may experience manic episodes. “Manic ADHD” is not a clinical term. However, symptoms of ADHD and bipolar disorder can share similarities. In addition, some symptoms may be difficult to distinguish from one another, such as emotional dysregulation and hypomania. Understanding these differences can be a way to differentiate between disorders and find the proper support from a mental health professional.
What is ADHD?
ADHD is a neurodevelopmental disorder and form of neurodivergence that is present from birth and persists throughout one’s life. Individuals living with ADHD may have a difficult time paying attention, staying on-task, retaining information, sitting still, or avoiding impulsive behavior.
There are three subtypes of ADHD listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), including predominantly hyperactive-impulsive, predominantly inattentive, or a combined type.
Predominantly hyperactive-impulsive
Those with hyperactive-impulsive ADHD may be prone to constant movement, fidgeting, or excessive talking. In school, these individuals may struggle to stay in their seats, interrupt others while talking, or shout out comments during class. This behavior may negatively impact their academic career and relationships with teachers or classmates.
Predominantly inattentive
Individuals experiencing inattentive ADHD may struggle to remember important details, finish tasks, or avoid becoming distracted. People with inattentive ADHD may also find organization and time management challenging, which may affect their performance at work or school.
Combined type
Combined type ADHD often meets the criteria for both predominantly inattentive and predominantly hyperactive-impulsive. These individuals may have difficulties focusing and paying attention while also struggling with impulsive behavior and a frequent desire for movement.
What is bipolar disorder?
Bipolar disorder is a mental health condition commonly associated with episodes of mania and depression, originally nicknamed “manic depression,” which is no longer a clinical term.
There are several types of bipolar disorder, including bipolar I disorder, bipolar II disorder, cyclothymic disorder, and unspecified bipolar disorder. The significant difference between these types tends to be the severity of symptoms, which may be best characterized by the appearance of mania or hypomania, as defined below.
Mania
Mania is a state present in individuals with bipolar I disorder that involves high levels of energy, rapid changes in mood, and new changes in behavior. Individuals experiencing a manic episode may struggle with logical thinking or feel euphoric. This euphoria could lead them to make decisions or engage in risky behavior that could negatively impact their lives. Often, manic episodes last a week or more.
Hypomania
Hypomania is a less severe version of mania that lasts for a shorter duration—in some cases, only a few days. A hypomanic episode may not impact an individual's work, school, or home life severely, whereas a manic episode often can. Individuals experiencing hypomania may have similar symptoms to those experiencing mania, such as excess energy, extreme mood swings, and unusual behavior.
Understanding bipolar disorder
Manic episodes only occur in those living with bipolar I disorder, while hypomanic episodes can occur in those living with any subtype of bipolar disorder. Both disorder types can experience depressive episodes, which may have symptoms such as the following:
- Thoughts of hopelessness or worthlessness
- Prolonged sadness or irritability
- Fatigue
- Difficulty concentrating
- A lack of interest in previously enjoyed activities
- Self-doubt or guilt
- Difficulty sleeping
Certain manic and depressive symptoms may make bipolar disorder challenging to discern from ADHD. Identifying these shared or similar symptoms may help individuals understand which disorder they may be living with.
Do ADHD and bipolar disorder share symptoms?
According to one meta-analysis involving 71 studies and 646,766 participants, one in 13 adults with ADHD was diagnosed with bipolar disorder, while nearly one in six adults with bipolar disorder also had ADHD.
Several symptoms may be shared by ADHD and bipolar disorder, including the following:
- Unstable mood
- Sudden bursts of energy
- Excessive talkativeness
- Impatience
- Low frustration tolerance
- Restlessness
- Difficulty concentrating or making decisions
For those experiencing bipolar disorder, these symptoms may be related to hypomania, the milder and shorter-lasting version of mania. According to Dr. Kelly Ryan of Michigan Medicine, there may be a significant number of similarities between hypomania and specific ADHD symptoms, specifically emotional dysregulation, distractibility, and hyperactivity.
Emotional dysregulation
Hypomania can result in emotional regulation difficulties or fast shifts in mood, which are common symptoms for those living with ADHD. This shift may result in difficulty tolerating frustration, as well as emotional outbursts, irritability, and aggressive behavior. In some cases, these behaviors may affect an individual’s relationships or ability to perform at work or school.
Distractibility
Inattention can be one of the core symptoms of ADHD, which may make it difficult for individuals to focus on tasks or conversations. Those with bipolar II disorder may also become distracted, though this symptom might not be present for everyone.
Hyperactivity
Hypomania may cause an individual to experience bursts of energy that can disrupt sleep and increase hyperactivity. Similarly, ADHD can cause individuals to become hyperactive or have a desire for constant movement. This symptom can make it difficult to stay still or cause someone to fidget.
However, there are several ways that ADHD and bipolar disorder are distinct. Understanding these differences may be beneficial in determining whether someone is experiencing mania, hypomania, or the symptoms of ADHD.
What sets ADHD and bipolar disorder apart?
While ADHD and bipolar disorder may share similarities, there are several symptoms that set them apart. For example, ADHD is a neurodevelopmental condition that persists into adulthood and does not have a cure. However, bipolar disorder can develop later, with research indicating that the peak onset is between 20 and 40 years old.
In addition to onset, one potential way to tell ADHD and bipolar disorder apart is the frequency with which symptoms occur. ADHD is persistent, meaning that symptoms are ongoing, while bipolar disorder is often episodic, which indicates that it occurs at irregular intervals. These intervals usually consist of periods of elevated mood, known as manic (or hypomanic) episodes, and periods of low mood, known as depressive episodes.
Another distinguishing factor may be the potential to experience psychosis, which can be more common for those living with bipolar disorder. According to the National Institute of Mental Health (NIMH), psychosis can encompass symptoms like the following:
- Paranoia
- Uneasiness with others
- Suspiciousness
- Difficulty communicating
- Delusions
- Non-conventional feelings
- Emotional numbness
- Social withdrawal
- Difficulty distinguishing reality from fantasy
- Hallucinations
While it may be possible for someone with ADHD to experience psychosis, it may not be as closely connected as it is with bipolar disorder. However, some ADHD medications may increase the risk of psychosis, specifically prescription stimulants.
One study reviewed data from 337,919 young adults and adolescents who received a stimulant prescription for ADHD. Half of the group (110,923) was prescribed methylphenidate, and the remaining half was prescribed amphetamines. Researchers found that 1 in 660 patients experienced psychosis, with amphetamine use accounting for a greater risk of psychosis than methylphenidate.
Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.
How can you treat ADHD and bipolar disorder?
When considering treatment, it may be helpful to seek a diagnosis from a medical doctor or mental health practitioner. These professionals may help you determine whether you are experiencing ADHD, bipolar disorder, or a combination of both and find a potentially viable treatment plan.
Some professionals may recommend medications such as stimulants, antidepressants, or mood stabilizers. In addition, certain therapeutic approaches may be beneficial for both ADHD and bipolar disorder, including cognitive-behavioral therapy (CBT). Research suggests that CBT can be effective at reducing the symptoms of ADHD, while further studies indicate that CBT can alleviate symptoms of bipolar disorder.
Whether a therapist specializes in ADHD, bipolar disorder, or the use of CBT, it may be helpful to speak with a professional. Individuals with and without mental disorders may get numerous benefits from therapy, such as the opportunity to find support, build valuable coping skills, and discuss their experiences in a safe environment. However, in-person therapy may not be accessible to everyone.
In some cases, a provider that specializes in ADHD or bipolar disorder may not be available in your area. Mental health providers may also have limited scheduling availability, which could increase the time it takes to get an appointment. In addition, individuals may wish to use other forms of communication for their therapy sessions, such as texting, calling, or video chats. In these cases, it may be beneficial to try different options, such as online therapy through a platform like BetterHelp.
Research indicates that online therapy can be an effective alternative to in-person therapy. In one meta-analysis of 12 randomized controlled trials, researchers reviewed data from 931 patients administered telehealth therapy and face-to-face therapy. Their research indicated no significant differences between in-person and online therapy in function, working alliance, client satisfaction, and overall improvement. These results were seen immediately after treatment and at three, six, and 12 months.
Takeaway
While ADHD may not cause mania on its own, individuals may experience both ADHD and bipolar disorder or symptoms that closely resemble a manic episode. These symptoms can include an unstable mood, excessive energy, and distractibility.
Bipolar disorder and ADHD can also be distinct in many ways, including in their age of onset, symptom frequency, and the presence of symptoms like psychosis. Managing ADHD and bipolar disorder may be accomplished with certain medications and psychotherapeutic techniques like cognitive-behavioral therapy.
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