By Dr. David Woo - April 10, 2023

Bipolar disorder and attention-deficit/hyperactivity disorder (ADHD) are sometimes confused with each other, despite being quite different conditions. This is because they share overlapping symptoms, making them difficult to distinguish depending on the severity and time since onset of symptoms. 

Do I Have Bipolar Disorder or ADHD?

It’s perfectly normal to experience emotional highs and lows and moments of impulsivity or distraction, but when these negatively impact our lives or relationships, they may be signs of an underlying mental health issue such as ADHD or bipolar disorder. To make sure that you get the appropriate treatment, it is important to know the differences between these two commonly confused conditions.

Bipolar Disorder

Bipolar disorder, formerly called manic depression, is characterized by extreme highs (mania) and lows (depression). The patient’s mood swings oscillate between two polar opposites, although there may be periods of stability or “balance”.

Manic episodes are sometimes mischaracterized as “happy” phases, but this is a common misconception. Instead, someone in a manic phase will usually experience the following:

• Extreme energy and alertness
• Feeling tense, agitated, jumpy or “wired”
• Euphoria (intense excitement or happiness)
• Insomnia
• Exaggerated feelings of self-confidence 
• Chattiness and rapid speech
• Distracted thoughts
• Poor impulse control leading to risky decisions on relationships, substances, money, etc.

Depressive episodes are characterized by the following symptoms:

• Intense feelings of sadness or emptiness
• A loss of interest in formerly pleasurable activities
• Weight loss or gain due to disrupted eating
• Insomnia or oversleeping
• Fatigue 
• Low sense of self-worth
• Thoughts of self-harm and even suicide

Periods of mania or depression can last weeks or months. The intensity and length of phases varies from patient to patient, with some extreme cases requiring hospitalization. 

Although there is no cure for bipolar disorder, symptoms can be treated with medications such as antidepressants or antipsychotics. Research has shown that transcranial magnetic stimulation (TMS) under supervision from a physician can be an effective non-pharmaceutical, non-invasive way to treat patients with bipolar disorder. (1,2)

ADHD

ADHD is characterized by impulsivity, hyperactivity, and problems concentrating or paying attention to things. The symptoms of ADHD often manifest in childhood and can include:

• Finding it hard to focus on tasks at work or school
• Being easily distracted
• Forgetfulness
• Difficulty following instructions or completing tasks
• Social awkwardness
• Excessive talking, including interrupting or talking over others

ADHD is often treated with stimulants and/or cognitive behavioral therapy. Because stimulants can actually worsen the negative effects of bipolar disorder, confusing it with ADHD in this case can be risky. However, TMS therapy has also been shown to effectively relieve ADHD symptoms. (3)

ADHD vs Bipolar: How to Spot the Difference

The above paragraphs show the many overlapping/similar symptoms of these two conditions. ADHD and bipolar disorder can both manifest in hyperactivity, problems concentrating, excessive talkativeness, sleep problems, emotional instability, and impulsivity.

It can be helpful to track symptoms and think about whether they are occurring in a manic-depressive cycle (indicative of bipolar disorder) or if they have been consistent since childhood (indicative of ADHD). However, it is also possible for a person to have both at the same time. (4)

Ultimately, the best course is to seek professional help rather than jump to conclusions. An experienced psychiatrist can give you a prosper diagnosis and recommend appropriate treatment options. To make an appointment with a licensed healthcare professional at Madison Avenue TMS & Psychiatry, contact us online or call (212) 731-2033.

Sources

1. Nahas Z, Kozel FA, Li X, Anderson B, George MS. Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: a pilot study of acute safety and efficacy. Bipolar Disord. 2003;5(1):40-7. Link. Accessed March 03, 2023.

2. Tavares DF, Myczkowski ML, Alberto RL, Valiengo L, Rios RM, Gordon P, de Sampaio-Junior B, Klein I, Mansur CG, Marcolin MA, Lafer B, Moreno RA, Gattaz W, Daskalakis ZJ, Brunoni AR. Treatment of Bipolar Depression with Deep TMS: Results from a Double-Blind, Randomized, Parallel Group, Sham-Controlled Clinical Trial. Neuropsychopharmacology. 2017;42(13):2593-2601. Link. Accessed March 03, 2023.

3. Alyagon U, Shahar H, Hadar A, et al. Alleviation of ADHD symptoms by non-invasive right prefrontal stimulation is correlated with EEG activity. Neuroimage Clin. 2020;26:102206. Link. Accessed March 03, 2023

4. Carmen Schiweck, Gara Arteaga-Henriquez, Mareike Aichholzer, Sharmili Edwin Thanarajah, Sebastian Vargas-Cáceres, Silke Matura, Oliver Grimm, Jan Haavik, Sarah Kittel-Schneider, Josep Antoni Ramos-Quiroga, Stephen V. Faraone, Andreas Reif,

Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis,

Neuroscience & Biobehavioral Reviews. 2021;124:100-123. Link.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.