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Bipolar disorder

Bipolar disorder is a mental health condition characterised by extreme, episodic shifts in mood, energy and activity levels. People with bipolar disorder experience intense emotional states that typically fall into two categories:

  • Mania or hypomania: periods of extremely elevated energy, racing thoughts, grandiosity, impulsive behaviour and a decreased need for sleep.

  • Depression: periods of profound sadness, deep exhaustion, hopelessness and a lack of interest in life.

Unlike the daily ups and downs most people experience, bipolar mood episodes are severe, can last for days or weeks at a time, and significantly disrupt a person's ability to function.

The link to ADHD: comorbidity and confusion

Both ADHD and bipolar disorder share core traits:

  • Racing thoughts

  • Extreme impulsivity

  • Restlessness and high energy

  • Emotional dysregulation

  • Difficulty concentrating

The connection between ADHD and bipolar disorder is strong and frequently misunderstood. Research suggests that up to 20% of people with ADHD may also have bipolar disorder. However, the true challenge lies in how heavily the two conditions overlap.

Because of this overlap, misdiagnosis is incredibly common. Someone with severe ADHD might be incorrectly diagnosed with bipolar disorder due to their intense emotional shifts. Conversely, someone's bipolar disorder might be missed because their manic impulsivity is written off as 'just their ADHD'.

What it looks like: telling them apart

Understanding the difference between ADHD and bipolar disorder – and recognising when both are present – is vital.

  • Episodic vs. continuous

    • ADHD is a neurodevelopmental trait; the brain is wired this way 24/7. While ADHD symptoms can fluctuate depending on stress or environment, they are a constant baseline. Bipolar disorder is episodic. A person will have distinct periods of mania or depression, often followed by periods of stable, typical mood.

  • The 'trigger' factor

    • Emotional dysregulation in ADHD (like rejection sensitive dysphoria) is usually triggered by a specific external event: an argument, a perceived slight, or a failure. The mood shift is instantaneous and intense, but it usually passes relatively quickly. Bipolar mood shifts can happen without any external trigger at all and last for weeks or months.

    • Sleep differences

    During an ADHD hyper-focus phase, a person might stay up late because they are distracted or engaged in a project, but they will eventually feel exhausted. During a bipolar manic episode, a person might not sleep for days and still feel completely energised and wired.

    Coping strategies and support

    Managing co-occurring ADHD and bipolar disorder is complex, but with the right specialised care, individuals can find stability and thrive.

    Sequential medication management

    This is the most crucial step. If a person has both conditions, doctors typically must stabilise the bipolar disorder first (usually with mood stabilisers or antipsychotics). If ADHD stimulant medications are given before the bipolar disorder is stabilised, the stimulants can accidentally trigger a severe manic episode.

    Rigid sleep hygiene

    While a lack of sleep makes ADHD worse, for someone with bipolar disorder, sleep disruption is one of the primary triggers for a manic episode. Establishing a strict, non-negotiable sleep routine is a medical necessity for keeping the nervous system regulated.

    Tracking moods vs. triggers

    Using a mood-tracking app or journal can help individuals and their doctors see patterns. If a mood shift lasts for a few hours after a stressful meeting, it’s likely ADHD. If the elevated mood or depression lasts for two weeks regardless of what happens at work, it points toward bipolar episodes.

    Building a "crisis plan"

    Because mania can lead to highly impulsive, dangerous decisions (like excessive spending, substance use or risky behaviour), having a pre-written crisis plan with trusted family members or friends is essential. This plan outlines what steps to take when early warning signs of an episode appear.

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    Timely detection matters

    When bipolar disorder and ADHD co-occur and are not correctly managed, the risk for severe outcomes skyrockets. The impulsivity of ADHD, combined with the recklessness of mania or the despair of bipolar depression, drastically increases the likelihood of substance addiction and suicide.

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    This is why the Matthew Lock ADHD Charity fiercely advocates for comprehensive, accurate screenings. Identifying the full picture of a person's neurodiversity and mental health is the first step in saving lives.

    Lived experience: ADHD and bipolar disorder

    "It took years to get my dual diagnosis. Doctors kept thinking my bipolar hypomania was just my ADHD hyperactivity. The difference is that my ADHD just makes me physically restless and talkative. But when I’m hypomanic, I feel like I'm invincible, like my brain is on fire in the best and worst way possible, and I make decisions that ruin my life. They are two totally different engines driving the same car."

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    "The hardest part is the medication tightrope. I desperately need my ADHD meds to function at work and keep my thoughts straight. But if we tweak the dose even a little bit too high, it tips my brain straight into a manic episode. It feels like a constant science experiment just trying to exist."

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    "ADHD emotional dysregulation means I can go from fine to furiously crying because I dropped my coffee, but an hour later, I'm okay. Bipolar depression means I wake up one day feeling completely hollow, and no matter what happens, that darkness doesn't lift for months. Managing both means I constantly have to ask myself: 'Is this a reaction to right now, or is this an episode starting?'"

    Source references

    The British Journal of Psychiatry

    Statistic supported: Up to 20% of adults diagnosed with bipolar disorder also meet the criteria for comorbid ADHD.

    Reference detail:

    ​"Cognitive and occupational functioning in bipolar disorder and ADHD: impact of comorbidity." (2026). The British Journal of Psychiatry.

    Depression and Bipolar Support Alliance (DBSA)

    Fact supported: 10% to 20% of adults with bipolar disorder also meet the criteria for ADHD, and the extreme overlap in impulsivity and emotional dysregulation makes misdiagnosis highly common.

    Reference detail:

    DBSA, "Co-occurrence of ADHD and Bipolar Disorder."

    ADDitude Magazine (Leading ADHD Medical Publication)

    Fact supported: Bipolar disorder is frequently missed or misdiagnosed as ADHD because ADHD is far more common in the general population, and stimulant medications used to treat ADHD can inadvertently trigger a manic episode if underlying bipolar disorder is not stabilised first.

    Reference detail:

    "ADHD vs Bipolar: Guide to Distinguishing Lookalike Conditions," medically reviewed literature.

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