The relationship between ADHD and what we might term mania in depressed individuals can be complex, as both ADHD and bipolar disorder (which includes mania) share overlapping symptoms, and they can sometimes co-occur. It’s perhaps important to state that bipolar disorder is different from clinical depression. With the latter manic coping mechanisms are generally absent and low mood persistent.
Here are key overlapping aspects of the relationship:
- Impulsivity
- Hyperactivity
- Restlessness
- Distractibility
- Racing thoughts
This overlap can sometimes make it difficult to distinguish between the two, especially when individuals with bipolar disorder alternate between different mood states.
ADHD and bipolar disorder often co-occur, with studies showing that individuals with ADHD have a higher likelihood of developing bipolar disorder compared to the general population. In those with bipolar disorder, ADHD can present throughout all mood states (depression or mania), whereas manic symptoms tend to be episodic.
ADHD is a neurodevelopmental disorder that begins in childhood, while bipolar disorder typically emerges later in adolescence or early adulthood and is arguably temporally environmental. However, when both are present, the impulsivity and inattention of ADHD may persist even during manic or depressive episodes.
Mania tends to be episodic, meaning it comes in waves and can last for days, weeks, or longer. During manic episodes, people may experience extreme energy, euphoric or irritable mood, grandiosity, reduced need for sleep, and risk-taking behaviors. These symptoms fluctuate over time.
ADHD symptoms, on the other hand, are chronic and tend to be more consistent across time and settings, although they may vary in intensity depending on the individual’s environment or anxiety levels.
Individuals with ADHD are at a higher risk for experiencing depressive states due to the challenges they face in academic, occupational, and social settings. Struggling with ADHD symptoms, such as inattention or impulsivity, can lead to low self-esteem, feelings of failure, and frustration, which may contribute to depressive episodes.
In depressed individuals with ADHD, it can be challenging to differentiate whether periods of increased energy or racing thoughts are part of an ADHD pattern or signify the onset of a manic episode within a bipolar disorder framework.
Misdiagnosis can occur, especially if clinicians focus on episodic symptoms like hyperactivity or impulsivity without considering the broader context of mood changes (e.g., depression and mania in bipolar disorder or other similar (perhaps comirbid) chronic mood disorders). A person with ADHD may be mistakenly diagnosed with bipolar disorder if their hyperactivity is seen as mania, or vice versa.
When assessing individuals with ADHD who have episodes of depression, clinicians need to carefully evaluate for bipolar disorder to avoid the potential worsening of symptoms with inappropriate treatment. For instance, using stimulants (commonly prescribed for ADHD) in someone with undiagnosed bipolar disorder may trigger or exacerbate manic episodes.
Depression can amplify the cognitive difficulties associated with ADHD, such as poor focus, forgetfulness, and sluggish thinking. During a depressive phase, ADHD symptoms may worsen.
Mania in someone with depression and ADHD may intensify the impulsive, hyperactive tendencies of ADHD, but mania in depression tends to be more severe and associated with mood elevation or irritability, whereas ADHD is more stable over time.
Of course treatment for individuals with both ADHD and bipolar disorder (depressive mania) requires careful management. Mood stabilizers or antipsychotics are often used to treat bipolar disorder, while ADHD is typically managed with stimulants or non-stimulant medications. However, stimulants can worsen mania, so mood stabilisation is often prioritised before addressing ADHD symptoms.
For individuals with co-morbid depression addressing both the mood disorder and the ADHD is crucial. Selective serotonin reuptake inhibitors (SSRIs) or other antidepressants might be used for depression, but care must be taken to monitor for potential shifts into mania if there is an underlying bipolar disorder.
ADHD and depression related mania can both present with overlapping symptoms, and their co-occurrence is not uncommon in individuals with depression. While ADHD is a chronic, stable condition that persists across situations, mania is episodic and often part of bipolar disorder. Proper diagnosis by a suitably qualified clinician such as a psychiatrist or clinical psychologist is crucial, to differentiate between these conditions and ensure appropriate treatment, as treatments such as stimulants for ADHD can exacerbate manic symptoms IF the person is actually experiencing an underlying bipolar disorder sympton.
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