The Challenge of Living With Both Bipolar Mania and ADHD
I’ve lived with a bipolar disorder diagnosis for four years now, and an attention-deficit/hyperactivity disorder (ADHD) diagnosis for about two. But as many people with mental illnesses will tell you, you don’t get a diagnosis immediately after you begin experiencing an illness. So, to put it another way, I’ve been living with bipolar disorder and ADHD for several years, and couldn’t pinpoint a “start date” even if I tried.
Bipolar disorder, for those who don’t know much about it, is a disorder characterized by instability in maintaining one’s mood, cycling between episodes of depression on one end of the spectrum, and mania at the other. Mania can be difficult to identify because it presents in a significant number of ways, and some symptom manifestations are rather unorthodox from what mania is best understood as in the clinical world. But to provide a broad definition: mania is atypically enhanced feelings of euphoria and/or energy. Personally, my manic symptoms usually include insomnia due to heightened energy levels, excessive and detrimental shopping habits, and increased “productivity,” which may sound like a good thing, but it’s to an extreme.
Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder that impairs cognitive abilities (mostly attention, but usually impacts other abilities like memory, comprehension, etc.) and behavioral symptoms which can include spontaneous bouts of undirected energy, increased motivation, and agitation. ADHD, clinically speaking, has two “types,” though not everyone with ADHD has a type. Hyperactive-type ADHD means a person’s symptoms are mostly behavioral, while inattentive-type ADHD expresses mostly cognitive impairments.
So, why did I just write out a synopsis of bipolar mania and ADHD when the two aren’t in the same class of disorders? Well, because I live with both of them, and let me tell you, it isn’t fun. It’s remarkably confusing to think about, but you may have already noticed the overlaps in my explanation. Mania usually consists of heightened energy and mood, and part of ADHD is symptoms of hyperactivity, like heightened energy and mood. It seems somewhat rare for someone to get both of these diagnoses because in my experience, mental health professionals usually just pick one and run with that. I consider myself lucky to have been diagnosed with both because I genuinely experience difficulties with daily life from symptoms unique to each. I was lucky enough to have doctors and therapists that looked beyond the surface and saw that I exhibited behaviors common to both, but also symptoms unique to each.
One of the biggest challenges I have living with both can be summarized with a simple question that I ask myself, and that my doctors and therapists ask me:
Do you think this is mania or hyperactivity?
Now, that question is usually asked when I’m exhibiting signs common to both disorders, and that is the difficulty with diagnosing and treating them together. When I’m really high energy and motivated, in my personal experience, I can’t really tell if it’s my ADHD or if I’m moving into a manic episode. If I can’t identify which it is, deciding the best course of action in terms of treatment and therapy is nearly impossible. And sometimes, the storm surges in just the right way where I enter a manic episode at the same time I start experiencing a bout of hyperactivity. The two work in tangent and elevate my mood and energy to an astronomical level. I feel incredible, but the reason mania and hyperactivity aren’t positive is because they become detrimental, and what that looks like varies from person to person.
Another difficulty, a much more pragmatic one, is medications. The classes of medications for bipolar disorder — particularly mania — and ADHD are totally separate, and in some cases actually do the opposite things for our brains and bodies. The most common medications for ADHD are known as stimulants. That may sound like a strange medication to take for someone who experiences hyperactivity and inability to maintain focus, and I thought the same thing at first: why would I want to increase my mental stimulation if that’s what’s making me hyperactive, and gives me the racing thoughts that make it difficult to focus? Without going into the very detailed chemistry and biology of it (my degree is in neuroscience, so I always have to control myself when writing about science), calling ADHD medications stimulants is scientifically accurate, but misleading in layman’s context. What those medications are actually stimulating is our brains’ ability to inhibit our energy levels when they get too high and the ability to control our focus better. A simpler way of putting it: these medications are stimulating our brains to better calm ourselves down. Now, that sounds at first like it would work perfectly for bipolar mania as well. Unfortunately, it isn’t so simple. People with bipolar disorder are actually highly recommended to stay away from stimulants if possible. Again, avoiding the complex science of it, the networks in our brains impacted by ADHD are not the same (largely) as the ones impacted by mood dysregulation in bipolar disorder. So, taking stimulants with bipolar disorder and ADHD can show improvements in the latter, but can actually induce episodes of mania or hypomania since they can stimulate those systems in our brains.
When it comes to bipolar disorder medications, traditionally mood stabilizers or antipsychotics, they can have the opposite effect, chemically and biologically, as ADHD medications. Taking both at the same time, depending on the wide variety of factors that all patients and health care providers consider, can lead to them canceling each other out and reducing their efficacy. For people with both bipolar mania and ADHD, this can make the hellish game of psychiatric medications even worse. For me, not only can I not escape the highs of mania and hyperactivity/inattentiveness, but the treatments available to me are double-edged swords.
Both bipolar mania and ADHD are characterized, to a certain degree, by instability. For people with both and trying to reach a more stable mental state, it generally is more difficult than people with just one of these diagnoses. The very nature of both leads to an almost unavoidable collision of the symptoms of both working in tandem to increase the severity of the other. Bipolar mania can increase the intensity of hyperactivity or worsen racing thoughts as a result of inattentiveness. Classic ADHD symptoms can sometimes induce manic or hypomanic episodes, and medications for both are double-edged swords in that they can help with one while exacerbating the other. Overall, ADHD and bipolar mania are a tough mixture. But if there’s anything I’ve learned in my journey with mental illness, it’s that there’s nothing that’s totally insurmountable. Progress in treatment, both in medications and therapy, is always possible in my opinion. Take it from someone who has made great strides in balancing treatments for both of these disorders at the same time. It is possible to reach a sense of stability. It isn’t easy, but trust me, it’s worth it.
Photo by Rostyslav Savchyn on Unsplash