ADHD or Bipolar II? Understanding the Overlap

Many people with mood swings, distractibility, or impulsivity wonder: Do I have ADHD, bipolar disorder, or both? The question comes up most often with Bipolar II disorder, where the differences can be subtle.

Why Bipolar I Is Easier to Spot

Bipolar I usually involves full manic episodes: needing almost no sleep, extreme confidence, rapid speech, risky behaviors, and sometimes even hallucinations or delusions. These episodes are hard to miss for family, friends, and clinicians alike. ADHD does not cause mania, which makes the distinction clearer.

The Gray Zone: ADHD vs. Bipolar II

Bipolar II disorder is harder to spot. It involves hypomania (a milder form of mania) alternating with depression. Hypomania can look a lot like ADHD:

• Racing thoughts

• High energy and restlessness

• Talkativeness

• Impulsivity

The crucial difference is in the pattern over time:

• ADHD is lifelong, starting in childhood, and symptoms are fairly consistent.

• Bipolar II symptoms come in cycles, shifting between elevated mood and depression. These shifts are not just reactions to daily stressors they often occur out of the blue.

Extra Clues That Point Toward a Mood Disorder

Research and clinical experience highlight a few “red flags” that suggest a mood disorder, especially Bipolar II, rather than ADHD alone:

• Family history of bipolar disorder – one of the strongest predictors.

• History of postpartum depression – sometimes the first sign of bipolar vulnerability.

• Struggles with addiction or substance misuse – more common with bipolar than ADHD alone.

• Antidepressants that don’t work, or make mood worse – can signal underlying bipolar.

• Cyclic depression – ADHD can coexist with depression or anxiety, but not usually in a repeating, episodic way.

• Hypomania that looks like “high anxiety” – both involve restlessness and racing thoughts, but hypomania is marked by less need for sleep, inflated confidence, or sustained elevated/irritable mood, while anxiety is fear-based.

Impact on Daily Life

Bipolar disorder doesn’t just affect mood; it impacts daily functioning. Mood swings can interfere with holding a steady job, maintaining relationships, and family life. ADHD also causes challenges with focus and impulse control, but it tends to be steady rather than destabilizing in cycles.

Can You Have Both?

Yes. Studies suggest that 10–20% of people with ADHD also develop bipolar disorder, most often Bipolar II. ADHD is usually diagnosed first in childhood, while bipolar tends to appear later in adolescence or young adulthood.

Why This Distinction Matters

Because the treatment approach is different:

• ADHD is often treated with stimulants (Adderall, Vyvanse, Ritalin).

• Bipolar II requires mood stabilization first (for example, with Lamotrigine or Lithium).

If bipolar isn’t stabilized, stimulants can worsen mood swings or trigger hypomania. Even after stabilization, prescribers approach stimulants with caution, since they are controlled substances with some risk for misuse.

Takeaway

When mood swings and impulsivity show up, it isn’t always clear whether it’s ADHD, Bipolar II, or both. The difference lies in the nature of the symptoms: ADHD is consistent and lifelong, while bipolar involves cyclical shifts in mood and energy.

The good news: with a careful evaluation and the right treatment plan, people living with ADHD, bipolar disorder, or both can find stability, clarity, and quality of life.