Bipolar Disorder and ADHD

Bipolar Disorder, or Manic-Depressive Disorder, is a serious, lifelong disorder of the brain causing extreme changes in mood and behavior. Many experience switching between phases of elevated, euphoric mood with high energy and phases of depressed mood with low energy. Some have episodes of high energy combined with irritability or agitation, instead of euphoria and reckless pleasure seeking.
Bipolar Disorder most commonly starts in adolescence and can present in children.
However, the reality is most young patients report a wide range of emotions, making for a confusing picture.

The challenge of differentiating ADHD and Bipolar Disorder
The checklist of symptoms for ADHD is almost the same as that of Bipolar Disorder in children and adolescents. Differentiating ADHD from Bipolar Disorder is an important area of concern, given the negative impact of ADHD medications in those with an untreated mood disorder.

Some hypothesize that stimulant medication exposure can permanently alter the course of Bipolar Disorder in some children. In addition, atomoxetine, FDA-approved for the treatment of ADHD, has been clinically found to be a potent mood destabilizer.

In 2004, Dr. Henderson and Dr. Hartman found that roughly 33 percent of children and adolescents became mood dysregulated on atomoxetine. In 2008, Europe warning labels for atomoxetine added mania, aggression, and hallucinations as dangerous side effects; no changes have been made to the American warning labels.

ADHD is not a simple diagnosis. Many other conditions, such as traumatic brain injury, fetal alcohol syndrome, bipolar disorder, and toxic encephalopathy also produce clinical symptoms (impaired attention, hyperactivity, and impulsivity) similar to ADHD and pose a problem in the differential clinical diagnosis of ADHD.

To further hinder the diagnostic process, several specific symptoms of ADHD are also part of the diagnostic criteria for other disabilities such as learning disabilities, petit mal seizures, anxiety, personality disorders, and/or depression.

Better diagnostics with neuroimaging
Just as traumatic brain injury or toxic brain injury look very different from ADHD on neuroimaging but present some of the same symptoms as ADHD, Bipolar Disorder appears quite different from ADHD in neuroimaging.

In addition, there is overwhelming neurobiological evidence for the existence of multiple forms of ADHD based on neuroimaging. A multitude of functional imaging studies utilizing a diversity of modalities, including SPECT, functional MRI (fMRI), PET, and QEEG repeatedly demonstrated similar results in children and in adults.

Research studies reviewed by Dr. Cherkasova and Dr. Hechtman show reduced activity during a concentration task in the prefrontal cortex, orbital frontal cortex, and caudate nuclei in some patients with ADHD. In addition, abnormal function and anatomy have been reported in the cerebellum of some patients with ADHD. Others diagnosed with ADHD have poorly functioning temporal lobes.