When ADHD symptoms overlap with conditions such as bipolar disorder, it is difficult to distinguish between disorders. The National Comorbidity Survey showed that attention-deficit/hyperactivity disorder or ADHD exist together in 21.2 percent of adult patients with Bipolar Disorder, as reported in 2006 by psychologist Ronald C. Kessler, Ph.D.
Adult ADHD and bipolar disorder sufferers’ responses to prescribed drugs vary. Patience on the part of both patient and doctor, along with trial and error, is essential to determine the most effective medications and dosages for an adult with ADHD and bipolar disorder.
Atomoxetine and Other Nonstimulants
Atomoxetine is the first Federal Drug Association-approved, non-stimulant medication for treating people with ADHD who also have bipolar disorder. According to psychologists M. Austin, N.S. Reiss and L. Burgdorf, this drug "seems to block norepinephrine receptors in the brain, which increases attention and controls hyperactivity and impulsivity." Unfortunately, for patients who have comorbid ADHD and bipolar disorder with manic features, atomoxetine could trigger a manic episode. However, for some people suffering from both conditions, atomoxetine taken with mood stabilizers may be a safe and effective treatment.
Nonstimulant ADHD prescription drugs are beneficial because they work 24 hours a day, allowing people with ADHD and bipolar disorder to function effectively from early morning until bedtime.
Bupropion is an atypical antidepressant for people who have both ADHD and the depressive symptoms of bipolar disorder. Patients with both conditions may benefit from taking bupropion (Wellbutrin) in addition to their antimanic agents, according to psychiatrists and authors, Drs. A.P. Wingo and S.N. Ghaemi, who co-authored a study on "Cormorbid Adult ADHD and Bipolar Disorder." The doctors suggest treating adults’ mood symptoms and then reassessing the ADHD diagnosis. If the patient has both conditions, doctors recommend keeping patients on mood stabilizers and prescribing bupropion, because it has low manic switch rates.
In a six-week trial of bupropion in 30 adults with ADHD and bipolar disorder, everyone stayed on their medication throughout the study and 82 percent of the "patients experienced a reduction of ADHD symptoms of 30 percent or greater ... without concurrent mania," as reported in the article, "APA: Co-Morbid ADHD in Bipolar Adults May Respond To Non-Stimulants," by Neil Osterweil, Senior Associate Editor of MedPage.
Lithium and Other Mood Stabilizers
While some psychiatrists agree that ADHD and bipolar disorder share many symptoms, including unstable moods, bursts of energy, restlessness, impatience and talkativeness, they do not necessarily agree about the percentage of ADHD individuals who also have bipolar disorder. Some doctors believe the mood swings experienced by people with ADHD are a symptom of attention deficit hyperactivity disorder. Others see the depressive and manic features as signs of a separate, co-existing condition called bipolar disorder.
Whether mood instability is a symptom of ADHD or of a comorbid condition, mood stabilizers, such as Lithium, prescribed to treat bipolar disorder, may be useful in alleviating irritability and managing extreme mood swings. If adults have both ADHD and bipolar disorder, and the conditions cannot be successfully treated simultaneously, many doctors treat the bipolar disorder first and then the ADHD, because some ADHD treatments may worsen bipolar disorder, according to psychiatrist William Dodd, M.D. in the magazine "ADDitude."