Bipolar

It’s tricky to diagnose ADHD because most adults have at least one other issue going on. Depression. Anxiety. And yes, even Bipolar Disorder. (Formerly known as Manic Depression.)

As Dr. Anthony Rostain Reveals even medical professionals who should know better dismiss ADHD as Bipolar! So I asked Dr. Ari Tuckman how these two disorders are alike, and how do we tell them apart. Fascinating.

Transcript

Dr. Anthony Rostain: My biggest beef, my biggest gripe is with my own colleagues who don’t take the diagnosis seriously. I was at a conference in Chicago at the American Clinical Psychiatry Association and I was an invited speaker on adults with ADD, and they had a guy that came there and said that adult ADHD was a fabrication and he said it’s all Bipolar disorder and you’re really missing the diagnosis etc…

He literally gave an hour speech to this group of clinical psychiatrists and I was, I kept my calm and my cool but I thought to myself this is really dangerous that this person is going around saying ADHD in adults is a myth or it’s over diagnosed.

Rick Green: That is Dr. Anthony Rostain who is brilliant and I’m Rick Green who is here and available. We’re going to take a look at Bipolar versus ADHD, what the difference is or are there differences?

And before we do I want to clarify a couple of things. First of all yes, ADHD is over diagnosed among children in some places, in other places in other parts of the country and especially around the world it is under diagnosed or not even a thing, a possibility.

Among adults Attention Deficit Hyperactivity Disorder is woefully under diagnosed everywhere. In fact the vast majority of adults who have this unique wiring still have no idea that that’s what is messing them up, or they may wonder if it might be but they’re afraid to look into it, what a waste, and so they crash through life struggling with restlessness and impulsivity and impatience and all of the rest.

In other videos we’ve shown how often ADHD is misdiagnosed as depression especially among women or it’s misidentified as an anxiety disorder. In other videos we explore how and why people with ADHD actually are at a much higher risk for depression and anxiety among many other things, but one reason for those two is decades of undiagnosed ADHD can leave you kind of depressed and rather anxious, been there done that bought the t-shirt, don’t want to go back.

In fact I did a survey and many of our Patreon supporters were misdiagnosed with something else before they or a good doctor finally figured out that the core problem was ADHD, Attention Deficit Hyperactivity Disorder and sometimes that misdiagnosis is Bipolar when it’s actually ADHD or the other way around, they’re diagnosed with ADHD when it’s actually Bipolar and of course as we’ll see sometimes it can be both, but as Dr. Anthony Rostain noted some doctors think all ADHD is Bipolar. Is that even possible? Are they the same, are they that similar or are there differences and what are the differences? Well

I asked Dr. Ari Tuckman what’s behind all the confusion.

Why Are ADHD and Bipolar Misdiagnosed?

Dr. Ari Tuckman: ADHD sometimes misdiagnoses Bipolar, now on the one hand I can see it because there’s definitely areas of overlap, so folks with ADHD and folks with Bipolar have trouble with sleep, they’ve trouble with spending, they’ve trouble about you know decisions they make such as you know decisions about sex or other things like that.

So there is a little bit of overlap but once you get into the nitty-gritties of it they really look completely different and the ways that they’re different are that for folks with ADHD it looks a little bit more like this (draws a almost straight line) so it’s there but it’s nothing monumental, folks who Bipolar it’s more like that (draws a roller coaster big ups and downs) you know there are these big swings, big up and then a big down and then they’re back to normal so to speak.

Whereas with folks with ADHD there’s this constant process that it’s always there always there, always there, so this greater emotionality that folks with ADHD have it’s always present as opposed to folks with Bipolar disorder it’s notably different. So anyone who knows this person well at all will say uh what’s wrong with Bob he’s not really himself anymore, things are different with him or what what’s going on with that?

Rick Green: Right, so it is dramatic it’s like a roller coaster high and low, whereas with ADHD.

Dr. Ari Tuckman: Whereas folks with ADHD it’s like, oh Bob yeah you know that’s Bob he’s always like that.

It’s Important to Find Out if it’s Bipolar or ADHD

I think it’s important to get that diagnosis right because the medication used for ADHD is really problematic for folks who are in fact Bipolar, especially if their Bipolar disorder isn’t medicated and treated, and on the other side medications for Bipolar disorder do nothing helpful for

ADHD. So you know this is one of those cases in medicine where you got to get the diagnosis right because the treatments are going to send you in very different directions.

Rick Green: Which means that a person and this is understandable is now convinced that ADHD medications are dangerous, in fact I know a couple of people who suddenly tipped into Bipolar, very successful people one guy an amazing businessman, successful, involved in causes, on the go, so when he started to slip into the manic stage no one really caught it at first, his usual drive and enthusiasm just seemed to be much more, he’s really on a roll, and then suddenly bam crash.

So ADHD I understand and know about, Bipolar not so much. It’s not constant like ADHD; I get that, but is it that every year you have three episodes? Is it regular like that? Or is it 10 years and then you can have it, or does it vary all over the place from person to person?

How Many Bipolar Episodes Per Year Do People Have?

Dr. Ari Tuckman: People with Bipolar disorder tend to spend most of their time kind of in the middle, so that normal up and down that most people might feel in their life, so some days are better and some days are worse in that normal sort of way, but then for whatever reason something sets them off, usually a big stress or some other major event in their life, which could be a negative but it could also be a positive, it sets them off into a Bipolar episode. So up they go and then they crash back down. For some people it happens quite often for other people it can be years in between but there’s this clear distinct period when they’re not themselves.

Rick Green: So Ari said that there are some Bipolar symptoms that are also common to people with ADHD, so I asked what are the signs that someone is going into a Bipolar episode? What would you look for?

Symptoms of Bipolar Disorder

Dr. Ari Tuckman: Typical symptoms of a manic episode are notably decreased need for sleep, so they’re sleeping two, three, four hours a night but are bursting with energy, which is the opposite like if you get two or three hours you should feel terrible and be tired but they are raring to go. Lots and lots of ideas, lots of thinking but almost to a point where it’s like they can’t get it out quick enough, everyone else is moving too slow, they might make incredibly impulsive major financial spending decisions, so go to the mall and buy two thousand dollars worth of shoes and clothes and everything else, whereas they’d normally spend a hundred dollars, so totally different.

Bipolar spending is generally pretty good financial management and then as they go up into a manic episode they spend in this really reckless sort of way as opposed to the ADHD spending is more, it’s not two thousand dollars it’s twenty dollars here, thirty dollars there, five dollars there, but it’s that little by little by little. Now it might add up to two thousand dollars at the end of the month but it doesn’t all come out in this you know really sort of crazy sort of way the way it does in a Bipolar episode.

So if you ask, do you spend money recklessly? If that’s your question someone with ADHD could think about it and say yeah I guess I do but you get into the details of it and it’s completely different in a manic episode compared to with someone who has ADHD.

Rick Green: Not recklessly so much as impulsively and let’s be honest we usually don’t have 2,000 bucks to spend on anything.

Dr. Ari Tuckman: Much greater sex drive you know, kind of like even little church ladies going out and picking up guys at a bar, totally out of character, or if they have a partner and they’re staying with their partner their interest in sex is sort of unquenchable and their partners just sort of like I’m done, leave me alone, but it’s a really different period of time compared to how they normally behave and then after the up comes the down and they crash into a depressive episode and again it’s that’s notably different than how they normally are, and then somehow or other they come back to level and then on they go with their life.

Rick Green: As I say I’ve known three or four people who have Bipolar, who have developed Bipolar and so much of what Ari is describing resonates, they become lit up, everything is awesome, enthusiasm, great to see you, energy, ideas, they’re go, go, go, and then bam. It’s astonishing, so the question I asked is, is this on a spectrum like ADHD, because with ADHD some people are so driven or restless or fidgety and have so much problem with focus and can barely finish a sentence, been there and done that. Other people are less so or some of the symptoms are less so.

Bipolar 1 vs Bipolar 2

Dr. Ari Tuckman: There’s two kinds of Bipolar disorder, so Bipolar 1, people have full-on manic episodes and if someone has a full manic episode they’re, well they’re kind of really out there, so in some of the most severe cases they’re becoming psychotic, they’re becoming delusional, they’ll you know write a 200 page letter to the president solving all the world’s problems in a way that’s really just sort of out of touch with reality.

Folks with Bipolar 2 have what’s called hypomanic, so hypo meaning less, so they have all those symptoms that I described but not as completely out there as someone who has a Bipolar one manic episode.

Rick Green: So okay, we know ADHD is genetic; it may involve wiring and certain neurotransmitters, especially dopamine, what’s going on with Bipolar? I asked Ari is there too much dopamine, too little?

Dr. Ari Tuckman: Bipolar disorder also involves dopamine but it’s one of those situations where mostly those neurotransmitters are well regulated and then something happens that upsets the balance and then things just you know go off for a time and then they click back in. As opposed to folks with ADHD, it’s always sort of there, you know there’s a certain amount of imbalance but it’s not completely off the charts.

Rick Green: No just this constant low grade. So to review, Bipolar is about mood swings that are polar opposites. ADHD isn’t like the poles it’s more like the equator going on and on, around in circles. Well that was clever.

It’s worth mentioning again that some people can have both disorders, in fact a couple of the adults in our video series on ADHD medication talk about the challenges of first diagnosing and then treating two very different issues because they have Bipolar and ADHD.

So thanks to Dr. Ari Tuckman and Dr. Tony Rostain and all the experts who share with us, and especially a big thanks to our patrons who support what we’re doing and make these videos possible. If you like these videos if you want more please become a patron.