Bipolar Disorder

  • hallmark is the up episodes, feeling better than most people, though it can also be agitation so it isn’t always a good feeling
  • overly confident, silly, risk taking, making poor decisions, needing less sleep than others
  • can be more productive than others but can start to spin wheels from taking on too much

Many people with ADHD talk about large mood swings, but the swings aren’t gigantic, are more often triggered by something, even if it is minor or innapropriate to react to, and swings tend to happen over several days to many months, rather than flipping thought the day depending on what’s happening and who pisses you off

In bipolar, patients only look ADHD when they are manic. In fact, being a little bit manic (hypomanic) often means people are especially productive.

Bipolar must be under control before you look at treating ADHD. Not doing so can put the patient in hospital, on the psychiatric ward and locked up. If the patient is on their mood stabilizer(s) and doing well, treating ADHD is not especially risky, though I do like someone to keep an eye on the patient as going manic, the patient is usually unaware that anything is wrong.

Bipolar is broken into Bipolar I – with extreme highs, extreme lows, sometimes bizarre behaviour and can lead to being picked up by the police and committed for assessment.

Bipolar II has fewer ups, of a less intense nature and usually involves far more downs than ups. By DSM5 definition, the ups have to last at least five days.

Bipolar Spectrum is a recent concept (last 10 years) and not everyone agrees with the term or even its existence. These are people with recurrent depressions, often coming on and going away quickly, or where there is a family history of bipolar but you don’t quite meet the DSM criteria.

Bipolar Spectrum might be suspected when there are many distinct episodes of depression, or a rapid improvement within a few days of going onto an antidepressant, or an antidepressant causing extreme agitation or irritability, or just stopping working within months.