Still Bipolar Strong, now complete with ADHD

_{The experiences shared are personal and should not replace professional medical advice.}

Surprise!

It’s Bipolar 2 and ADHD

Is it a surprise, really, though? 

Let me back up a little. 

When I first got my bipolar 2 diagnosis, I had done a lot of research and it felt like it could’ve also been ADHD. It’s no surprise considering both conditions involve impulsivity, irritability, hyperactivity, emotional dysregulation, sleep problems, a racing brain, and problems with maintaining attention.

Bipolar disorder often co-occurs with ADHD in adults, with comorbidity rates estimated between 5.1 and 47.1 percent (source) . Recent research, however, suggests that about 1 in 13 patients with ADHD has comorbid BD, and up to 1 in 6 patients with BD has comorbid ADHD (source)

https://www.additudemag.com/bipolar-disorder-adhd-puzzle/

But the key is in the context of the symptoms. 

A cyclical pattern of depressive and hypomanic episodes defines bipolar 2, while ADHD is persistent and consistent. Another way to differentiate is by looking at depression, which is actually what made me suspect that I might have ADHD in addition to bipolar 2. In ADHD, depression is often triggered by external factors that can be easily pinpointed, while in bipolar 2, depression stems from internal sources. Sometimes I get hit with these sudden depressive episodes that can stick around for a few days with no external triggers.

There are a few great medical articles about how these two disorders overlap and diverge, so I won’t go too far into the technical side of things. Instead, I want to talk about my experience, why I suspected ADHD, and how life has been since I began treatment for it in October, 3 years after I began treatment for bipolar 2. 

Over the course of the past 3.5 years since my initial bipolar 2 diagnosis, I’ve spent a significant amount of time understanding my symptoms, how they manifest in my life, and how I can avoid triggers or get through episodes. I can identify when a really good mood can turn into a hypomanic episode (more on this a little later). I know how a depressive episode tanks my productivity, appetite, and sleep cycle. 

I don’t have things “under control” but I have stretches of time where I am relatively balanced. It was during these stretches that I noticed a few symptoms that didn’t fit with bipolar 2.

Depression versus executive dysfunction and ADHD paralysis

When I’m in a depressive episode, it’s difficult to even get out of bed sometimes, let alone focus enough to get through the workday. If it’s a less intense episode, it takes me ages to get focused and I have short bursts of energy where I can be productive. However, during the balanced stretches of time, I noticed that I would have moments of paralysis, where I knew that I needed to get up and do something, but I’d just be frozen. 

Here’s the example I gave to my doctor when she asked me what made me think I could have ADHD: I love cooking and baking. There are some recipes that take a long time, but it’s really a joy for me to be in the kitchen focusing on them. On several occasions, I would plan to spend my afternoons cooking by preparing the ingredients and playing music, but then I would find myself unable to gather the willpower to actually go into the kitchen. 

There are other instances of executive dysfunction and ADHD paralysis that have screwed me over both in my personal life and my career. 

Hypomania versus hyperactivity 

So, I’m a very passionate person and can sometimes have a chaotic energy. And if I’m in a good mood, I like to express that. But of course, once I got diagnosed with bipolar 2, I began to identify when a really good mood would escalate to a hypomanic episode. If I’m not really careful, it can happen pretty quickly. 

In my case, the most prominent symptom of hypomania is the hyper fixation, which can also happen with ADHD, so how can I tell the two apart? With hypomania, the hyper fixation is irrational. Rational side of my brain knows that it’s something that shouldn’t be happening, but I can’t stop myself. The best example of this is the hypomanic episode that led to my therapist recommending I get the assessment. In the not-so-extreme cases, it’s something like irrationally hyper-focusing on finding a specific item even if I don’t need it at that moment, but I have to turn the apartment inside out to find it. 

ADHD causes me to experience hyper-focus when working on my projects. When I do finally focus, I can spend hours focused on a project without getting up (like when I went through 15 years of blog posts a few weeks ago to clean up this site).

Treatment for both 

So, the fun thing about having ADHD and bipolar 2 is that the medication for ADHD could potentially trigger a hypomanic episode. My doctor recommended that we start with a low dose of a non-stimulant medication, and thankfully, that has worked well for me so that we don’t have to go the stimulant route. I’ve previously written about my medication for bipolar 2.

Bipolar Strong with a touch of ADHD

I recognize that I’m very lucky in being able to get a diagnosis for both disorders. I was 35-years-old when I got my first diagnosis, and 38-years-old when we added the ADHD treatment to the mix. It’s been about 6 months since I began my ADHD medication and I have seen an improvement in my daily life. 

I am more focused at work and can be productive as long as I’m not hit with a depressive episode. February was a particularly rough month, but I got through it. 

I have to remember to take my medication or it can get pretty hairy. Let’s just say there have been rough days. 

I’m very open about my experiences, sharing examples of how they can affect daily life. It’s both a way to help myself document to recognize patterns and put it out into the world in order to be seen because there are still moments I don’t trust my brain. 

The war in my brain rages on, but I’ve been winning more battles throughout the past 3.5 years. 

I’m still Bipolar Strong because I keep showing up to life and advocating for myself. And the battles I lose don’t keep me down for long. 

It’s exhausting, but I’m here. 

I’m not going anywhere.

World Bipolar Day is on March 30 in honor of Vincent Van Gogh.

***Psst…did you know that I have a newsletter called The B-Roll? It’s how I can stay connected with you while sharing what’s on my mind, what has caught my eye, and amplifying causes I care about.