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Diagnosed with ADHD, but therapist thinks I might have bipolar disorder?

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Hi all,

I just got done a therapy appointment and I feel perplexed.

I was diagnosed with ADHD a few months ago and, after reading about people's experiences, I felt super understood and not alone. I was talking to my therapist today about how I have felt emotions intensely all of my life and didn't realize that it could've been a symptom of undiagnosed ADHD.

Well, I guess that piqued her interest and she cracked open the DSM V and began looking at bipolar disorder (specifically II). I thought all of my problems with emotions were due to ADHD. If I do have bipolar disorder, so be it (it can join the list), but I feel iffy about it! I thought that my emotional regulation issues were because of my ADHD.

I guess I feel very comfortable with my ADHD diagnosis, and I am afraid of being misdiagnosed. I'm on Adderall right now and I'm finally feeling like the clouds in my brain have gone away. Does anyone have any experience with this kind of situation? Is it possible that my ADHD is comorbid with bipolar disorder? My therapist said that she would continue to look into it and wait until she's done enough research before deciding, which I'm incredibly thankful for. In the meantime, I'm doing my own research as well!

Any experiences anyone wants to share or any comments at all would be super appreciated! :)

20 Replies

Sometimes stimulant medication can cause mania in ADHD. Naturally, ADHDers are very quite energetic in a kind of cycle. Low-lows. High-highs. Adding and stimulant (in my own experience) makes this fluctuation more extreme as a result of the stimulant suppressing the limbic system. Sometimes you feel like dirt, and experience emotional blunting/dissociation, go into a low, then the next week you feel like a god.

The main question i’d ask is what's the dose your on? Lower the dose if you can, if you experience less ups and downs, and notice you can think more in the grey area (rather than black or white) it's probably just the medication that's too high combined with the ADHD. I'm going through this myself and have decided that the higher dose is good for now and that I just need to suck it up and deal with the side effects for the time being while I figure some major life event out.

I’m on 20mg right now, but I have experienced this before I was ever on medication. It’s been something l’ve experienced my whole life. I haven’t noticed a huge difference being on medication yet, so I think my dose now is good. I did have a low just a few days ago, but it wasn’t any more or less intense than when I wasn’t on a stimulant.

Oh. Maybe you need a higher dose?

A psychiatrist told me I was on a “preschool” dose when I was on 20mg. He said, “adults usually should be on at least 50-60mg”

Yeah, probably! I suppose it'll all get figured out with time :)

If you're currently feeling good on your medication and there's no risk to yourself or others then I don't see why you'd need to take anything else regardless of any diagnosis. Enjoy the feeling of fog free thinking, I've just started medication for ADHD and know exactly how joyful that can be 😀

I’m glad you’re feeling the fog free feeling too! You’re right! As long as I feel good right now that’s what matters :)

I’m more concerned that your therapist needs to pull out the DSM for points on bipolar. Not only should they know what bipolar is but they shouldn’t be guessing at a diagnosis for you. Like a previous poster said, if the Adderall is working well for you, why rock the boat? For my emotional dysregulation, I needed a higher dose of Adderall and full day coverage. I take 15mg 3x a day and it’s perfect. But getting there took some time and frustration. When I didn’t have good coverage, it made my adhd and emotional dysregulation worse whe I was coming off the Adderall for the day. If I skipped a dose or ran out of meds, I was worse than before I started the meds. I was experiencing a rebound effect from the Adderall. It wasn’t good. But while I was on it... I was great. Crashing was the hard part. Now that I take the right dose 3 times a day, I don’t crash or rebound. Read about bipolar. When I was originally looking into “what was wrong with me”, it just didn’t fit. My “highs” and “lows” were always situational. If I changed the situation, I could change my mood. From what I’ve read about bipolar, their emotions can sometimes be less situational. They may wake up depressed for no reason and it may last a long time until it suddenly lifts for no reason. Then they may wake up feeling invincible and it may last a long time until it’s gone for no reason. Sometimes people with adhd get depressed. If you ask them why, they may say “I don’t know”. That could sound like bipolar if there isn’t a reason. However with adhd we can often say “I don’t know” for a few reasons. Perhaps we aren’t good at labeling our feelings. Perhaps there are currently 1000 reasons in our head and we can’t pick just one. Or perhaps were overwhelmed with everything and can’t even decide which feeling is most prevalent. Or maybe all the feelings happen so quickly and passed just as quickly that we don’t even know exactly what happened in a step by step way.

I hope this helps.

Adhd is infamous for the mood symptoms it can cause. You're correct diagnosis should be " mood disorder NOS". I can tell you from personal experience that us with Adhd have mood disorders at a very high rate. Don't be worried about a therapist diagnosis just make sure your psychiatrist is diagnosing you correctly and you're getting he help you need. If not just get up and leave your intuition should tell you when you have a right fit.

Gjs80: Thanks! I will definitely discuss it with my psychiatrist and see what she thinks!

Yes, thank you so much for the detailed reply! I think I'm currently (since posting the original post, this wasn't something I had noticed prior to my therapy appointment) experiencing the crash with the prescription that I have now. I am usually content in the morning, then once the adderall is kicking in I'm feeling generally upbeat and ready to take on the day, and then once the late afternoon comes around I'm sad lol. It's kind of freaking me out actually, so I'll definitely bring it up with the psychiatrist at my next appointment. I think you definitely hit the nail on the head! I think there is definitely usually some actual reason why I end up feeling easily irritable, but there are usually either too many causes or I just can't pinpoint the exact cause. It definitely doesn't usually seem like it's happening for no reason.

That’s the tough part of Adderall. Some people can find the crash too hard. When I wasn’t on the right dose yet, it REALLY helped to take L-tyrosine 500mg when the crash started. It didn’t stop the meds from wearing off but it softened the blow a little. My poor nephew would crash so hard off Adderall he would have melt downs at night that more than once required my sister to call the police! He just got switch to Concerta (Ritalin based) and doesn’t crash at all!! I call it the Jeklly and Hyde effect. It is most definitely not unheard of with Adderall. I’m glad you got some insight.

Good to know it's not uncommon (well, not good for those who experience crashes)! I will likely need a dose increase again as I feel like the good and bad effects of the Adderall are already leveling out. I'm not quite feeling the high highs or the low lows anymore (and I'm quite happy about the latter). It makes me nervous about increasing my dose, I don't want to feel a worse crash than what I have already (it wasn't the worst, but it wasn't the best either) but I will look into L-tyrosine! Thank you!!!

Yeah I hear ya. I take vyvanse 70mg and a 20mg adderall. I don’t feel anything anymore either

That’s exactly how it progressed for me. I eventually got to this point as well. The medication felt effective and I wasn’t having too high highs or too low lows but was still feeling the crash. As I adjusted more and more to that dose, it started to wear off sooner and I would get the crash symptoms mixed with a deep disappointment and frustration that the meds were wearing off. I found that the longer I was on the medication, the harder it was to deal with the unmedicated me. At first, I was grateful for any “break” the medication gave me from my stressful self. But I could still handle myself. I was still very used to dealing with myself. But the longer I took the meds, the more I forgot how to “deal” with all the stress that the unmedicated me produces. All of that added to my crash.

For me personally, the key was full day coverage. My day is 6am to 8pm. My dr kept wanting to give me 2 doses a day (I can’t take the XR). They wanted to keep upping the 2 doses. For me, upping a dose didn’t make it last longer. What ended up working MUCH better for me was 3 doses a day. Now I have no crash! Zero! I go to bed and watch tv at the end of my last dose. So I can have everything for the day done and don’t have to worry about anything. It was a lifesaver. I don’t know how much you’re taking or how much more titrating you have to do but keep a booster in mind. People who take the XR can still have a booster. If you find yourself starting to crash around 3-4 in the afternoon and you still have to finish work, pick up the kids, make dinner, clean the house, get kids to bed, finish some work, talk to your husband or wife about important issues, you may need a booster to help handle the work load and help deal with everything in stride. . People often think adhd medication is for going to work but honestly, for some people, work is the easy part of the day. Being home and juggling home life can be extremely difficult. I take my 3rd dose at 3pm and that gets me to 7:30 (when my son goes to bed). Then I just have to finish some housework and relax. But I burn through my meds quickly.

I hope something here helps.

Side note: when I was on the XR, which we realize now doesn’t work well for me, upping the XR also didn’t make it last longer. I would crash by 2pm (but again, I think I burn through my meds. Your time maybe different).

(Sorry about the late reply! I forgot I posted here!! 😅) Yes thank you so much! I'll keep a booster in mind!! Thank you for all of the amazing advice :)

Don’t assumed until you get a brain scan. I recently have diagnosed and am on bipolar meds as well. I’m on vyvanse and adderal. For my bipolar I’m. On olanzepine and fluoxetine

I went to a psychiatrist years ago to get diagnosed with ADHD and get on medication, if necessary. I had read a lot about it because I thought I might have it and so did my son. But he told me I had bipolar disorder and wrote me a prescription for ritalin. I said but I thought I had ADHD and he said you probably do, and generalized anxiety disorder. He totally shocked me. I never filled the prescription and never went back. I felt like he should have asked me more questions and spent more time before deciding in one meeting on three diagnoses and maybe explaining more about what I had and what I needed to do. I mean besides taking a pill. Later, I went to a primary care doctor who had experience with psychotropic drugs. He put me on medication for one thing at a time. ADHD, then antidepressants, then when I had trouble sleeping and my mind was racing, the doctor put me on risperidone to fight off mania, since the psychiatrist had diagnosed me as bipolar. I asked him several times over the years if he really thought I had bipolar or was I just hyper from ADHD. He said he didn't like to label people and just was treating the symptoms. Now, though, it is hard to go off of antipsychotic drugs, and I don't know if the reason I haven't had any of the racing thoughts and trouble sleeping (until recently, trouble sleeping) is because of the medication he put me on, and I DO have bipolar or if it is just part of the ADHD. Whichever it is, I don't think I have full blown mania. Maybe just hypomania. The only thing that convinced me was over the years several counselors have told me that I seem manic. I've seen my ex husband act like he was in manic episode and he had some big delusions. He thought he could cure cancer (he was an engineer) he said he was smarter than everyone else. (Which he often said but I just thought he was arrogant), and that other drivers could only drive forward and sideways but he could drive backwards and in circles (On the freeway). That was all after taking antidepressants. Which can push someone into a manic episode if you take the wrong ones. Anyway, I still don't really know if I believe that I'm bipolar. I'm on the medication and I don't want to go off of it because I don't have the symptoms right now. I still get depressed even though I'm on antidepressants, but I think that sometimes it is just going to happen. No matter if I'm on medications or not. I still have anxiety, even though my antidepressant is Prozac, which helps with anxiety as well. I think, if your psychiatrist listens to your counselor and wants to diagnose you with bipolar disorder, or does his own examination and diagnoses you with bipolar disorder, I would consider getting a second opinion before you get on the medication. Because there are side effects and it is difficult to get off some medications. But, if you are bipolar, it doesn't have to be debilitating. Medications can help, I would just do due diligence to to make sure. Best wishes! Take care!

If you think about it, how does a psychiatrist really know, they don't even look at the brain to see what's wrong or right. IT's a guess and if the first guess is wrong then they try another guess. There may be more going on than ADHD, but if you don't look at the brain how can you find out. Besides a brain san you can try blood work, I just found a place Great Plains lab on line and they do tests that a lot of labs don't. They have an ADHD lab panel that is very inclusive. I am waiting to here from them because I am going to try it.

Just wondering whether you'd care to update where you are now. I'm the opposite: diagnosed BP II 10-15 years ago, but I really don't think that diagnosis fits as well as ADHD does. I'm just starting to research and get assessed for ADHD. I just posted about this yesterday and included some of the differences in symptoms between BP and ADHD that I heard someone describe. Like, with BP, the highs and lows often do not seem related to situations. They just come out of nowhere, whereas with ADHD they are more likely to be situational and/or based on generally feeling bad about yourself because you can't focus or function the way you think you should. If you're in hypomania, you're generally talking fast, feeling on top of the world, thinking you have it all figured out and everything is great. With ADHD, it's more likely you're feeling great because you found some new interest or thing to do or you got started on some healthy habits. But then you lose interest or can't organize yourself enough to follow through or forget about your new healthy habits, and you get depressed because you feel sad about your inability to function like other people. I'm definitely not an authority on this and just starting out on research, but I'm wondering how that might fit with your experience. Anyway, hope you're doing better and getting things figured out. Finding the right mental health diagnosis and meds can be a crap shoot, for sure.

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