The Bipolar-Anxiety Connection
Although bipolar disorder and anxiety disorder are separate conditions, they have a lot in common, which can complicate treatment.
The link between the two is impossible to ignore – studies have found that around 50 percent of people with bipolar disorder also suffer from some form of anxiety disorder, and those patients may need to take a different approach to lifestyle and disease management.
The Link Between Bipolar and Anxiety Disorders
To understand how bipolar disorder and anxiety are related, it’s important first to understand how each is defined. Many people experience multiple cognitive or emotional disorders without realizing they are suffering from distinct illnesses, which results in an inaccurate diagnosis.
Anxiety disorder is characterized by overwhelming fear, constant worry, and feelings of panic. But it also manifests in physical ways, like:
- Problems sleeping
- Heart palpitations
- Sweaty, clammy palms.
- Gastrointestinal distress
Bipolar disorder is characterized by manic highs and depressive lows, and either end of that emotional spectrum can easily produce anxiety.
For instance, panic attacks and physical discomforts can come with manic episodes, and deep worry, fear and distraction is common in depressive phases. However, many people with bipolar disorder also have an anxiety disorder (not just sporadic anxious episodes), where anxieties plague the mind constantly, for months or years, regardless of the manic, depressive or normal state of mind.
Research has found that patients of both disorders have low levels of serotonin (a neurotransmitter thought to play an important role in mood balance), and certain antipsychotic medications have been found to relieve symptoms of both disorders.
What the Research Says
When you have both an anxiety disorder and bipolar disorder, your quality of life suffers, and you are at a higher risk for substance abuse, this according to one report reported in the journal Drug and Alcohol Dependence.
There is also an increased risk of suicide with bipolar anxiety, as noted by researchers from Zurich University Psychiatric Hospital, Switzerland in 2005.
Some anxiety symptoms, including problems with sleep, can trigger manic episodes. In fact, sleep loss in people with bipolar disorder triggers moodiness, depressed and anxious moods, trouble concentrating and making decisions, and puts them at higher risk for suicidal thoughts.
One 2015 meta-analysis of 52 studies reported in the journal EBioMedicine suggests a high rate of concurrent anxiety disorders for bipolar disorder. The lifetime prevalence of an anxiety disorder for someone with bipolar disorder is 42.7 percent.
The co-occurrence of an anxiety disorder with bipolar disorder can worsen symptoms and disease course for both disorders, so it is important both are treated. However, according to researchers from the University of Louisville School of Medicine, Louisville, KY USA, sometimes treatment can be a challenge because anxiety medications may adversely affect the course of bipolar disorder and trigger manic episodes.
It is, therefore, important to identify anxiety disorders in people with bipolar disorder early on because anxiety can worsen the symptoms of bipolar disorder and negatively affect the quality of life. Doctors will work with patients to find treatments that balance out any adverse effects some medications may have.
How Anxiety Exacerbates Bipolar Symptoms
Unfortunately, an anxiety disorder can seriously impact life with bipolar disorder, and without treatment, bipolar symptoms can spiral dangerously out of control.
Many bipolar patients who suffer from anxiety disorder are prone to self-destructive behaviors and even deeper emotional issues, such as:
- Substance abuse
- Suicide attempts
- Impulsive, daredevil behavior
- More pronounced mood swings
- Shorter intervals between mood swings
In some cases, anxiety symptoms act as triggers for bipolar symptoms, making manic or depressive phases much more challenging to handle.
For instance, insomnia – a very common symptom of anxiety disorders – can bring on a manic episode in a bipolar patient, which will almost certainly compound the intensity of discomfort.
Treating Bipolar and Anxiety Simultaneously
When anxiety is a symptom, it could improve with treatment for bipolar disorder. However, if anxiety doesn’t improve, it is possible you have a separate anxiety disorder.
Treating coexisting anxiety and bipolar disorders can be challenging. This is because the most common treatment for anxiety disorders are medications called selective serotonin reuptake inhibitors (SSRIs) and SSRIs are known for triggering manic episodes.
Depending on which research studies you rely on, the risk for a manic episode with an antidepressant is 4 to 44 percent, this according to a report from PsychEducation on various studies about the anxiety-bipolar connection and treatment with antidepressants.
The International Society for Bipolar Disorders does not encourage the use of antidepressants, but because they may benefit some patients, they advise prescribing them with mood stabilizing medications.
Antipsychotics are also common treatments for managing bipolar disorder and lessening anxiety. The research on antipsychotics for treating comorbid anxiety in patients with bipolar disorder is growing, as some antipsychotics have helped patients manage both conditions effectively.
One 2009 study out of the Case Western Reserve University School of Medicine, Cleveland, Ohio, USA, finds newer antipsychotic medications, including olanzapine, risperidone, and quetiapine are well tolerated. While they do cause severe fatigue and drowsiness, the long-term benefits might outweigh risks.
Your primary doctor and mental health provider should work together to find the best treatment plan for you.
Your treatment plan will likely include:
- Medications to treat symptoms of anxiety and bipolar disorder and address sleep issues
- Individual psychotherapy that includes cognitive-behavioral therapy and relaxation therapy
- Family or couples therapy, depending on your circumstance
Your doctor will likely treat your anxiety and bipolar disorders with medication first. Mood stabilizers should be given before antidepressants and antidepressants will be given in low doses.
Make sure you keep your doctor apprised as to any side effects, adverse reactions, and increasing symptoms of anxiety or mania.
Anxiety and bipolar disorders are treatable. Because it can be a challenge to find the right treatment to manage symptoms, it is important to learn to cope with the symptoms of both conditions.
In addition to usual advice about taking care of yourself, eating healthy, and learning to relax and manage stress, you should also strive to improve your sleep and exercise regularly.
Insomnia and other sleep issues increase the chance of having an anxiety attack, manic episode or both. While both conditions can make it hard for you to sleep, establishing good sleeping habits can help you to sleep better.
For example, you could create a bedtime routine to enforce stability and comfort. The routine could involve shutting off all electronic devices an hour before bedtime, taking a relaxing bath before getting into bed, drinking a cup of decaffeinated tea or listening to soothing music.
Exercise works wonders for people with mental health disorders. This is because activity produces extra serotonin, the chemical your body that stabilizes mood and promotes relaxation.
The more serotonin your body gets, the more relaxed your mood will be. And regular exercise will make it easier for you sleep at night.
If you have anxiety symptoms or an anxiety disorder in addition to being bipolar, make sure your doctor and mental health provider know and are on the same page about treating both. The key is to find the right treatments to manage both, without making either condition worse.
Once you begin treatment, keep your doctor updated about how you’re doing and if medications are helping or causing you to feel worse.
Of course, living with both bipolar disorder and anxiety is tough, as both are lifelong conditions. But it is possible to treat both successfully and improve your quality of life so hang in there.