Anxiety disorders are common among people with bipolar disorder. Treatment for both conditions may involve medications and talk therapy.
Everyone experiences some anxiety from time to time, such as before taking a test or making a big decision. However, some people have anxiety disorders, which aren’t limited to short-term worries or specific life events. Anxiety disorders can often interfere with their ability to carry out their everyday activities.
Research suggests that anxiety disorders are more common among people with bipolar disorder than they are in the broader population. Bipolar disorder is a lifelong mental condition that causes extreme shifts in mood. A person’s moods can change very quickly, and they may experience extreme highs and lows.
Keep reading to learn more about the link between bipolar disorder and anxiety and what resources are available to help people manage both conditions.
Most people with bipolar disorder have a coexisting mental health condition of some sort, with anxiety disorders being the most common.
According to a 2019 literature review, at least half of people with bipolar disorder will experience an anxiety disorder during their lifetime. A 2018 study found that anxiety disorder rates among people with bipolar disorder are 3 to 7 times higher than rates among the broader population.
Possible reasons for this link include:
- shared genetic risk factors
- similar neurological pathways
- similar psychological, social, or environmental risk factors
- anxiety disorders as a risk factor for bipolar disorder
People with bipolar most often have one or more of the following anxiety disorders:
Some of the symptoms of bipolar disorder can be associated with an anxiety disorder. For that reason, it’s not always easy to separate an anxiety disorder diagnosis from a bipolar disorder diagnosis.
When an anxiety disorder and bipolar disorder co-occur, symptoms may worsen. According to experts, the impact of having both disorders may include:
- having an increased number of mood episodes
- seeing an increased rate of first episodes that are depressive episodes
- having an increased rate of episodes with mixed features (which are characterized by simultaneous symptoms of mania and depression)
- having an increased rate of rapid cycling (in rapid cycling, a person has at least four mood episodes a year)
- seeing an increase in the frequency and severity of mood episodes
- undergoing longer periods of untreated illness
- undergoing longer periods between remission
- having increased suicidal thoughts and making plans to die by suicide
- having an increased risk of substance use disorder
- experiencing an increase in severe negative events after taking medication
- experiencing an increased use of healthcare
- experiencing increased amounts of psychological distress
- having a weaker response to treatment
- having a more difficult time adhering to a treatment plan
- experiencing a decrease in functioning and quality of life
Both conditions can negatively affect a person’s quality of life and functioning.
People with both bipolar and anxiety have an increased chance of:
Suicide prevention
If you think someone is at immediate risk of self-harm or hurting another person:
- Call 911 or your local emergency number.
- Stay with the person until help arrives.
- Remove any guns, knives, medications, or other things that may cause harm.
- Listen, but don’t judge, argue, threaten, or yell.
If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline.
Call or text the 988 Suicide and Crisis Lifeline at 988 or use the chat feature at 988Lifeline.org.
Bipolar disorder and anxiety disorder are challenging to treat individually. Treating both disorders together can be even more challenging.
A primary care physician and mental health professional will often work together to ensure you receive the best possible care.
Treatment for bipolar and anxiety disorders typically involves a combination of:
- medications
- individual psychotherapy
- couples therapy, depending on your situation
Doctors usually treat co-occurring bipolar and anxiety disorders with medication first. They may initially prescribe a mood stabilizer to address your bipolar disorder.
Medications
Medications for anxiety may be part of your treatment.
This may include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem) and sertraline (Zoloft). However, these medications can worsen manic symptoms. Your prescriber will monitor you very carefully for any signs of problems.
Doctors will often prescribe benzodiazepines to treat anxiety disorders. The medications don’t appear to worsen bipolar disorder symptoms.
However, they may cause physical dependence and tolerance, increasing a person’s risk for substance misuse. If a doctor recommends benzodiazepines, it may be for only a limited duration, such as 2 weeks.
Therapy
Therapy can be a safer way to treat anxiety in people who are already taking mood-stabilizing medications. It gives a person an alternative to using antidepressants, which may cause adverse effects.
Some common types of therapy used to treat anxiety co-occurring with bipolar disorder include:
- Cognitive behavioral therapy (CBT): CBT is a short-term form of psychotherapy focused on changing behaviors to diminish anxiety.
- Family therapy: Family therapy can help reduce distress levels within a family that may contribute to or be caused by a person’s symptoms.
- Relaxation techniques: Relaxation techniques can help a person develop ways of coping with stressors that affect anxiety and mood.
- Interpersonal and social rhythm therapy: This type of therapy involves scheduling and record-keeping. It may help a person with both conditions maintain stability and avoid changes in anxiety and mood.
Living with bipolar disorder can be tough, but it can be even more challenging if you’re also living with an anxiety disorder. While these are lifelong conditions, it’s possible to treat both and increase your quality of life.
Once you begin treatment, make sure to communicate regularly with a healthcare professional.
Let them know if your medication or therapy seems less effective than usual or is causing any unpleasant or severe side effects.
Your healthcare team will help you find and adhere to an effective treatment plan that works best for you.