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Anxiety & Bipolar Disorder: Part II

Anxiety and Bipolar

Anxiety & Bipolar Disorder: Part II

By LaRae LaBouff
~ 2 min read

This article is Part II of “Anxiety & Bipolar Disorder.” You can read part one here.

Anxiety disorders are highly prevalent in those with bipolar disorder. Over 50% of patients have at least one. That means a person may not only be dealing with bipolar disorder but also generalized anxiety disorder and panic disorder, for example. Those that have both anxiety disorders and bipolar disorder tend to fare worse than those with bipolar disorder alone, so receiving the correct treatment is imperative.

What does anxiety look like in bipolar disorder?

Even outside having a co-occurring (comorbid) anxiety disorder, people with bipolar disorder can still experience debilitating anxiety. There are a couple of ways this can happen. The first is that bipolar disorder patients are still people. They can experience anxiety just like anyone else, even without having an anxiety disorder.

The other is having a bipolar episode with the specifier “with anxious distress.” Specifiers are basically extensions of the diagnosis. They help add clarification and specificity to the patient’s current mood state. Anxious distress can occur during any episode whether mania, hypomania or depression.

The diagnostic handbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) classifies a patient as having anxious distress if two of the following symptoms are experienced throughout an episode:

1 Feeling keyed up or tense.
2 Feeling unusually restless.
3 Difficulty concentrating because of worry.
4 Fear that something awful may happen.
5 Feeling that the individual might lose control of himself or herself.

The severity of the anxious distress is defined as:
Mild: Two symptoms.
Moderate: Three symptoms.
Moderate-severe: Four or five symptoms.
Severe: Four or five symptoms with motor agitation.

What impact does anxiety have on people with bipolar disorder?

People with comorbid anxiety and bipolar disorders tend to fare worse than those with bipolar disorder alone. Here are more ways bipolar disorder is impacted by anxiety:

People with both anxiety and bipolar disorders have longer episodes.
There is less time between episodes when both disorders are present.
Social phobias tend to proceed hypomanic episodes.
Nearly one-third of panic attacks are experienced in hypomania.
Those with both disorders begin having symptoms at a younger age.
Those with both disorders don’t respond as well to treatment.
Comorbid anxiety and bipolar disorders lead to worse functioning and lower quality of life.
People with both anxiety and bipolar disorders have a higher suicide rate.
What treatments for anxiety are available?

Treating an anxiety disorder in addition to bipolar disorder is tricky. The standard treatments for anxiety disorders are antidepressants and benzodiazepines. However, these medications can cause problems in people with bipolar disorder.

Antidepressants can induce manic or hypomanic symptoms in some people with bipolar disorder. They can also worsen symptoms over time and possibly trigger rapid cycling, in which the patient experiences more than four episodes in a single year.

Benzodiazepines are effective for acute anxiety but come with the risk of abuse and addiction. More than half of bipolar disorder patients also experience substance use disorder at some point in their lives.

When treating bipolar disorder and anxiety, bipolar disorder should be considered the primary illness and treated before an anxiety disorder. There is some evidence that treatments for bipolar disorder also treat anxiety. Mood stabilizers like gabapentin and divalproex have shown anti-anxiety effects. There is also limited evidence that atypical antipsychotics like risperidone may have anti-anxiety effects as well.

Any treatment plan should be constructed with a mental healthcare professional. Anxiety with bipolar disorder is especially complicated and must be treated according to the individual. Some may not need additional treatment other than those medications for bipolar disorder. Others may be able to tolerate antidepressants or benzodiazepines. Whatever the treatment plan, it must be followed and closely monitored so that the person with bipolar disorder can receive the best treatment possible in order to achieve a better quality of life.

Cape Coral Office:
1404 Del Prado Blvd, Unit 135
Cape Coral, FLORIDA 33990

Sarasota Offices:
1487 2nd Street Suite C-4
Sarasota, FL 34236
(239) 565-6921

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