More than 50% of bipolar disorder patients deal with additional psychological disorders. Eating disorders, substance abuse disorders and personality disorders are among the most common. Anxiety disorders top the list. At least half of patients experience at least one type of anxiety disorder at some point in their lives. Unfortunately, these people tend to have a worse prognosis and have to work even harder to deal with their bipolar disorder. There are two types of anxiety disorders that stand out as being more closely associated with bipolar disorder- generalized anxiety disorder and panic disorder.
A new study published in the journal World Psychiatry searched medical records of over 9,000 patients diagnosed with bipolar disorder and examined them for further diagnoses of anxiety disorders including agoraphobia, generalized anxiety disorder (GAD), obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, specific phobias and social phobias. They found that people with anxiety disorders in general have nine times the risk of developing or being diagnosed with bipolar disorder than the general population.
That rate increases with generalized anxiety disorder and panic disorder specifically. Those with a diagnosis of generalized anxiety disorder were 12 times more likely than the general population to receive a bipolar disorder diagnosis and those with panic disorder were 10 times more likely to have comorbid bipolar disorder.
Anxiety is often present in bipolar disorder, whether or not the patient has a diagnosable anxiety disorder. Anxiety as a symptom of bipolar disorder often manifests as irritability or agitation. There can be racing thoughts and physical restlessness. If the anxiety is solely a symptom of bipolar disorder, it should improve with treatment along with other symptoms of bipolar disorder. However, this may not be the case if a patient is dealing with a separate anxiety disorder.
Some signs that indicate an anxiety disorder in addition to bipolar disorder include:
- Symptoms appearing at an earlier age (mid-twenties is typical onset of bipolar disorder)
- More severe illness
- Longer symptomatic periods
- Panic attacks and increased anxiety during mood episodes, especially mixed states
- Symptoms persisting between episodes
- Insomnia and other sleep disturbances
- Having trouble finding effective and appropriate treatment
Treating comorbid anxiety and bipolar disorders can be difficult. The most common treatment for anxiety disorders are SSRI’s, which can trigger manic episodes. Mood stabilizers used to treat bipolar disorder can mitigate some symptoms of anxiety disorder, but not all. Benzodiazepines are frequently used to treat breakthrough anxiety disorder symptoms and panic attacks, but carry the risk of addiction and abuse. Antipsychotics, which are also common in bipolar disorder treatment, can lessen anxiety as well as provide sedative effects to help with insomnia.
It’s important for any patient with anxiety or depression to be screened for bipolar disorder and vice versa. If one or more comorbid disorders are discovered, treatment plans can be adjusted accordingly.
Image credit: Jonathan Gross
Edit 6/21/16: “There are two types of bipolar disorders that stand out as being more closely associated with bipolar disorder- generalized anxiety disorder and panic disorder.” has been corrected for clarification.