Understanding How Bipolar Anxiety And Related Anxiety Disorders Can Overlap In Mental Health
- For those experiencing suicidal thoughts, please contact the 988 Suicide & Crisis Lifeline at 988
- For those experiencing abuse, please contact the Domestic Violence Hotline at 1-800-799-SAFE (7233)
- For those experiencing substance use, please contact SAMHSA National Helpline at 1-800-662-HELP (4357)
“Comorbid” is a term that refers to any two or more health conditions that present in the same individual simultaneously. Understanding comorbidity can be an important factor in making sure that a person receives the right care if they’re experiencing multiple mental health conditions at once. Two types of conditions that occur together fairly commonly are bipolar disorder and anxiety disorders. Below, we’ll provide a brief overview of both types of disorders along with what you need to know about when they are comorbid with each other.
What is bipolar disorder?
Bipolar disorder is a category of mental health conditions that cause an individual to alternate between states or “episodes” that are characterized by manic symptoms, depressive symptoms, or a mixture of both. Symptoms of these two types of episodes can impact a person’s judgment, sleep patterns, energy levels, and capacity to think clearly and focus.
Note that there are a few different types of bipolar disorder according to symptom severity. Bipolar I disorder is characterized by the most severe symptoms, which can include psychotic episodes and may sometimes require hospitalization for stabilization. Bipolar II disorder is characterized by less severe symptoms, and cyclothymic disorder is characterized by less severe symptoms that include hypomanic rather than manic states.
According to the diagnostic criteria outlined in the DSM-5, a manic episode will typically manifest as three or more of the following symptoms all or most of the day, every day, for at least a week. A hypomanic episode will typically manifest as three or more of the following symptoms all or most of the day, every day, for at least four days:
- An inflated sense of self-esteem
- Racing thoughts
- Being easily distracted
- A decreased need for sleep
- Talking more than usual
- Increased goal-directed activity
In contrast, a depressive episode is usually characterized by at least five of the following symptoms experienced during a two-week period, which correspond with symptoms of major depressive disorder:
- A depressed mood (feelings of sadness, emptiness, hopelessness)
- Significant weight gain or loss
- Significant changes in sleep patterns
- Restlessness or slowness
- Trouble concentrating
- Fatigue
- Feelings of worthlessness or guilt
- Thoughts of suicide
Bipolar disorder can occur alongside several other mental health conditions—aside from anxiety disorders—including post-traumatic stress disorder, substance use disorder, and conduct disorders. Obsessive-compulsive disorder (OCD) can also develop as a comorbid condition. Obsessive-compulsive symptoms often arise during depressive phases. Comorbid OCD and bipolar disorder can cause longer mood episodes, reduced medication adherence, and decreased treatment responsiveness.
What is an anxiety disorder?
It’s normal for people to experience occasional feelings of worry, concern, or anxiety from time to time, especially in the face of a stressful or uncertain situation. However, when these feelings are persistent, debilitating, and/or interfere with an individual’s daily functioning, they may signify an anxiety disorder.
Common types and symptoms of anxiety disorders
The American Psychiatric Association estimates that 30% of adults will experience an anxiety disorder at some point in their lives. There are various types, from generalized anxiety disorder (GAD) and social anxiety disorder (also called social phobia) to panic disorder and specific phobias. While each will present with its own unique set of symptoms, anxiety and panic disorders in general often manifest as:
- Physical symptoms such as sweating, trembling, headaches, stomach aches, a racing heart rate, hyperventilation or other breathing problems, muscle tension, chest pain, neck pain or other unidentified pain without an apparent cause, and fatigue
- Behavioral symptoms such as actively avoiding people or places that may cause anxiety, and significant changes to eating and sleeping habits
- Psychological symptoms such as mood swings, “brain fog” or the mind going blank, trouble concentrating, disorientation, irritability, a persistent and overwhelming sense of impending doom or constant danger, extreme nervousness that doesn’t go away, and difficulty controlling worry
In addition to co-occurring bipolar disorder, individuals with anxiety disorders have a greater risk of living with depressive disorders and substance use disorder than the general population. Post-traumatic stress disorder is another potential co-existing mental health condition.
The mental health connection between these disorders
While bipolar disorder and anxiety disorders are separate mental health conditions, they frequently occur together in the same individual.
Bipolar disorder and anxiety disorders: Mental health impact
There are several other types of anxiety linked to bipolar disorder, though, including social anxiety disorder, generalized anxiety disorder, and agoraphobia. Comorbid anxiety and bipolar disorder can cause additional adverse effects and influence treatments. Another study suggests that at least half of those with bipolar disorder are likely to develop a comorbid anxiety disorder at some point in their lifetime.
Being aware of the fact that these two conditions are often comorbid can be important for three key reasons. First, symptoms of one condition may complicate symptoms of the other, and understanding how the two might coexist in the same individual can inform both the diagnosis and treatment processes. Second, the treatment of one may interfere with the treatment of the other, so being aware of the comorbidity can allow a provider to adjust their recommendations as needed for maximum effectiveness.
Third, according to an article published in the World Journal of Psychiatry, the comorbidity of anxiety and bipolar disorders is associated with substantial increases in the burden that symptoms place on the affected person. This can include a higher risk of psychosis, earlier onset of psychiatric symptoms, longer periods of untreated illness, decreased response to treatment, impaired quality of life, and an increased risk of substance or alcohol use disorders and suicidal thoughts and behaviors.
Treatment options
For people with bipolar disorder, the recommended treatment is usually a combination of medication and psychotherapy—typically interpersonal and social rhythm therapy or cognitive behavioral therapy. Patients with bipolar disorder may be prescribed a mood stabilizer, antipsychotic medication, or antidepressant, depending on their symptoms. According to a systematic review conducted by the International Society for Bipolar Disorders, the mood stabilizer lithium may be particularly effective in preventing recurrence.
Psychotherapy
For people with anxiety disorders, the recommended treatment is usually psychotherapy—typically cognitive behavioral therapy (sometimes styled as cognitive behavior therapy), which may or may not be advised in tandem with medication. Psychotherapeutic treatment of anxiety disorders can take several forms, including individual, group, or family therapy. A proper diagnosis of both conditions is crucial for effective treatment because the medications frequently prescribed for each can negatively interact with each other.
Medication
As an article in The Mental Health Clinician journal states, serotonergic antidepressants are typically used to treat anxiety disorders and some other mood disorders. However, these pharmacological anxiety treatments can increase the risks of a manic switch and potentially destabilize mood in an individual with comorbid bipolar disorder. That’s why individuals who have comorbid bipolar disorder and an anxiety disorder will typically be placed on mood stabilizer therapy first before any medications are added to their treatment plan.
Benzodiazepines, which are often used for short-term treatment of severe anxiety symptoms, are typically avoided as well for people with an anxiety disorder and bipolar disorder. These medications can exacerbate manic symptoms and lead to addiction and substance misuse.
Self-care
Self-care strategies can also help individuals with co-occurring anxiety and bipolar disorder alleviate their symptoms. Maintaining a balanced diet, exercising regularly, and getting plenty of high-quality sleep can boost mood and reduce symptoms of both conditions. Additionally, utilizing relaxation techniques like deep breathing exercises and progressive muscle relaxation can alleviate stress that is connected to bipolar disorder and anxiety disorders.
Seeking the support of a therapist
Since some form of medication is typically required to effectively treat bipolar disorder, it’s usually recommended that you meet with a psychiatrist for evaluation if you’re experiencing symptoms. They may recommend that you also meet with a therapist to help you learn how to challenge and shift distorted thoughts and develop healthy coping mechanisms, which can be helpful for symptoms of an anxiety disorder as well. A therapist can also provide you with a safe space to express and process your feelings if you’re experiencing distress after having received a new mental health diagnosis.
For some people, meeting with a therapist in person is uncomfortable, intimidating, or inconvenient. Those who would prefer to connect with a qualified provider from the comfort of home can explore online therapy options. With an online therapy platform like BetterHelp, you can get matched with a licensed therapist whom you can meet with via phone, video call, and/or in-app messaging to address the challenges you may be facing. Research suggests that there’s no difference in effectiveness between online and in-person methods, so most people can feel confident in selecting whichever one works best for them.
Takeaway
How do people living with bipolar disorder act when stressed?
Like anyone else experiencing stress, people living with bipolar disorder may have increased irritability, anxiety symptoms, and fatigue when experiencing stress. They may also be more likely to utilize unhealthy coping mechanisms, like binge eating, substance abuse, or overspending, to cope with the feelings of stress.
In some cases, stress may trigger a manic episode, depressive episodes, or contribute to mood disorders, especially when comorbid anxiety disorders or comorbid bipolar conditions are present. These patterns are often seen in bipolar patients, particularly those with a history of mood stabilizer use or issues with medication adherence, and can reflect underlying mental health challenges.
Is overthinking a symptom?
Overthinking is something many people experience and is not necessarily indicative of bipolar disorder. People with mood disorders, bipolar and anxiety disorders, depression, substance use issues, comorbid anxiety, such as generalized anxiety disorder, panic disorder, or obsessive-compulsive disorder, and other mental health concerns may experience overthinking.
It can also accompany depressive symptoms, depressive episodes, or be part of broader mental health or psychiatric disorder profiles. In bipolar patients, especially those with a history of substance abuse or unmanaged bipolar symptoms, overthinking might coincide with a manic episode or other fluctuating mood symptoms.
What are the 3 signs you have bipolar disorder?
Bipolar is a mood disorder that can present differently in each person it affects, including those with bipolar and anxiety disorders, or comorbid anxiety disorders. However, three common signs of the disorder include not sleeping (often seen in a manic episode), having emotional intensity or extreme highs and lows (key bipolar symptoms), and talking much quicker than usual. These patterns can also occur in bipolar patients with overlapping depressive symptoms and mood symptoms, especially when mental health support or mood stabilizer treatment is lacking.
What is the best medicine for bipolar anxiety?
The best treatment for bipolar and anxiety disorders, particularly in bipolar patients with comorbid anxiety disorders, such as generalized anxiety disorder or panic disorder, usually combines mood stabilizer medication with adjunctive therapy like cognitive-behavioral therapy. A mood stabilizer treatment (e.g., lithium or lamotrigine) is typically initiated first to prevent mixed episodes and reduce the risk of triggering mania from serotonergic antidepressants.
For bipolar patients with bipolar depression, major depressive disorder, or obsessive-compulsive disorder, personalized medication treatment guided by mental health professionals is key to managing anxiety symptoms while supporting overall mental health.
Clinical guidelines, including those informed by the Diagnostic and Statistical Manual and findings from randomized controlled trials, emphasize that careful diagnosis is important, especially since bipolar spectrum disorders are often misdiagnosed. Bipolar disorder patients with depressive episodes, comorbid posttraumatic stress disorder, or a history of suicidal ideation may require additional monitoring. A formal bipolar diagnosis from qualified health care providers supports the development of an appropriate treatment plan backed by systematic treatment enhancement programs and placebo-controlled trials documented in psychiatric disorder research.
How to calm down anxiety from bipolar disorder?
Bipolar patients often experience comorbid anxiety disorders, such as panic disorder or obsessive-compulsive disorder, which can intensify anxiety symptoms during mood episodes. Managing this comorbidity starts with a clear bipolar diagnosis from trained health care professionals.
The recommended approach usually combines a mood stabilizer like lithium with adjunctive therapy, such as cognitive behavioral therapy. These treatments help regulate mood disorders and reduce the risk of suicidal ideation and functional impairment, often found in bipolar disorder patients with comorbid anxiety or major depressive disorder.
Additional support may include relaxation training and careful medication management. Some serotonergic antidepressants may help with anxiety, but they must be prescribed cautiously due to their potential to trigger mania in bipolar spectrum disorders. For those with bipolar depression or comorbid posttraumatic stress disorder, ongoing medication treatment and monitoring are important.
Placebo-controlled trials and randomized controlled trials support the effectiveness of combining medications and therapy for the acute treatment of both conditions. Consultation with health care providers ensures that any plan addresses the specific mental health diagnoses affecting each individual.
Can you have panic attacks with bipolar?
Yes, bipolar patients can experience panic attacks, especially when comorbid anxiety disorders are present. This bipolar panic disorder comorbidity is common among bipolar patients, particularly those within the bipolar spectrum disorder, and may heighten both anxiety symptoms and overall mood disorder severity.
Studies show that comorbid anxiety increases the risk factor for more intense mood episodes, complicates acute treatment, and may lead to bipolar depression or chronic depression. Proper diagnosis by health care professionals using the Diagnostic and Statistical Manual is essential to guide mental health diagnoses and determine the appropriate use of mood stabilizers, serotonergic antidepressants, or relaxation training.
Addressing these mental disorders early can reduce the increased risk of suicide attempts and illness progression among individuals from bipolar disorder families or those already struggling with bipolar illness.
Do bipolar people worry a lot?
Yes, many bipolar patients tend to worry a lot, especially when comorbid anxiety disorders are present. Conditions like panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder can contribute to persistent anxiety symptoms and excessive worry. This overlap, referred to as comorbid anxiety, is common in those with bipolar depression and bipolar II disorder.
Excessive worry may also signal early signs of mood episodes or an anxious distress specifier, and it can impact overall functioning and increase the risk of suicide attempts. Addressing these interconnected mental disorders often requires personalized care from qualified health care providers, and in some cases, treatments supported by placebo-controlled trials, such as quetiapine XR or other medications, may be considered to help treat bipolar depression while managing anxiety.
How long does bipolar anxiety last?
The duration can vary depending on the individual, the presence of comorbid anxiety disorders, and the effectiveness of mood stabilizer treatment. For many bipolar patients, anxiety can persist throughout different mood episodes, especially when obsessive-compulsive disorder or posttraumatic stress disorder are also present.
Ongoing anxiety symptoms may appear as part of an anxious distress specifier or in the context of comorbid anxiety. If left untreated, they can contribute to what studies refer to as “decrease psychosocial functioning”. In some cases, unmanaged anxiety may contribute to suicide attempts, particularly during intense episodes of mental illness or when experiencing rapid cycling. Treatments like quetiapine XR, along with targeted therapy. Support from mental health professionals can help manage anxiety symptoms.
What are bipolar eyes?
It’s an informal phrase used to describe changes in eye expression or behavior sometimes noticed in bipolar patients, such as intense staring, widened eyes, or dullness during depressive phases. While not a clinical term, these visual cues may reflect underlying anxiety symptoms, emotional intensity, or early symptoms of mental disorders.
These signs can also appear in people experiencing rapid cycling, or coexisting conditions such as posttraumatic stress disorder and other related disorders, if not managed with a proper mood stabilizer. In some cases, they may align with an anxious distress specifier in clinical evaluations.
Can you take Xanax if you are bipolar?
Yes, bipolar patients can be prescribed Xanax (a benzodiazepine), but it’s typically used with caution. While it may temporarily reduce anxiety symptoms or co-occurring posttraumatic stress disorder, it can increase the risk of rapid cycling or dependency. Long-term use is generally avoided unless closely monitored by a psychiatrist.
- Previous Article
- Next Article