Can You Have Anxiety and Bipolar Disorder at the Same Time?

It is normal for all of us to feel anxious about something or the other at some point in our lives. It is also natural for everyone to suffer from mood swings once in a while, especially when things are not going according to our plan. While we sometimes experience these feelings, in most people, these feelings tend to disappear after some time. However, in some people, these hopeless feelings refuse to go away and instead, start affecting their life and jobs. People with bipolar disorder tend to experience some level of anxiety, as well. However, can you really have anxiety and bipolar disorder at the same time? Let’s take a look.

Can You Have Anxiety and Bipolar Disorder At The Same Time?

Bipolar disorder is a mental health condition marked by episodes of sudden mood swings ranging from manic highs to depressive lows.(1) Bipolar is a challenging condition because the illness is usually also associated with multiple medical and psychiatric conditions.(2) Not only do bipolar patients have to deal with numerous mood swings, but most patients also tend to have a coexisting anxiety disorder.

There is no cure for bipolar disorder, and it is a lifelong mental condition that causes not just significant changes in a person’s mood, but also their energy and activity levels. The bipolar disorder interferes with the quality of life and disrupts a person’s day to day activities.

While it is normal for people who don’t have bipolar to also experience some level of anxiety, people who suffer from an anxiety disorder, though, tend to have more than your daily worries. People with anxiety disorders have such severe worries or anxiety attacks that it starts to interfere with their ability to live a normal life.(3) This does not mean that there is only one type of anxiety which everyone experiences. There are several types of anxiety disorders. These include:

Is There A Link Between Bipolar Disorder and Anxiety?

It is known that anxiety disorders tend to occur, along with other mental health conditions. Some of these common mental health conditions may include:

Anxiety disorders are known to be associated with bipolar disorder. It is known that most patients of bipolar disorder will end up experiencing at least one anxiety disorder during their lifetime. Both these conditions are manageable, but they are challenging to live with, and the patient has to continue taking medications lifelong.

Similar Symptoms of Both Bipolar and Anxiety Disorder

There are many symptoms of both these disorders that are similar to each other. For this reason, doctors sometimes find it difficult to separate the diagnosis of bipolar disorder from that of anxiety disorder. However, medical experts have identified certain symptoms that indicate that a person has both anxiety and bipolar disorder.(7)

These include:

  • Having difficulties falling asleep or staying asleep due to anxiety
  • Experiencing panic attacks or severe anxiety
  • Avoiding doing activities that cause stress, while also displaying depression or mania
  • Showing ongoing anxiety even when they are not in a manic state
  • Not responding to the initial form of treatment
  • Having a higher sensitivity to the side effects of treatment or medication
  • Taking longer than average to respond to the correct medication dosing
  • Taking longer to find the right combination of drugs for the bipolar disorder

However, even though both the disorders may co-exist, certain severe symptoms of bipolar disorder tend to overpower the symptoms of an anxiety disorder. These include:

  • Severe worries
  • Obsessive thoughts
  • Compulsions

Due to these reasons, doctors start doubting that a person may be suffering from both bipolar and anxiety disorder at the same time. Thus, they begin the diagnosis process for assessing the patient for both these disorders.

Challenges of Having Both Anxiety and Bipolar Disorder

It is very difficult for a person to suffer from both anxiety and bipolar disorder. Both these conditions dramatically reduce a person’s quality of life and disrupt their attempts to work through their daily activities and chores.(8) People with both these disorders also have a higher risk of:

  • Falling into substance abuse
  • Having suicidal thoughts and behaviors or attempting to harm themselves
  • Experiencing manic episodes due to insomnia, which is a symptom of anxiety disorder

Is There Are A Treatment For Both The Conditions, Anxiety and Bipolar Disorder?

Even individually, both anxiety disorder and bipolar disorder are severe conditions to treat. When a person has both these conditions together, then it becomes even a bigger challenge to treat these disorders. In such cases, mental healthcare providers and the primary physician tend to work together to ensure that you receive the best possible treatment for controlling and managing the symptoms of both disorders.

Anxiety and bipolar disorders are usually treated with combination therapy. This includes a combination of:

  • Medications
  • Psychotherapy
  • Couples or family therapy (this depends on your individual situation)

Medications for Treating Anxiety and Bipolar Disorders

The first step of treatment for both bipolar and anxiety disorders is with medications. A mood stabilizer is prescribed for treating bipolar disorder.

Medications are also used for treating anxiety disorder. Treatment usually begins with the use of selective serotonin reuptake inhibitors (SSRIs).(9) However, selective serotonin reuptake inhibitors can generally end up worsening the manic symptoms of bipolar disorder. This is why, during this period, your doctor will be monitoring you very carefully for any signs of a problem.

Doctors may also prescribe benzodiazepines to people who have both anxiety and bipolar disorder together. Benzodiazepines are medications that are used in the treatment of anxiety disorders.(10) These drugs do not worsen the symptoms of bipolar disorder, but they may lead to physical dependence and tolerance. This increases the risk of drug abuse, which is, in any case, higher for people with both these disorders.

All these medications, though, are usually only used for a limited period of time and do not generally exceed a period of two weeks.

Therapy for Treating Anxiety and Bipolar Disorders

An individual treatment plan for each of these conditions also often includes therapy. Therapy is a safer way of treating anxiety and bipolar disorder, especially in those people who are on mood-stabilizing medications for bipolar. Therapy also provides an alternative treatment rather than taking antidepressants, which has many side effects.

Here are some of the commonly used therapy methods for treating anxiety and bipolar disorder together:

Cognitive Behavioral Therapy (CBT): A type of psychotherapy, cognitive behavioral therapy is only used only in the short term for changing behaviors that cause anxiety.(11)

Interpersonal and Social Rhythm Therapy: This type of therapy focuses on scheduling and maintaining records to help a patient maintain stability in their daily schedule. It also avoids situations that lead to them feeling anxious, such as sudden changes in their schedule.(12)

Family Therapy: This type of treatment is used to lower the levels of stress within a family that appears when one family member suffers from both these disorders.

Relaxation Methods: These help a patient and their family find ways of coping with triggers that lead to an anxiety attack and mood swings.

Conclusion

Living with either bipolar disorder or anxiety disorder is challenging, but living with both these conditions is even more challenging. Bipolar disorder and anxiety disorder are lifelong conditions, but it is possible to treat them and manage the symptoms to have a better quality of life.

Once your doctor decides on the best course of treatment for managing both these conditions, make sure that you keep them informed about any change in your symptoms, no matter how small. If, for example, you find that your medication seems to less effective lately, then make it a point to bring it up at your next appointment.

Watch out for any side effects while you are taking the medications. Together with your doctor, you will be able to find out the most effective way of treating and managing bipolar disorder and anxiety disorder.

References:

  1. Belmaker, R.H., 2004. Bipolar disorder. New England Journal of Medicine, 351(5), pp.476-486.
  2. Green, M.F., 2006. Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. The Journal of clinical psychiatry, 67, pp.3-8.
  3. Beck, A.T., Emery, G. and Greenberg, R.L., 2005. Anxiety disorders and phobias: A cognitive perspective. Basic Books.
  4. McNally, R.J., 1994. Panic disorder: A critical analysis. Guilford Press.
  5. Spitzer, R.L., Kroenke, K., Williams, J.B. and Löwe, B., 2006. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), pp.1092-1097.
  6. Stein, M.B. and Stein, D.J., 2008. Social anxiety disorder. The lancet, 371(9618), pp.1115-1125.
  7. Freeman, M.P., Freeman, S.A. and McElroy, S.L., 2002. The comorbidity of bipolar and anxiety disorders: prevalence, psychobiology, and treatment issues. Journal of affective disorders, 68(1), pp.1-23.
  8. Boylan, K.R., Bieling, P.J., Marriott, M., Begin, H., Young, L.T. and MacQueen, G.M., 2004. Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar disorder. The Journal of clinical psychiatry.
  9. Stein, D.J. and Stahl, S., 2000. Serotonin and anxiety: current models. International clinical psychopharmacology, 15, pp.S1-6.
  10. Swartz, M., Landerman, R., George, L.K., Melville, M.L., Blazer, D. and Smith, K., 1991. Benzodiazepine anti-anxiety agents: prevalence and correlates of use in a southern community. American Journal of Public Health, 81(5), pp.592-596.
  11. Feeny, N.C., Danielson, C.K., Schwartz, L., Youngstrom, E.A. and Findling, R.L., 2006. Cognitive‐behavioral therapy for bipolar disorders in adolescents: a pilot study. Bipolar Disorders, 8(5p1), pp.508-515.
  12. Frank, E., Swartz, H.A. and Kupfer, D.J., 2000. Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biological psychiatry, 48(6), pp.593-604.

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