How to Treat Anxiety in Bipolar Disorder

How to Treat Anxiety in Bipolar Disorder

by Dr Sagnik Mukherjee

Posted on 4th December, 2023 at 7:03:46 PM

Antipsychotic medicines

Bipolar disorder and anxiety are both mental illnesses that need immediate treatment by a psychiatrist. 

Bipolar disorder is a mental disorder where the person experiences extreme mood swings, ranging from depression to mania. Anxiety is a condition where the person is restless, tense, and highly agitated.

Do these two mental illnesses coexist and how can we successfully treat anxiety in bipolar disorder? Let us analyze.

What are the types of Anxiety Disorders?

Anxiety is a feeling of worry or stress but if this becomes a frequent habit, it could be a mental illness called Anxiety Disorder.

The American Psychiatric Association classifies Anxiety disorders as:

Generalized Anxiety Disorder- GAD

Here the person with GAD worries continuously about life events for months together. This affective disorder drains his energy levels. If ignored, he may even develop suicidal thoughts.

Obsessive-compulsive disorder-OCD

An OCD patient may have a continual fear or obsession along with compulsive behavior of doing things repeatedly.

Panic Disorder

Here the person experiences a sudden bout of fear along with physical symptoms like dizziness, nausea, chest pain, shortness of breath, etc.

Social Anxiety Disorder 

A person with social anxiety disorder becomes tense when he comes in contact with people around him.

Apart from this,  bipolar patients also exhibit anxiety symptoms. Then this mental condition is called Co-Occurring Bipolar and Anxiety Disorders.

Can a patient have both Bipolar disorder and Anxiety?

Anxiety is a condition caused by mental distress. When a patient suffers from an irritable mood episode due to bipolar illness, he is bound to show anxiety symptoms due to distress.

A person with bipolar illness has two extreme mood episodes- a hyperactive manic phase and a hypomanic phase. Anxiety occurs usually during the depressive phase or when the two states combine together. 

When there are such mixed stages of depression, it is best to administer atypical antipsychotics and anticonvulsant medicines.

Clinical studies indicate that 50% of bipolar patients show anxiety symptoms. The prevalence of Anxiety Disorders is at least 5 times more in bipolar patients.

Expert Mental Health Professionals always look for Anxiety Disorder Comorbidity when they make a Bipolar Disorder Diagnosis.

What is ‘Anxiety with Bipolar Disorder Symptoms?

Increased irritability

Bipolar disorder patients are always tense and get irritated easily. When they show manic symptoms, they become violent when even slightly disturbed. During the hypomanic episode, there is a risk of suicide. 

Insomnia and lack of response to initial treatment

Patients complain of lack of sleep and do not respond to the initial treatment. This increases the anxiety in patients and delays the effect of anxiety medication.

Persisting anxiety even when not in the manic phase

Even when they do not show manic symptoms, the patients are always fearful or worried.

Occurrence of panic attacks

Due to excessive worrying, the patient may have a panic attack with physical symptoms.

Substance use disorder 

Substance abuse weakens the resolve of the patient to get better. Here the person medicates himself with drugs or alcohol. This can only make the anxiety worse after the drug effect wears off.

What is the treatment for Co-Occurring Bipolar and Anxiety Disorders?

Bipolar disorder has a lifetime prevalence and must be treated with care. Its accompanying anxiety should be addressed first to correct the mood disorders.

This peculiar mental health condition can be treated only with a combination of medications like Risperidone, clozapine, etc that are antipsychotic medicines used for long-term treatments.

Anticonvulsant medicines

Bipolar spectrum disorders use anticonvulsants like lamotrigine and valproate sodium as current medications.

Benzodiazepine medication 

Benzodiazepines work well for anxiety. But they are a high risk for bipolar patients owing to the dependence or addiction factor.

Antidepressant Therapy 

Antidepressants must be used in limitation as they can increase depressive disorder along with bipolar symptoms.

Cognitive Behaviour Therapy-CBT

Cognitive Behavioral Therapy uses talking and counseling to treat anxiety and panic attacks.

Interpersonal Therapy and Social Rhythm Therapy

This adjunctive therapy teaches people with Bipolar to maintain a regular schedule of work and sleep with adequate social interactions.

Effective treatment of Anxiety disorders reduces the duration of illness and improves the quality of life.

Treating anxiety along with bipolar disorder is like walking a tightrope.
Alternative medicine, interpersonal therapy, and psychological treatments are a must to reduce the illness severity and successful treatment.

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