Treating Nonspecific Anxiety And Anxiety Disorders In Patients With Bipolar Disorder: A Review
Objective: To review the evidence for treating anxiety in patients with bipolar disorder.
Data Sources: A literature search from 1950 to week 1 of August 2009 was conducted via OVID and the National Institutes of Healths clinical trials online databases. Search terms included anxiety, anxiety disorders, bipolar disorder, panic disorder, generalized anxiety disorder, social phobia, social anxiety, obsessive compulsive disorder, specific phobia, posttraumatic stress disorder, and treatment. Reference lists of identified articles were also searched.
Study Selection: Fourteen treatment studies that included patients with bipolar disorder with either a syndrome-defined anxiety disorder or nonspecific anxiety were selected.
Data Extraction: Sample size, bipolar disorder subtype, comorbid anxiety disorders, baseline anxiety, treatment interventions, and outcome measurements were extracted.
Results: The majority of studies focus on treating anxiety disorders and nonspecific anxiety occurring during bipolar mood episodes. Studies of syndrome-defined anxiety disorders reveal that risperidone monotherapy did not separate from placebo and that olanzapine was superior to lamotrigine when used to augment lithium treatment. A study using open-label divalproex sodium and an uncontrolled study of group cognitive-behavioral therapy both suggest some benefit from these treatments in patients with bipolar disorder with panic disorder.
J Clin Psychiatry
Volume: 71
Depression In Overall Morbidity
Of note, overall time in depressive phases of BD, and duration of depressive episodes are much greater than in mania or hypomania . Moreover, morbidity has been surprisingly high in BD despite supposedly effective treatment. Indeed, BD patients averaged 45% of time ill during long-term follow-up, and depression accounted for 72% of time-ill, and somewhat more with BD-II than BD-I .
Table 1 Depressive morbidity in clinically treated bipolar disorder subjects.
Who Is At Risk For Bipolar Type 2 Disorder
Bipolar disorder is highly genetic. Those with a first-degree biological family member with bipolar disorder are at the highest risk of developing the disorder. Having a family history of bipolar disorder also is a strong predictor of developing it.
Others who should be screened for bipolar disorder include those for whom antidepressants are not effective or that worsen mood symptoms and those who frequently experience depression that is interrupted by periods of feeling “better than good.” Also, teenagers between the ages of 13 and 18 who experience frequent depression should be screened for bipolar disorder.
Bipolar disorder is highly heritable, with genetic influences contributing 60%â80% to the risk.
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Which Treatments Are Available For These Conditions
Bipolar disorder and anxiety disorder are challenging to treat individually. Treating both kinds of disorders together is even more of a challenge.
Your primary care physician and mental healthcare provider will often work together to ensure you receive the best possible care.
Bipolar and anxiety disorders are typically treated with a combination of:
- medications
- individual psychotherapy
- couples therapy, depending on your individual situation
Doctors usually treat co-occurring bipolar and anxiety disorders with medication first. They may initially prescribe a mood stabilizer to address your bipolar disorder.
More Than Half Of People With Bipolar Also Have An Anxiety Disorder Just As Symptoms Overlap So Do Coping Techniques Here Are Six To Try Today
Unraveling the symptoms of anxiety from those of bipolar can be a bit tricky, especially when you are diagnosed with both bipolar and an anxiety disorder. Fortunately, the wellness strategies for addressing those overlapping symptoms of overwhelm, stress, and fear are not only similar but also generally good for your mind, body, and soul. Here are a few ideas to lower those stress levels and free your thoughts to focus on the here and now.
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Current Status Of Bipolar Depression
Adequate understanding, timely diagnosis, and effective short- and long-term treatment of depressive episodes in BD patients are critically important but remarkably insufficiently resolved . Clinical significance of bipolar depression is underscored by strong association with overall morbidity, other co-occurring psychiatric conditions , disability, and excess mortality owing largely to suicide in young patients and intercurrent medical illness in older patients .
Antidepressants And Mood Switching
There is widespread concern that antidepressant treatment for bipolar depression risks switching into potentially dangerous agitation or mania, especially in BD-I . Such risk is more associated with the long-term BD course-pattern of depression followed by mania before a stable interval than the opposite . However, it is difficult to distinguish spontaneous from antidepressant-associated switching in BD, mean rates of which are similar . Though it is plausible to expect mood-stabilizing and antipsychotic drugs to prevent mood-switching with antidepressants, required randomized comparisons are lacking . Trials of antidepressants have found little difference in risk of new mania between antidepressants and placebo, with or without a mood-stabilizer included, although exposure times were short . However, one study found that switching in BD was 2.8-times greater within 9 months after adding an antidepressant, but not if a mood-stabilizer also was used , and switching risk was increased in the rare long-term trials with an antidepressant included in treatment .
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Medication Treatment For Bipolar Disorder
Most people with bipolar disorder need medication in order to keep their symptoms under control. When medication is continued on a long-term basis, it can reduce the frequency and severity of bipolar mood episodes, and sometimes prevent them entirely. If you have been diagnosed with bipolar disorder, you and your doctor will work together to find the right drug or combination of drugs for your needs. Because everyone responds to medication differently, you may have to try several different medications before you find one that relieves your symptoms.
Check in frequently with your doctor. Its important to have regular blood tests to make sure that your medication levels are in the therapeutic range. Getting the dose right is a delicate balancing act. Close monitoring by your doctor will help keep you safe and symptom-free.
Continue taking your medication, even if your mood is stable. Dont stop taking your medication as soon as you start to feel better. Most people need to take medication long-term in order to avoid relapse.
Dont expect medication to fix all your problems. Bipolar disorder medication can help reduce the symptoms of mania and depression, but in order to feel your best, its important to lead a lifestyle that supports wellness. This includes surrounding yourself with supportive people, getting therapy, and getting plenty of rest.
Could Mental Illness Be Caused By Oxidative Stress
Top clinicians and researchers are exploring the role role oxidative stress plays in mental illness. There are several studies to peruse on PubMed.
A Meta-Analysis of Oxidative Stress Markers in Depression :
Studies have suggested that depression was accompanied by oxidative stress dysregulation, including abnormal total antioxidant capacity , antioxidants, free radicals, oxidative damage and autoimmune response products. This meta-analysis aims to analyse the clinical data quantitatively by comparing the oxidative stress markers between depressed patients and healthy controls.
Theres more.
See, Is depression associated with increased oxidative stress?
A systematic review and meta-analysis.
And, The efficacy of adjunctive N-acetylcysteine in major depressive disorder: a double-blind, randomized, placebo-controlled trial
These data implicate the pathways influenced by NAC in depression pathogenesis, principally oxidative and inflammatory stress and glutamate, although definitive confirmation remains necessary.)
See also, The Glutathione System: A New Drug Target in Neuroimmune Disorders
Glutathione depletion and concomitant increase in oxidative and neurological stress and mitochondrial dysfunctions play a role in the pathophysiology of diverse neuroimmune disorders, including depression, myalgic encephalomyelitis/chronic fatigue syndrome and Parkinsons disease, suggesting that depleted GSH is an integral part of these diseases.
On and on it goes.
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Advocate For Yourself To Receive The Best Care
Treatment providers are not created equally. As Michael Otto, PhD, a Boston University psychology professor, says, recent research makes clear that seeking out a good therapist can have powerful effects beyond a mood stabilizer in treating bipolar depression and helping prevent relapse.
Read more about bipolar disorder and anxiety:
Are These Treatment Options Approved For Maintenance Treatment
At present, lithium, lamotrigine, olanzapine, aripiprazole, quetiapine, long-acting injectable risperidone and aripiprazole, and ziprasidone are approved for maintenance therapy for bipolar disorder. Most patients with bipolar disorder have a polarity, relapsing more often in mania or depression . The polarity of the patient influences the choice of maintenance treatment. For patients with depressive polarity, the recommended therapies are lamotrigine or quetiapine .
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Depression Anxiety & Bipolar Disorder
Know the Difference
Life events, relationships, job stress, financial or family problems affect us in many ways. Oftentimes these issues can be triggers for anxiety or depression. If these feelings become extremely intense and impact everyday life or our quality of life, it can become very hard to address the issues that prompted these feelings to begin with.
Sometimes being depressed can cause anxiety and the reverse is also true. Feeling anxious can cause depression if your anxiety is getting in the way of your activities. There can also be an underlying cause such as bipolar disorder. So how do you sort through your feelings to determine how best to deal with them?
The first steps in seeking treatment are to acknowledge your feelings, determine if you can, what triggers the feelings and being open and candid with a professional you trust. Your general practitioner may be able to do an evaluation or recommend a psychiatrist or psychologist specially trained in these areas. It is important that your practitioner sees you regularly to determine if the medication prescribed is right for you. A visit with your provider frequently would be reasonable and effective depending on the severity of your symptoms.
Symptoms of Depression
- Persistently feeling sad, anxious or empty
- Feelings of hopelessness like theres no way out
- Lack of interest in activities you would usually enjoy
- Difficulty sleeping, concentrating, focusing
- Changes in your appetite or weight
Symptoms of Anxiety
What Does It Mean To Have Bipolar Disorder Or An Anxiety Disorder
Bipolar disorder is a lifelong mental condition that causes extreme shifts in mood. A persons moods can change very quickly, and they may experience everything from high highs to low lows.
These shifts in mood can cause major changes in their energy and activity levels. The shifts can also interfere with their quality of life and daily activities.
Everyone experiences some anxiety from time to time, such as before taking a test or making a big decision. However, some people have anxiety disorders that cause them to experience more than short-term worries.
Anxiety disorders arent limited to specific life events and may worsen over time. Sometimes people with anxiety disorders have worries so severe that they interfere with their ability to carry out their everyday activities.
The various types of anxiety disorders include:
at least half of people with bipolar disorder will experience an anxiety disorder during their lifetime.
A 2018 study found that anxiety disorder rates among people with bipolar disorder are 3 to 7 times higher than anxiety disorder rates among the general population.
Both conditions are treatable, but theyre long-term conditions that can sometimes be challenging to live with.
Some of the symptoms of bipolar disorder can be associated with an anxiety disorder. For that reason, its not always easy to separate an anxiety disorder diagnosis from a bipolar disorder diagnosis.
Both conditions can negatively affect a persons quality of life and functioning.
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Proven Pharmacological Treatment Options
Despite the devastating impact of bipolar depression on life, there has been a dearth of knowledge about its underlying etiology and the development of therapeutic strategies especially in its acute phase . Today, we only have three different approved agents to choose from: OFC, quetiapine , and lurasidone . summarizes the proven studies of above three agents in acute bipolar depression .
How Does Anxiety Affect Bipolar Disorder
Both bipolar disorder and anxiety are treatable, manageable conditions. However, it is important to distinguish between the two, as this will affect the type of medication and therapy a healthcare professional will prescribe.
When a person has both conditions, they may find their anxiety affects the symptoms of bipolar disorder. This could
Although anxiety and bipolar disorders have some similarities, they have distinct sets of symptoms and diagnostic criteria.
However, some symptoms suggest a person may have co-occurring anxiety. They include:
- A persistent, intense feeling of nervousness: This can include worrying, anxiety, and panic attacks. A person may also avoid taking part in activities. These symptoms persist during manic and depressive episodes.
- Sleep and anxiety problems: People may find they have issues sleeping even when they are not in a manic state. They may feel persistently anxious despite receiving treatment.
- History of symptoms: Some people may have lived with anxiety and bipolar disorder symptoms from childhood and adolescence.
Learn more about the symptoms of anxiety and bipolar disorder here.
If someone has an anxiety disorder in addition to bipolar disorder, a doctor should diagnose and treat the conditions together.
When a doctor, psychiatrist, or psychologist is developing a persons treatment plan, they will take multiple factors into consideration. Usually, medication and therapy form the basis of the treatment plan.
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How Does It Affect People
Bipolar disorder affects both men and women. For many people, the first symptoms show up in their early twenties. However, research has shown that the first episode of bipolar disorder is occurring earlier: It often shows up in adolescence, and even children can have the disorder.
Recent research suggests that kids and teens with bipolar disorder don’t always have the same behavioral patterns that adults with bipolar disorder do. For example, kids who have bipolar disorder may experience particularly rapid mood changes and may have some of the other mood-related symptoms listed below, such as irritability and high levels of anxiety. But they may not show other symptoms that are more commonly seen in adults.
Because brain function is involved, the ways people with bipolar disorder think, act, and feel are all affected. This can make it especially difficult for other people to understand their condition. It can be incredibly frustrating if other people act as though someone with bipolar disorder should just “snap out of it,” as if a person who is sick can become well simply by wanting to.
Bipolar disorder isn’t a sign of weakness or a character flaw it’s a serious medical condition that requires treatment, just like any other condition.
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Symptoms Of Bipolar Type 2 Disorder
Because bipolar disorder can look like other mental health disorders, it is often misdiagnosed. Symptoms of bipolar disorder can appear as depression, anxiety disorders, obsessive-compulsive disorders, personality disorders, and even schizophrenia. Understanding the symptoms of bipolar disorder, and specifically bipolar type 2 disorder, is an important way to ensure an accurate diagnosis and effective treatment.
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