Bipolar Disorder and Anxiety Disorder as Its Comorbid Condition

Introduction:

Anxiety and bipolar disorders can be classified as mental health issues. Both conditions share similar symptoms and can occur at the same time. It was found that some sort of mental health issue always accompanies bipolar disorder. Anxiety was found to be the most commonly occurring symptom of bipolar disorder.

What Is Bipolar Disorder?

Bipolar disorder is a mental health issue that involves extreme mood swings. In this condition, the individual may exhibit emotional highs (mania or hypomania) and lows (depression).

When an individual with bipolar disorder experiences depression, they may feel sad and hopeless and may lose interest in other activities. When the individual’s mood changes to mania, they may feel euphoric, full of energy, or unusually irritable. The mood changes can affect sleep, energy, behavior, and judgment.

What Is Anxiety Disorder?

Anxiety disorder is a mental health issue in which an individual may react to certain situations with fear and dread. These individuals may have physical symptoms such as sweating and a pounding heart.

It is considered normal to experience anxiety occasionally, but some individuals experience anxiety-related symptoms like worry and fear every day. In this condition, there is a sudden, intense feeling of anxiety and fear that can be noticed. These symptoms may reach a peak within minutes (panic attacks).

Individuals with this disorder may avoid certain places or situations to prevent these symptoms. Anxiety disorders may be of different types, such as separation anxiety, social anxiety disorder or phobias, and generalized anxiety.

How Are Bipolar and Anxiety Disorders Linked?

Other mental health issues accompany bipolar and anxiety disorders. Bipolar disorder was found to have coexisting conditions. This type of condition is called a comorbid condition or a comorbidity.

An individual with bipolar disorder was found to exhibit a six times greater chance of having anxiety disorder as a comorbidity for a lifetime. According to a meta-analysis study, 42 % of individuals with bipolar disorder suffer because of any of the anxiety disorders.

Healthcare providers always check for both disorders at the same time. It was observed that some of the symptoms of both disorders appear similar. This causes complications in both conditions' presentation, treatment, and prognosis.

When anxiety disorder appears as a comorbidity, it may increase the risk of substance abuse and suicidal thoughts. Hence, symptoms need to be monitored. Bipolar disorder with anxiety disorder as a comorbid condition can be most commonly seen among youth. Generalized anxiety disorder (GAD) and separation anxiety types most commonly occur as comorbid conditions.

Anxiety disorder always tends to accompany other mental health issues. These include,

• Depression.

• Obsessive-compulsive disorder.

• Bipolar disorder.

• Substance use disorder.

According to a study done in 2011, it was observed that anxiety disorder is the most commonly occurring condition as a comorbidity with bipolar disorder. A study conducted in 2019 found that at least half of individuals with bipolar disorder suffer from anxiety disorder during their lifetime.

According to a study done in 2018, it was observed that the rate of anxiety disorder as a comorbidity is three to seven times higher among individuals with bipolar disorder when compared to the general population without bipolar disorder. These two conditions are treatable but challenges are faced by individuals to live with.

Both disorders' symptoms are similar, so it becomes difficult to separate the diagnosis of these two conditions. Whenever anxiety disorder occurs as a comorbid condition with bipolar disorder, symptoms get worse. Researchers have found the impact of both disorders.

These include,

• The number of episodes related to mood increases.

• An increased rate of depressive episodes can be observed.

• Increased rate of episodes that involve mixed features (simultaneous symptoms of mania and depression).

• Increased rate of rapid cycling (in such cases, an individual experiences four episodes in a year).

• Increased frequency and severity of episodes.

• Individuals undergo longer periods of untreated illness.

• Experience increased suicidal thoughts.

• May increase the risk of substance abuse disorder.

• Experiencing negative events after taking medications.

• Increased use of healthcare is observed.

• Increased psychological stress can be noticed.

• Poorer responses to treatment.

• Lowered functioning and quality of life.

What Is the Treatment for Bipolar Disease With Comorbidity of Anxiety?

It is very challenging to treat bipolar disorder and anxiety individually. It has been noticed that treating these conditions together is still more challenging. Generally, primary care physicians and mental healthcare professionals work together to provide treatment.

Bipolar and anxiety disorders are treated with

• Medications.

• Psychotherapy (individual or couple). This depends on the situation of the individual.

Medications:

Medications are first used for the treatment of bipolar disorder and anxiety.

• Mood stabilizers are prescribed for bipolar disorder. Antidepressants and antipsychotics are given for anxiety. Sometimes, anticonvulsants and other medications like gabapentin are given.

• Selective serotonin reuptake inhibitors (SSRIs) are used for treatment. These may worsen the manic symptoms. The prescriber closely monitors these symptoms.

• Benzodiazepines are given as a treatment. These are given to treat anxiety disorders. These medications do not worsen the symptoms of bipolar disorder. In the long run, these medications may pose a risk of physical dependence and substance misuse. Hence, benzodiazepines should be used for a limited period of time.

Therapy:

Therapy is considered safe to treat anxiety if an individual is already on mood stabilizers. This can be successfully used in place of antidepressants that may cause negative effects.

Therapies include

• Cognitive Behavioral Therapy (CBT): This therapy helps reduce anxiety through behavioral change.
• Family Therapy: This therapy aims to reduce the distress among family members caused by an affected individual.
• Relaxation Techniques: These techniques help reduce anxiety and mood changes that are caused by stressors.
• Interpersonal and Social Rhythm Therapy: This type deals with scheduling and record maintenance. This helps in maintaining stability and avoiding changes in anxiety and mood.

Conclusion:

Bipolar disorder and anxiety disorders do occur together and are found to be very challenging to treat. When anxiety presents as a comorbidity and is treated, it may worsen the other condition called bipolar disorder. Hence, it is safer to make use of therapies to treat anxiety. An exact diagnosis of anxiety disorder with bipolar disorder is very crucial because, if misdiagnosed, it may increase the cost of care and worsen the situation. Hence, it becomes important to know about bipolar disorder, anxiety, their link, and management.