AnxietyAnxiety And Bipolar Disorder: Understanding The Link And Management Strategies

Anxiety And Bipolar Disorder: Understanding The Link And Management Strategies

Anxiety disorders are a common co-occurrence in people with bipolar disorder, significantly affecting their mood and quality of life. Bipolar disorder itself is a mental illness characterised by extreme mood swings, including emotional highs known as mania or hypomania and lows known as depression. The link between bipolar disorder and anxiety disorders is well established, with a marked increase in the intensity and frequency of anxiety symptoms in those who also navigate the turbulent waters of bipolar episodes.

Managing both bipolar disorder and anxiety can present a unique set of challenges. Effective treatment is multifaceted and often involves a combination of medication, psychotherapy and lifestyle changes to help manage symptoms and improve overall functioning. It’s important for people to get an accurate diagnosis to ensure that both conditions are treated simultaneously, recognising the impact that untreated bipolar disorder can have on anxiety levels and vice versa.

Key Takeaways

  • Bipolar disorder is characterised by extreme mood swings.
  • Anxiety often co-occurs with bipolar disorder, making treatment more difficult.
  • Diagnosing and treating both conditions at the same time is crucial.

Anxiety And Bipolar Disorder: Overview

Bipolar disorder is characterised by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). The condition results in episodes of elevated mood and energy levels, contrasted by periods of markedly depressed mood and decreased energy.

Anxiety disorders, which include conditions such as generalised anxiety disorder (GAD), panic disorder and social anxiety disorder, involve persistent and excessive worry that interferes with daily activities. The presence of anxiety disorders in people with bipolar disorder is recognised as a comorbidity, meaning that both disorders occur together more often than would be expected by chance.

The comorbidity of bipolar disorder and anxiety disorders complicates both diagnosis and treatment. Research suggests a reciprocal relationship between the two, with anxiety potentially triggering manic or depressive episodes, and bipolar disorder exacerbating anxiety symptoms.

Treatment for people with both anxiety and bipolar disorder usually involves a combination of medication and psychotherapy. Mood stabilisers and antidepressants are commonly used in pharmacological treatment. Psychotherapeutic interventions may include cognitive behavioural therapy to address thought patterns associated with both anxiety and depression.

Understanding the interaction between mood and anxiety disorders is critical to improving treatment outcomes. In bipolar disorder, it’s known that episodes of mania and depression can recur, and treatments are tailored to reduce the impact of these episodes and improve functioning.

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Challenges And Management Of Bipolar Disorder And Anxiety

People with both bipolar disorder and anxiety disorder often face a complex set of challenges. Managing these conditions requires a carefully balanced treatment plan, usually including both medication and therapy, in order to achieve a sustainable quality of life.


Medication for co-occurring bipolar and anxiety disorders may include a combination of mood stabilisers, antidepressants, and occasionally benzodiazepines for acute anxiety relief. Mood stabilisers can help prevent the ups and downs associated with bipolar disorder and provide a more stable mood base. Antidepressants are used cautiously to treat anxiety symptoms because of the risk of triggering manic episodes. Mental health professionals may also recommend that benzodiazepines are used sparingly, as they can become habit-forming and complicate the treatment of bipolar disorder if used long term.

  • Mood stabilisers: Lithium, valproate, carbamazepine
  • Antidepressants: SSRIs, SNRIs (used cautiously)
  • Benzodiazepines: Clonazepam, lorazepam (short-term use)


Therapy is a cornerstone in the treatment of bipolar disorder with comorbid anxiety. Cognitive behavioural therapy (CBT) is a type of psychotherapy that helps patients identify and modify negative thought patterns associated with both disorders. Incorporating self-monitoring strategies, such as the use of daily mood diaries, can enhance the effectiveness of CBT by helping people identify triggers and early warning signs of mood changes. In addition, therapists can focus on stress reduction techniques and teach coping skills to improve overall mental health and well-being.

  • CBT techniques: Identifying cognitive distortions, practising challenging thoughts
  • Therapeutic strategies: Stress management, mood monitoring

By integrating pharmacological approaches with psychotherapeutic interventions, people with bipolar and anxiety disorders can manage their conditions more successfully. Ongoing communication with a therapist and mental health professional is essential to adjust the treatment plan as needed to optimise outcomes.

Impact Of Untreated Bipolar Disorder

Impact Of Untreated Bipolar Disorder

Untreated bipolar disorder can lead to significant challenges in many aspects of a person’s life, including personal relationships, work performance and overall mental health stability.

Personal Life

Untreated bipolar disorder often disrupts personal relationships through the erratic behaviour associated with manic and depressive episodes. People may experience increased conflict, strained communication and a decline in social engagement. Routine activities can become overwhelming, leading to isolation and damaged relationships with loved ones.


In the workplace, people with bipolar disorder face difficulties in maintaining a stable work life. The functional impairment caused by untreated symptoms can lead to reduced performance, poor attendance and even job loss. Severe mood episodes can affect concentration and decision-making, with a direct impact on work productivity and career progression.

Mental Health Risks

The presence of comorbid anxiety disorders, such as social anxiety disorder, can increase the severity of bipolar disorder. Without treatment, the risk of substance misuse, increased suicidal thoughts and possible psychosis increases. In addition, the likelihood of hospitalisation increases if bipolar disorder is left untreated, as does the need for more intensive interventions in the future, highlighting the importance of early diagnosis and treatment.

Understanding Bipolar Disorder Episodes

Bipolar disorder is characterised by extreme mood swings that include emotional highs, called manic episodes, and lows, called depressive episodes. These episodes can affect a person’s energy level, activity, behaviour and overall ability to function.

Manic Episodes

During a manic episode, people may experience increased energy, restlessness and a decreased need for sleep. They often exhibit impulsive behaviour and may engage in risk-taking activities without considering the consequences. Racing thoughts and rapid speech are common signs of mania, which can escalate into severe psychosis requiring immediate medical attention. Mood swings during mania can cause problems in personal and work relationships, as the person may appear overly energetic or irritable.

Depressive Episodes

Depressive episodes in bipolar disorder involve a persistent feeling of sadness or loss of interest in external stimuli. These episodes can manifest as a major depressive episode, where people can experience deep feelings of guilt, worthlessness and fatigue. They often struggle with significant changes in sleep patterns and appetite, difficulty concentrating, and may have thoughts of death or suicide. Depressive episodes contrast sharply with manic episodes, sometimes leading to withdrawal from social situations and a marked decrease in functioning.

When To Seek Help

People with bipolar disorder often experience fluctuating periods of depressive and manic episodes. Knowing when to seek help is crucial to managing the condition effectively. A person should consider professional help if they

  • Experience persistent feelings of sadness or hopelessness that interfere with daily functioning.
  • Experience severe mood swings that cause problems in relationships.
  • Have thoughts of self-harm or suicide, in which case immediate intervention is essential.

People with bipolar disorder may also have co-morbid conditions such as anxiety disorders, which may require additional support. As bipolar disorder can co-exist with other mental health conditions such as ADHD, schizophrenia or obsessive-compulsive disorder, it is important to recognise worsening symptoms associated with one of these diagnoses.

Here are clear indications of when to seek medical advice:

  • Significant impact: When symptoms are interfering with your career, education or social life.
  • Unmanaged symptoms: When current treatment strategies don’t seem to be working.
  • Behaviour: The emergence of dangerous or uncharacteristic behaviour.

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  • Depressive episodes: Make an appointment with a mental health professional.
  • Manic episodes: Contact your healthcare provider for possible medication adjustments.
  • Anxiety or obsessive-compulsive patterns: Seek cognitive behavioural therapy.
  • Signs of ADHD: Talk to a psychiatrist about treatment options.

Recognising the need for help is a step towards better management of bipolar disorder and any associated psychiatric conditions.

Frequently Asked Questions

The co-occurrence of anxiety and bipolar disorder presents unique challenges. These FAQs distill current research and expert consensus on managing these co-occurring conditions.

How can someone manage anxiety during a hypomanic episode?

People can manage anxiety during a hypomanic episode by following treatment plans that include medication, psychotherapy, and lifestyle changes. Techniques such as mindfulness and regular exercise can also play a supportive role in managing symptoms of anxiety during these periods.

What are the best approaches for treating morning anxiety in bipolar patients?

For morning anxiety in bipolar patients, establishing a consistent morning routine and optimising the timing of medication can provide significant relief. Cognitive behavioural therapy (CBT) is also recommended to address the specific anxiety and stress that manifests during the morning hours.

Which antidepressants are most effective for treating anxiety in people with bipolar disorder?

Antidepressants such as SSRIs and SNRIs are considered for treating anxiety in bipolar disorder, although their use must be carefully managed to avoid triggering mania. A psychiatrist can give tailored advice, taking into account the individual’s full mental health profile.

How is anxiety in bipolar disorder characterised and treated?

Anxiety in bipolar disorder is characterised by restlessness, worry and difficulty concentrating. Treatment typically involves a combination of medication, such as mood stabilisers or anti-anxiety drugs, and psychotherapeutic interventions aimed at reducing anxiety.

Could frequent panic attacks be a sign of underlying bipolar disorder?

Frequent panic attacks can be a sign of underlying bipolar disorder, especially if they are consistent with mood swings. A thorough psychological assessment is essential to distinguish panic disorder from bipolar disorder and to determine an appropriate treatment approach.


Anxiety disorders often co-occur with bipolar disorder, making treatment more difficult. High rates of comorbidity can exacerbate bipolar disorder and affect quality of life. Treatments include cognitive behavioural therapy (CBT) to manage anxiety and mood symptoms, mindfulness and relaxation techniques to reduce stress and control emotions. Interpersonal and social rhythm therapy (IPSRT) helps to stabilise routines, improve relationships and reduce bipolar mood triggers.

Combining these therapies with medication improves outcomes for patients with both anxiety disorder and bipolar disorder. Comprehensive, collaborative treatment involving healthcare providers, patients and support systems is essential for the best prognosis.


  1. Anxiety and Depression Association of America. “Understanding Anxiety: Co-Occurring Disorders – Bipolar Disorder.” ADAA. Link.

  2. Anxiety and Depression Association of America. “Understanding Anxiety: Related Illnesses – Bipolar Disorder.” ADAA. Link.

  3. National Center for Biotechnology Information. “Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults.” PubMed Central, PMC6323556. Link.

  4. National Center for Biotechnology Information. “Bipolar Disorder and Comorbid Anxiety Disorders.” PubMed Central, PMC6213896. Link.

  5. National Center for Biotechnology Information. “Bipolar Disorder.” Bookshelf, NBK558998. Link.

Mark Willson, holding a Ph.D., functions as a psychotherapist in Washington, D.C. His specialized fields encompass addiction, anxiety, depression, as well as sexuality and interpersonal connections. Dr. Willson holds the distinction of being a diplomat for the American Board of Addiction and Anxiety, further serving as a certified counselor and addiction specialist.

Aside from his personal professional endeavors, Dr. Wilson has engaged in roles as an author, journalist, and creator within substantial medical documentary projects.

Isabella Clark, Ph.D., held the position of a professor within Emory University’s School of Medicine, working in the Department of Mental Health and Nutrition Science. Alongside this role, she served as a research associate affiliated with the National Research Center. Dr. Clark’s primary area of research centers on comprehending the mechanisms through which adverse social encounters, encompassing prolonged stress and traumatic exposure, contribute to a spectrum of detrimental mental health consequences and coexisting physical ailments like obesity. Her specific focus lies in unraveling the reasons behind the varying elevated susceptibility to stress-linked disorders between different genders.


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