Bipolar disorder and anxiety: what’s the connection?

Bipolar disorder vs anxiety disorder

Bipolar disorder is a mental health condition that affects someone's mood. Also known as manic depression, bipolar disorder causes people to experience extreme episodes of depression (intense feelings of sadness and low mood) and mania (emotionally high and increased energy levels).

Anxiety disorder is a persistent feeling of worry or uneasiness, often connected to certain scenarios like social events, a trauma in your past or your health. While we all feel anxiety at some point in our lives, people with anxiety disorders will experience persistent symptoms of anxiety over many weeks and months.

It's not uncommon for someone with bipolar disorder to have a co-existing anxiety disorder. For a person with these co-occurring conditions, it's crucial they get the correct diagnosis so they're able to access the right treatment for both disorders, and manage them effectively.

The connection between bipolar disorder and anxiety

Many people who are diagnosed with bipolar disorder will also suffer from a co-existing mental health condition, with anxiety disorders being the most common. Research suggests that anxiety disorders are three to seven times more prominent in people with bipolar disorder than in the general population (source). A study in the World Journal of Psychiatry says that over half of people with bipolar disorder will experience an anxiety disorder at some point in their lives.

Bipolar disorder is a mood disorder, and so many of the symptoms people experience can overlap with the symptoms of anxiety. Examples include:

• Feeling restless
• Withdrawing from friends and family
• Changes to the amount of sleep you're getting, whether this is more sleep or less sleep
• Changes to your appetite
• Feelings of sadness or hopelessness

While bipolar disorder and anxiety are both serious conditions on their own, the combination of the two can be extremely challenging for someone to live with. The symptoms of one, or both, of these conditions, may worsen. The impact that might have includes:

• Suffering from low confidence and self-esteem
• Risk of substance abuse such as alcohol and drugs
• Increased number of mood episodes
• Increased risk of suicide
• Decreased quality of life
• Negative treatment outcomes

Self-care tips for managing bipolar and anxiety disorders

Self-care can be a big part in managing bipolar and anxiety disorders simultaneously, helping you to calm your anxiety and better understand your bipolar disorder symptoms. Try incorporating the following recommendations into your weekly routine.

• Meet up with family and friends – your anxiety may leave you feeling as though you want to isolate yourself, but it's important to get out of the house and speak to others. You could meet up with someone you trust to talk about your worries and work out solutions together. A good catch-up can also distract you from your symptoms and boost your mood
• Exercising regularly – the chemicals released into your brain as you exercise can be a great mood stabiliser. Try to get outside and do some form of exercise that you enjoy for 30 minutes, 3 times a week
• Establish a good sleep routine – insomnia can be a trigger for manic episodes so it’s important to establish a good sleep routine. Wake up and go to sleep at similar times every day, even at weekends, and try not to nap during the day. Also, avoid using electronic devices in the hours before you go to sleep, or when you're in bed
• Avoid alcohol and drugs – you may try to self-medicate using drugs and alcohol. But this can aggravate your symptoms, worsen mood disorders and lead to addiction issues
• Try some relaxation techniques - breathing exercises, visualisations and muscle relaxation are all effective ways to deal with anxiety. In the long-term, it could reduce your anxiety and help you to focus more on overcoming your bipolar disorder

Treatment options for co-occurring bipolar and anxiety disorders

When you're receiving treatment for bipolar disorder and anxiety, it's important that any medication and therapy is suitable for both conditions. Speak to your GP or another medical professional and they can advise on how best to treat your co-existing conditions. Treatments include:

Medication

Antidepressants are an effective pharmacological treatment for anxiety disorders, but they can adversely affect the course of bipolar disorder. They can destabilise your mood and cause hypomanic or manic episodes. The risks mean that you must always consult a doctor about the medication you're taking and what might be best to manage both of your conditions.

Mood stabilisers are an alternative form of medication for bipolar disorder, which can be used alongside suitable treatment for their co-morbid anxiety.

Therapy

Cognitive behavioural therapy (CBT) and relaxation training can be useful for those with bipolar disorder looking to manage their anxiety.