Anxiety is often a symptom of bipolar disorder.  In a depressive or manic state, a person can feel excessive worry, panic, paranoia, agitation, irritability, and experience social phobia.  The level of anxiety can fluctuate along with the bipolar mood states.

It is also possible to have bipolar disorder with a separate diagnosis of an anxiety disorder, where a person’s worries and fears can go on for months or even years, even when the bipolar moods are stable.  There doesn’t have to be a reason for the anxiety.  It could just be a sense of something bad about to happen at any moment.

There are several types of anxiety disorders including:

Panic Disorder

People with panic disorders have unexpected panic attacks with intense fear, shortness of breath and fast heartbeats; some may sweat and feel like they are choking or are going to faint or die.  They feel like they are out of control when having a panic attack.  They often fear they will have another one, and avoid the places where they have had them before.

Intense fear and highly noisy, over stimulating, chaotic environments, such as a kid’s birthday party, can bring on a panic attack for me.  I used to get them at work, at sporting events, at the grocery store, and recitals.  So, improvements have been made, but I do still suffer from them.

Social Anxiety Disorder

People with social anxiety disorder fear being around others, where they are worried about being embarrassed or judged or rejected.  They have a hard time talking to others and making eye contact.  They often feel like running away in social situations.  They may sweat, shake or get nauseous when called upon to interact with others.

My social anxiety manifests itself in many of the ways described above, however, I am not always completely shy as one might imagine someone with social anxiety being.  Quite the opposite, I will often overcompensate and come off a bit brash.  I blame that on my bipolar impulsivity.

So, I actually take an fast, but short-acting, antianxiety medication prior to social events to, one, decrease my chances of having a panic attack, and two, to give my prefrontal cortex a bit more time to censor what I want to say.

Generalized Anxiety Disorder (GAD)

People with GAD tend to worry about things, both large and small, but out of proportion to the impact of the event.  They can’t let go of the worry, and worry about being worried all of the time.  They feel restless and can’t relax.  They are fatigued, irritable, have trouble sleeping, and are tense to the point of having sore muscles and headaches and/or GI problems.  They have a hard time concentrating or their mind often goes “blank,” except when carrying every option out to its possible negative conclusion.

Even when their worries don’t completely consume them they still feel anxious for no apparent reason.  I function most frequently in this state, always worried about my safety and that of my children, and feeling like something bad is going to happen at any moment.

 

Do I Have An Anxiety Disorder or Is It Part Of My Bipolar?

Of course, any disorder has to be properly diagnosed by a professional, which I am not.  To find out for sure if you have an anxiety disorder, talk to your physician.  From what I have learned and personally experienced, however, the difference between having one of these anxiety disorders in addition to bipolar disorder and having “bipolar anxiety” alone is that with anxiety as a symptom of bipolar, one may experience a mix-mash of random symptoms from each disorder.  Having a separate anxiety disorder, on the other hand, requires the person to fit the diagnostic criteria for said disorder.

For panic disorder, for example, one would have to have recurring attacks, and be fearful of having future ones to the point of avoiding situations and places where he or she have had them in the past.

For GAD the person would have to have:

“excessive and unrealistic worry over a period of at least six months…associated with at least three of the following symptoms:

• Restlessness
• Fatigue
• Difficulty concentrating
• Irritability or explosive anger
• Muscle tension
• Personality changes, such as becoming less social”

Source: http://www.webmd.com/anxiety-panic/guide/anxiety-attack-symptoms

If a person is only experiencing some of the symptoms of anxiety but not enough to fit the diagnostic criteria of having the disorder, then he or she merely has anxiety as a symptom of the bipolar disorder.

The reason this is important is because they are treated in different ways.

Treatment

If a person has bipolar disorder with anxiety symptoms, as his or her bipolar disorder came under control, the anxiety symptoms would most likely subside.  If he or she has bipolar disorder and an anxiety disorder, the moods may be stable but the anxiety may still be disabling.

The problem with having both bipolar disorder and an anxiety disorder is that while anxiety disorders alone are normally treated with antidepressants, it is often unwise to give someone with bipolar an antidepressant since it may trigger a manic episode.  Many physicians treat people with these comorbid conditions by addressing the bipolar symptoms first with mood stabilizers and other “bipolar medications.”

Once the person’s mood is stabilized, then any remaining anxiety symptoms are addressed in any number of ways depending on the doctor and patient’s plan.  Since antidepressants could have detrimental effects on the course of one’s bipolar disorder, atypical antipsychotics are often used to treat anxiety disorders in those with bipolar.

Psychotherapy or Cognitive Behavioral Therapy and relaxation training are always safe bets.  If antidepressants are tried, careful monitoring for any hypomania or mood cycling must be done.  Benzodiazepines are effective in relieving many anxiety disorder symptoms, but they are habit-forming and must be prescribed with caution.

Do you have comorbid bipolar and anxiety disorders?  How has this mix played out in your every day life?

Sources:
Mayo Clinic
National Institute of Mental Health (NIMH)
Psychiatric Times