Bipolar disorder is a mental illness marked by extreme mood episodes ranging from mania to depression.  Anxiety can be a symptom of bipolar disorder as stated by Dr. Emil Kraepelin, back in 1921.  The International Society for Bipolar Disorders (ISBD) also claimed that anxiety is a symptom of bipolar disorder in a Task Force report on “mixed states” in bipolar disorder.  They described this anxiety as:

• General hyperarousal
• Inner tension
• Irritability/impatience
• Agitation
• “Frantically anxious”

Individuals in mixed states may feel increased energy and have racing thoughts while also experiencing hopelessness and despair.  They may have insomnia and increased risky behavior but also feel empty and blank inside and have unexplained crying spells.

While anxiety can be a symptom of bipolar disorder, it can also be a separate condition in addition to bipolar disorder.  Having more than one condition or disorder is referred to as “co-morbid” and basically means that the two conditions stand alone and are not a symptom of one or the other.

It is important to know the difference because if the anxiety is coming from the bipolar disorder then it should get better when the bipolar disorder gets better.  If not, then when the bipolar disorder is stabilized, the anxiety may still persist.

There are several types of anxiety disorders.  They include:

• Generalized Anxiety Disorder (GAD)
• Social Phobia
• Panic Disorder (with or without Agoraphobia)
• Post-Traumatic Stress Disorder (PTSD)
• Obsessive-Compulsive Disorder (OCD)
• Specific Phobias

Regardless of whether the anxiety is a symptom of the bipolar disorder or in addition to the bipolar disorder, mood stabilizers are recommended as first line treatment choice due to the potentially mania-inducing risk of antidepressants in patients with bipolar disorder.  Psychotherapy or cognitive behavioral therapy is sometimes then recommended even before antidepressants as well.

References:
psycheducation.org/diagnosis/mixed-states/anxiety-and-bipolar-disorder/
http://www.dbsalliance.org/site/PageServer?pagename=education_brochures_bipolar_disorder_rapid_cycling