Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third find that some linger. A small percentage experience chronic unremitting symptoms despite treatment.
Bipolar I disorder is the classic form of the illness, which involves recurrent episodes of mania and depression. People with bipolar II disorder never develop severe mania; instead they experience episodes of hypomania that alternate with depression.
When four or more episodes of illness occur within a twelve-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.
Most people with bipolar disorder can lead healthy and productive lives when the illness is properly treated. Without treatment, however, the disorder tends to worsen. Over time a person may suffer more frequent and more severe manic and depressive episodes than when the illness first appeared.
Some people with bipolar disorder become suicidal. Risk for suicide appears to be greater earlier in the course of the illness. A person with bipolar disorder, or anyone thinking about committing suicide, needs immediate attention from a mental health professional or a physician.
To achieve wellness, it is essential that people receive treatment for a co-occurring anxiety disorder and bipolar disorder. Treatment for both, however, is more complex than treatment for one.
Carefully consider all treatment options with your doctor or mental health provider: medication, therapy, or a combination. With proper treatment, anxiety disorders and bipolar disorder can be overcome.
When treating a co-occurring anxiety and bipolar disorder with medication , most doctors first prescribe a mood stabilizer to address the bipolar disorder.
Starting an antidepressant (a common medication approach for anxiety disorders) before mood stabilization is achieved may worsen the bipolar disorder symptoms. However, an antidepressant can trigger manic episodes, even while taking a mood stabilizer.
For this reason, doctors sometimes avoid prescribing antidepressants or prescribe them at a low dose for patients with co-occurring disorders, and they monitor carefully any patients who are taking a mood stabilizer and an antidepressant.
Because benzodiazepines (a class of drugs often used to treat anxiety disorders) do not appear to have negative effects on bipolar disorder, they may be used for anxiety in patients with co-occurring bipolar disorder. However, they may cause side effects, including physical dependence and tolerance (a need for more medication over time), and there is some risk of abuse among people suffering from bipolar disorder, particularly those who have experienced alcohol or substance abuse.
People may need to try a few different combinations to find the most effective medications.
Types of Therapy
People with bipolar disorder should receive medication for mood stabilization. But therapy also plays an important role.
Using cognitive-behavioral therapy (CBT) or another evidence-based psychotherapy instead of medication for an anxiety disorder addresses concerns about side effects from taking mood stabilizers with anti-anxiety medications.
Below are forms of therapy with varying levels of research evidence for anxiety disorders:
Consider asking the following questions during your initial consultation:
Exercise regularly. Exercise can have a beneficial effect on anxiety, bipolar disorder, and depression because chemicals released during exercise have a stabilizing effect on mood. Set a goal of 30 minutes of activity three to five times a week: Jog, walk, bike, or dance.
Get a good night’s sleep. Sleep deprivation is never beneficial. As noted above, insomnia can be a trigger for manic episodes. Learn more about anxiety and sleep disorders[LINK to new page].
Avoid alcohol and drugs. Alcohol and drugs that have not been prescribed can aggravate anxiety, trigger panic attacks, and worsen episodes of mood disorders. Find out more about anxiety disorders and substance abuse .