Confronting Concurrent Anxiety in Bipolar Disorder

Comorbid anxiety disorders compound challenges associated with bipolar disorder treatment.

While offering insight into this connection, a review published in the February 2015 edition of Current Psychiatric Reports looks forward to individualized therapy specifically tailored to patients in this population.

Current research suggests that between 60% and 90% of patients with bipolar disorder type I suffer from concurrent anxiety disorders, which include various phobias, panic disorder, post-traumatic stress disorder, generalized anxiety disorder, and obsessive-compulsive disorder.

The presence of comorbid anxiety has been correlated with negative treatment outcomes in bipolar patients, including a greater quantity of depressive episodes. As the number of patients’ anxiety symptoms increases, so does the length of their depressive episodes.

Some health care professionals have questioned the role of selective serotonin reuptake inhibitors (SSRIs) in the treatment of bipolar patients with comorbid anxiety disorders because SSRIs can destabilize mood and aggravate manic symptoms. Preliminary research indicates that the use of particular atypical antipsychotics may be more appropriate. For instance, quetiapine monotherapy and olanzapine and fluoxetine combination therapy have both shown initial efficacy in reducing anxiety symptoms.

Nonpharmacologic interventions such as psychotherapy have also shown promise, but much about them remains unknown. Previous studies have exhibited a lack of power, heterogeneous methodology, and a failure to incorporate etiological factors such as genetics and environment.

More research is needed to explore the connection between specific anxiety disorders and bipolar disorder. Such research will help enable clinicians to tailor pharmacologic and psychotherapeutic treatments to patients with bipolar/anxiety disorder comorbidity, and to maximize beneficial outcomes in their treatment.