Most people feel anxious at times and have their ups and downs. It is natural for a mood to change or anxiety level to rise when a stressful or difficult event occurs.
But some people experience feelings of anxiety or depression or suffer mood swings that are so severe and overwhelming that they interfere with personal relationships, job responsibilities, and daily functioning. These people may be suffering from an anxiety disorder, bipolar disorder, or both.
It is not uncommon for someone with an anxiety disorder to also suffer from bipolar disorder. Many people with bipolar disorder will suffer from at least one anxiety disorder at some point in their lives.
The good news is that the disorders are treatable separately and together.
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function.
The mood episodes associated with the disorder persist from days to weeks or longer, and can be dramatic, with periods of being overly high and/or irritable to periods of persistent sadness and hopelessness.
Severe changes in behavior go along with the mood changes. These periods of highs and lows, called episodes of mania and depression, can be distinct episodes often recurring over time, or they may occur together in a so-called mixed state. Often people with bipolar disorder experience periods of normal mood in between mood episodes.
A manic episode is diagnosed if an elevated mood occurs with three or more primary symptoms most of the day, nearly every day, for at least one week. With an irritable mood, four additional symptoms must be present for a diagnosis.
Signs and symptoms of a manic episode can include the following:
- Increased energy, activity, and restlessness
- Excessively high, overly good, euphoric mood
- Extreme irritability
- Racing thoughts and talking very fast, jumping from one idea to another
- Distractibility, inability to concentrate well
- Little sleep needed
- Unrealistic beliefs in one's abilities and powers
- Poor judgment
- Spending sprees
- A lasting period of behavior that is different from usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
- Provocative, intrusive, or aggressive behavior
- Denial that anything is wrong
A depressive episode is diagnosed if five or more primary depressive symptoms last most of the day, nearly every day, for a period of two weeks or longer.
Signs and symptoms of a depressive episode can include the following:
- Lasting sad or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in activities once enjoyed, including sex
- Decreased energy, a feeling of fatigue or of being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Restlessness or irritability
- Sleeping too much, or having trouble sleeping
- Change in appetite or unintended weight loss or gain
- Thoughts of death or suicide, or
- Suicide attempts
It can be helpful to think of bipolar disorder as a spectrum of moods.
At one end is severe depression, above which is moderate depression, and then mild low mood, which may be called the blues when it is short-lived and dysthymia when it is chronic.
Next is normal or balanced mood, then hypomania (mild mania that may feel good and be relatively brief and less severe), and then severe mania, which can include hallucinations, delusions, or other symptoms of psychosis.
Some people may experience symptoms of mania and depression together in what is called a mixed bipolar state. Symptoms often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad hopeless mood even while feeling extremely energized.
Co-Occurring Anxiety Disorder and Bipolar Disorder
According to Naomi M. Simon, MD, Associate Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and Assistant Professor in psychiatry at Harvard Medical School, making a diagnosis of an anxiety disorder plus bipolar disorder can be confusing, and it is best to seek help from a mental health professional.
But, Dr. Simon says, a few clues may suggest the presence of both an anxiety disorder and bipolar disorder:
- The presence of panic attacks, significant anxiety, nervousness, worry, or fearful avoidance of activities in addition to periods of depression and mania or hypomania.
- The development of symptoms as a child or young adult, which people with both disorders are more likely to report.
- Significant problems with sleep and persistent anxiety even when not in a manic state, and lack of response to initial treatment.
- Increased sensitivity to initial side effects of medication, and sometimes a longer time frame for finding the right medication combination and dosing.
Suffering from an anxiety disorder and bipolar disorder has been associated with decreased functioning and quality of life and an increased likelihood of substance abuse and suicide attempts. Insomnia, a common anxiety disorder symptom, is a significant trigger for manic episodes.
Many children with bipolar disorder also suffer from at least one co-occurring anxiety disorder. The age of onset for an anxiety disorder often precedes the age of onset for bipolar disorder. The co-occurrence of an anxiety disorder with bipolar disorder can worsen the symptoms and course of each disorder, so it’s essential that both are treated.
Sometimes severe mood episodes, extreme irritability, and other pronounced symptoms of bipolar disorder mask underlying obsessive thoughts, compulsions, worries, or other anxiety symptoms. It’s recommended that children with bipolar disorder are also assessed for an anxiety disorder.