By Joseph F. Goldberg, MD (bio)
How common are anxiety disorders in bipolar disorders
Anxiety disorders run neck-and-neck with substance use disorders as being among the most common comorbid conditions in patients with bipolar disorder. The lifetime prevalence rates of anxiety disorder comorbidity in bipolar disorder (all anxiety disorders combined) are about 40 to 60% (Spoorthy et al., 2019).
That is, about half of patients with a bipolar disorder also have an anxiety disorder.
Note: The prevalence rates of anxiety comorbidity might be different in treatment-seeking vs non-treatment-seeking patients, patients at academic centers versus in the community, and so on.
What difference does it make?
Adherence to medications for bipolar disorder is lower when comorbid anxiety disorders are present (Aftab et al., 2018).
Which anxiety disorder is most commonly comorbid with bipolar disorders?
The most common anxiety disorder in persons with a bipolar disorder is panic disorder (Spoorthy et al., 2019). This is followed by generalized anxiety disorder (GAD), social phobia, and simple phobias.
How about more than one comorbid anxiety disorder?
Also, about one-third of persons who have both a bipolar disorder and an anxiety disorder will have more than one anxiety disorder co-diagnoses (Spoorthy et al., 2019).
More in bipolar I or bipolar II?
No difference. Bipolar I and II disorder patients appear to have comparable prevalence rates of both any anxiety disorder and of individual anxiety disorder co-diagnoses (Pavolva et al., 2015).
I wonder how many of these anxiety disorders in persons with a bipolar disorder are being correctly and specifically diagnosed. Though I am not aware of any research data to confirm this, it is possible that specifically identifying and treating these comorbid anxiety disorders may improve outcomes in persons with bipolar disorders.]
How to differentiate between hypomania and anxiety
It can sometimes be challenging to differentiate between complaints of “anxiety” and hypomania. In such situations, careful questioning can help to determine whether the symptoms are truly typical of hypomania. Here are examples of the kinds of things that may help to differentiate between the two:
1. Is there increased goal-directed activity (e.g., undertaking purposeful projects) or is the person just spending their mental energy on inner tension and worry.
2. If sleep is impaired, does the person feel tired the next day or is the energy paradoxically increased after a night of decreased sleep?
Next, please see the following page for a discussion of the pharmacological management of anxiety disorders that occur in persons with bipolar disorders:
Aftab A, Levin J, Aebi M, Bhat C, Sajatovic M. Associations of Comorbid Anxiety With Medication Adherence and Psychiatric Symptomatology in a Population of Nonadherent Bipolar Disorder Subjects. J Nerv Ment Dis. 2018 Apr;206(4):258-262. doi: 10.1097/NMD.0000000000000788. PubMed PMID: 29351117; PubMed Central PMCID: PMC5876117.
Pavlova B, Perlis RH, Alda M, Uher R. Lifetime prevalence of anxiety disorders in people with bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry. 2015 Aug;2(8):710-717. doi: 10.1016/S2215-0366(15)00112-1. Epub 2015 Jun 23. Review. PubMed PMID: 26249302.
Pavlova B, Perlis RH, Mantere O, Sellgren CM, Isometsä E, Mitchell PB, Alda M, Uher R. Prevalence of current anxiety disorders in people with bipolar disorder during euthymia: a meta-analysis. Psychol Med. 2017 Apr;47(6):1107-1115. doi: 10.1017/S0033291716003135. Epub 2016 Dec 20. PubMed PMID: 27995827.
Spoorthy MS, Chakrabarti S, Grover S. Comorbidity of bipolar and anxiety disorders: An overview of trends in research. World J Psychiatry. 2019 Jan 4;9(1):7-29. doi: 10.5498/wjp.v9.i1.7. eCollection 2019 Jan 4. Review. PubMed PMID: 30631749; PubMed Central PMCID: PMC6323556.
Copyright © 2020, Simple and Practical Medical Education, LLC, and Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.
Disclaimer: The content on this website is provided as general education for medical professionals. It is not intended or recommended for patients or other laypersons or as a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified health care professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most recently updated information.