Everything You Wanted to Know about the Bipolar-Anxiety Connection

Anxiety disorders are the most prevalent coexisting condition with bipolar. In fact, recent studies indicate that more than half of those with bipolar also have a diagnosis of anxiety. The overlap is so striking, medical researchers are questioning whether or not it could be a precursor to bipolar. Either way, chronic worry, stress, and tension play such an influential role in how we respond to treatment that assessing for these symptoms is a crucial first step. Understanding how both health conditions intersect is key to effective care.

Close-up of a man's hands as he nervously picks at his nails.

Anxiety Two Ways

It’s important to determine how these puzzle pieces fit together; anxiety can be either a symptom of bipolar or a separate comorbid condition. Making a distinction requires monitoring both mood and anxiety, noting the duration of disturbances in each. If your anxiety alleviates when you achieve mood stability, then it is likely a symptom of bipolar. However, if your mood is stable but your tension and nervousness persist, then you likely have a coexisting condition that should be treated as such by a health professional.

Greater Impact

Obtaining accurate and early diagnoses can have a big influence on well-being because anxiety exacerbates the course of bipolar in a number of ways. Specifically, research shows that it results in bipolar symptoms that are more severe and more frequent; it is linked to decreased medication adherence; and it is associated with greater “residual symptoms” when a mood episode resolves.

Mistaken Identity

Whether a symptom of bipolar or its own diagnosis, anxiety can often be mistaken for acute, or temporary, stress—or vice versa. This generally occurs during troubling life circumstances, such as going through a negative experience or dealing with a traumatic event. Yet sometimes anxiety can come out of nowhere, remaining a concern even in the absence of an identifiable cause or trigger. Part of the challenge for diagnosis and treatment is the fact that these two conditions interact in varied ways for different individuals.

Know the Symptoms

Because it’s not always easy to distinguish between where anxiety falls in relation to bipolar (as a separate condition or a symptom), health professionals point to the following as an indication of a coexisting diagnosis: panic and dread; poor sleeping due to anxiety; ongoing anxiety while bipolar symptoms are stable; not showing response to anxiety treatment; and difficulty finding appropriate medication dosing. In contrast, when it is a bipolar symptom, it generally presents as irritability or agitation; physical restlessness and racing thoughts; and improved treatment along with other symptoms of bipolar.

Setting the Scene

Although more research needs to be done, some studies have found that anxiety diagnosis typically precedes the onset of bipolar symptoms and may even represent risk markers for a subsequent bipolar diagnosis. This is especially true with generalized anxiety disorder (GAD) and panic disorder. In fact, according to one study, individuals with GAD were “12 times more likely than the general population to receive a bipolar disorder diagnosis,” and those with panic disorder were “10 times more likely to have comorbid bipolar disorder.”

What to Do?

Because a coexisting anxiety condition tends to worsen the course of bipolar, getting an accurate diagnosis as early as possible is essential. In addition to a tailored medication and psychotherapy treatment protocol, there are other ways to help manage anxiety symptoms: physical activity, mindfulness meditation, adequate sleep, joining a support group, avoiding caffeine, and learning to reshape negative thoughts and behaviors, perhaps with the assistance of talk therapy.

“Treatment of Anxiety Disorders in Patients with Comorbid Bipolar Disorder,” Mental Health Clinician 8, no. 6 (Nov. 2018): 256–­63
J. Phelps, MD, “Two Ways to Have Anxiety with Bipolar Disorder,” PsychEducation (June 2019)
L. LaBouff, “Two Anxiety Disorders Tied to Bipolar,” Bipolar Laid Bare (June 2016)
“Specific Anxiety Disorders and Subsequent Risk for Bipolar Disorder: A Nationwide Study,” World Psychiatry 15, no. 2 (June 2016): 187–88


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