Anxiety, sneaky rascal that it is, can hit us from so many angles. Sure, the traditional anxiety disorders, but were that our only exposure. Anxiety and bipolarity have always been chums, which really begs discussion. Yeah, with goofy friends like that, who needs enemies?
That’s because antidepressants are often prescribed to treat an anxiety disorder. But those same antidepressants can make bipolarity worse, as they may generate degrees of mania.
For our chat, I’m going to rely upon the work of psychiatrist Jim Phelps, a Chipur favorite. Dr. Phelps is a think outside-the-box kind of guy, with a down to earth writing style. I know you’ll enjoy his perspective.
One more thing before we roll. Instead of “bipolar disorder,” I use the term “bipolarity.” And that’s because I view it as a spectrum disorder, not a cut-and-dried bipolar I, II, cyclothymic thing. Actually, Dr. Phelps’ point of view brought me there.
Okay, one more, more thing. If you’re dealing with some nasty anxiety, as you dig-in, please don’t knee-jerk believe you’re on the bipolarity spectrum. But if you have concerns, take them to a professional. Got it?
Let’s get after it…
Anxiety in Bipolarity
Absolutely, Dr. Phelps believes anxiety can be a symptom of bipolarity, citing the 1921 work of Emil Kraepelin, as well as Freeman, Freeman, and McElroy. Look this stuff up, it’s interesting.
Phelps also mentions an International Society for Bipolar Disorders (ISBD) Task Force report. According to the good doctor, the ISBD assembled committees of highly respected bipolarity experts to draft reports on several aspects of diagnosis.
One particular paper was on “mixed states,” which noted that anxiety is a “core symptom.” Included were…
- General hyper-arousal
- Inner tension
- Irritability/impatience
- Agitation
- Feeling “frantically anxious”
All of this considered, Phelps knows confusion continues to exist because several of the anxiety disorders can look like – mimic – mixed states.
How You Can Have Anxiety with Bipolarity
Dr. Jim Phelps
According to Dr. Phelps there are but two ways one can have anxiety with bipolarity. It can be a symptom of the bipolarity itself or a separate anxiety disorder, in addition to bipolarity (comorbidity).
So if anxiety is a piece of a diagnosed bipolarity, it should improve as the bipolarity gets better. But, of course, if the anxiety persists, it would appear to be a separate condition.
And, man, if it’s a separate condition, things can become complicated. That’s because antidepressants are often prescribed to treat an anxiety disorder. But those same antidepressants can make bipolarity worse, as they may generate degrees of mania.
What Does Anxiety with Bipolarity Look Like?
Dr. Phelps, and his patients, provide us with a ton of help by painting a vivid picture of anxiety with bipolarity…
Patients most often reported “agitation,” and Phelps confirms because he observes behaviors such as a foot bouncing on the floor, nail-picking, and pacing around the office.
Phelps also knows the agitation can be internal, as his patients comment on “too much energy inside my skin,” feeling like they’re going to “explode,” and thoughts “racing” inside their heads. And the ante can be upped by extremely disorganized thoughts, making it impossible to pay attention to just one thing for more than a few seconds.
To the extreme, things can very quickly turn desperate. At that point, many turn to substances. And though there may be brief moments of “relief,” it only makes the symptoms worse in the long run.
Finally, Dr. Phelps believes when this kind of anxiety is present with depression, it may be the worst combo of all. He points-out that anxiety is an extremely strong risk factor for suicide when one is depressed. Of course, Phelps calls for immediate intervention, even an ER visit, under these circumstances.
For the record, he emphasizes that even this situation is “very treatable.”
Comorbidity Specifics
Okay, Dr. Phelps presents some very informative and helpful info regarding how anxiety and bipolarity may present together. I’m providing a thumbnail, so hit the link at the end and read all he has to say…
- Generalized Anxiety Disorder (GAD): Lots of overlap, and Phelps believes they could even be the same thing. If you’ve been diagnosed with GAD or believe you have it, Phelps’ GAD and bipolar II page is a must-read.
- Social Anxiety Disorder: It’s believed 15-50% of those enduring bipolarity also have social anxiety disorder. And some 20% of social anxiety disorder sufferers have bipolarity. Phelps states that some patients experience cycling in their social anxiety disorder symptoms. To him, that suggests a connection with bipolarity.
- Panic Disorder (with or without agoraphobia): Phelps’ experience indicates when people have their bipolarity cycling under management, they cease having panic attacks in almost all cases.
- Posttraumatic Stress Disorder (PTSD): Some 40% of those with bipolarity also have PTSD. Phelps sees the two together frequently, stating it’s sometimes hard to tell them apart.
- Obsessive-Compulsive Disorder (OCD): Phelps believes OCD has a complex relationship with bipolarity. He submits that in some cases, the two may somehow be part of the same thing. He cites a study that indicates some 20% of those with bipolarity also have OCD. In another study, it was found that bipolarity seemed to be more directly related to OCD, as opposed to the incidental connection with unipolar depression.
- Specific Phobias: No specific connection with bipolarity.
Again, take the time to read all of Phelps’ information.
Phelps Treatment Thoughts & Wrap-Up
In closing, it’s important to mention a couple of priority treatment thoughts from Dr. Phelps…
- Antidepressants are a standard treatment for anxiety disorders, but they can make bipolarity worse. So treat the bipolarity first. If anxiety symptoms remain, treat them with psychotherapy. If after therapy has been tried, an antidepressant still has to be used, it needs to be added to already in use mood stabilizers.
- If anxiety symptoms exist, or if you have an anxiety condition in addition to your symptoms of bipolarity, make sure you tell your doctor and/or therapist. And that’s because even with bipolarity, anxiety symptoms are treatable. The trick is to make sure the treatment for one doesn’t make the other worse. That can be accomplished.
Man, I broke a sweat writing this baby. But it’s, indeed, incredibly important information.
No doubt, anxiety can hit us from all angles. And that chummy relationship it has with bipolarity really has to be considered and monitored.
Yep, with goofy friends like that, who needs enemies?
Do yourself a huge favor and read Dr. Phelps’ Anxiety and Bipolar Disorder page. And while you’re on his site, check-out more of his impressive insight and information.
I’m counting five Chipur articles featuring Dr. Phelps’ work. Just enter Phelps in the search box and they’re all yours.
As always, plenty of Chipur mood and anxiety disorder articles to keep you busy (for weeks). Hit the titles.
