Understanding Bipolar Anxiety: Causes, Symptoms, and Treatment

Bipolar anxiety is a challenging condition that combines the mood extremes of bipolar disorder with constant anxiety. It’s a struggle that deeply impacts daily life, making it difficult to manage emotions and fears. 

Explore the causes, symptoms, and treatment options for bipolar anxiety and bipolar disorder, and call us if you or a loved one require professional mental health support.

What Is Bipolar Anxiety?

Bipolar anxiety refers to the co-occurrence of anxiety symptoms in individuals diagnosed with bipolar disorder. Bipolar disorder is a mental health condition characterized by extreme mood swings, including manic, hypomanic, and depressive episodes. Anxiety, which involves persistent worry, fear, or unease, can significantly complicate the management of bipolar disorder.

Anxiety in bipolar disorder can manifest in various ways, depending on the current mood phase. During manic or hypomanic episodes, individuals may experience heightened agitation, restlessness, and racing thoughts. Conversely, during depressive episodes, they may feel excessive worry, fear, and a sense of impending doom. This overlap of symptoms can make it challenging to differentiate between the two conditions and complicate the treatment process​​​​.

Understanding bipolar anxiety is crucial because it often leads to increased impairment and a higher risk of complications, such as substance abuse and suicidal behavior. Addressing this co-occurrence involves a comprehensive approach that includes accurate diagnosis, tailored treatment plans, and ongoing support to help individuals manage both their bipolar disorder and anxiety symptoms effectively​​​​.

Causes of Bipolar Anxiety

Genetic Factors

Genetics play a significant role in the development of both bipolar disorder and anxiety. Studies indicate that individuals with a family history of bipolar disorder are at a higher risk of developing the condition themselves. 

Similarly, anxiety disorders also have a hereditary component, making those with close relatives who have anxiety more susceptible. The interplay between these genetic predispositions can increase the likelihood of experiencing both conditions concurrently​​​​.

Environmental and Psychological Triggers

Environmental and psychological factors can trigger or exacerbate symptoms of bipolar anxiety. Stressful life events, such as the loss of a loved one, financial difficulties, or major life changes, can precipitate both manic and depressive episodes in individuals with bipolar disorder. 

Trauma, particularly during childhood, has also been linked to the development of anxiety and bipolar disorder. These stressors can lead to heightened anxiety levels, especially during the vulnerable periods of mood swings​​​​​​.

Neurobiological Aspects

Neurobiological factors, including brain structure and function differences, are associated with bipolar disorder and anxiety. Research has shown that individuals with bipolar disorder often have variations in the size or activity of certain brain regions, such as the amygdala and prefrontal cortex, which are involved in mood regulation and emotional responses. 

These differences can contribute to the mood instability and anxiety symptoms observed in bipolar anxiety. Neurotransmitter imbalances, particularly involving serotonin, dopamine, and norepinephrine, also play a crucial role in both conditions​​​​.

Co-Occurrence with Other Mental Health Conditions

Bipolar disorder frequently co-occurs with other mental health conditions, which can complicate its presentation and management. Common co-occurring conditions include attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), and substance use disorders. 

These additional diagnoses can exacerbate anxiety symptoms and make the overall clinical picture more complex. For instance, individuals with bipolar disorder and ADHD may experience increased restlessness and difficulty concentrating, while those with PTSD might have heightened anxiety and intrusive thoughts​​​​.

Understanding the multifaceted causes of bipolar anxiety is essential for developing effective treatment strategies. By considering genetic predispositions, environmental triggers, neurobiological aspects, and co-occurring conditions, healthcare providers can tailor their approach to better support individuals dealing with this challenging combination of symptoms.

Symptoms of Bipolar Anxiety

Bipolar disorder is characterized by dramatic mood swings encompassing extreme highs, known as mania, and profound lows, referred to as depression. These episodes of mania and depression typically extend for several days or longer.

Depression:

• Persistent feelings of sadness, hopelessness, or irritability

• Low energy levels

• Challenges with concentration and memory

• Loss of interest in daily activities

• Experiencing emptiness or worthlessness

• Overwhelming guilt and despair

• Pessimism about everything

• Self-doubt

• Delusions, hallucinations, or irrational thoughts

• Decreased appetite

• Sleep difficulties, including early awakening

• Suicidal ideation

Mania:

• Intense feelings of happiness, elation, or euphoria

• Rapid speech

• Heightened energy levels

• Grandiose self-perception

• Profound creativity and ambitious plans

• Easy distractibility

• Increased irritability or agitation

• Delusions, hallucinations, or irrational thinking

• Reduced need for sleep

• Impulsive actions, such as extravagant spending or risky behavior

• Decision-making and statements that deviate from one's usual character and may appear dangerous or harmful to others

Diagnosing Bipolar Anxiety

Diagnosing bipolar anxiety involves a physical and psychological evaluation. You may also be asked to record your mood and sleep patterns to inform treatment. Here’s how the process works:

Physical Examination

Your physician may conduct a physical examination and laboratory tests to detect any underlying medical conditions contributing to your symptoms.

Psychiatric Evaluation

You may be referred to a psychiatrist who will engage in discussions with you regarding your thoughts, emotions, and behavioral patterns. Additionally, you might be asked to complete a psychological self-assessment or questionnaire. With your consent, family members or close associates may also be consulted to provide insights into your symptoms.

Mood Tracking

You might be requested to maintain a daily record of your mood variations, sleep patterns, or other relevant factors that can assist in the diagnostic process and determine the most suitable treatment.

Bipolar Disorder Criteria

Your psychiatrist may assess your symptoms about the criteria for bipolar and related disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Treatment of Bipolar Disorder

The most effective approach to treatment is guided by a specialized medical doctor with expertise in diagnosing and managing mental health conditions, particularly a psychiatrist. Your treatment team may encompass a psychologist, social worker, and psychiatric nurse. Keep in mind that bipolar disorder is a lifelong condition, but one that can be effectively managed. Depending on your individual requirements, treatment may involve:

Medications

In many cases, the initiation of mood-stabilizing medications may be required to regulate your emotional states promptly.

Ongoing Treatment

Bipolar disorder mandates continuous treatment with medications, even during periods when you may feel relatively stable. Skipping maintenance treatment increases the risk of symptom recurrence or the progression of minor mood fluctuations into severe manic or depressive episodes.

Day Treatment Programs

Your healthcare provider may recommend participation in a day treatment program, offering the necessary support and counseling while helping you gain control over your symptoms.

Substance Abuse Treatment

If you encounter challenges related to alcohol or drug misuse, concurrent substance abuse treatment becomes essential. Effectively managing bipolar disorder can be challenging without addressing substance-related concerns.

Hospitalization

Hospitalization may be advised if you exhibit risky behaviors, experience suicidal thoughts, or become detached from reality (psychotic). Receiving psychiatric care in a hospital setting can help ensure your safety, promote emotional stability, and manage manic or major depressive episodes effectively.

Psychotherapy

Psychotherapy is pivotal in treating bipolar disorder and can be administered in individual, family, or group therapy sessions. Various therapeutic approaches can prove beneficial, including:

Interpersonal and Social Rhythm Therapy (IPSRT)

IPSRT centers on establishing stable daily rhythms, encompassing activities like sleep, waking times, and meal schedules. A consistent routine can enhance mood regulation. Individuals with bipolar disorder may find value in establishing daily patterns for sleep, nutrition, and exercise.

Cognitive Behavioral Therapy (CBT)

CBT is focused on recognizing and replacing unhealthy, negative beliefs and behaviors with positive ones. This therapeutic approach aids in pinpointing triggers for bipolar episodes. It equips individuals with practical strategies to manage stress and cope with distressing situations.

Psychoeducation

Understanding bipolar disorder through psychoeducation helps individuals and their support networks comprehend the condition. This knowledge enables better support, issue identification, relapse prevention planning, and treatment adherence.

Family-Focused Therapy

Involving family support and communication can facilitate adherence to the treatment plan and enable individuals and their loved ones to effectively identify and manage warning signs of mood fluctuations.

Struggling with Bipolar Anxiety? We're Here to Help

Understanding bipolar anxiety is crucial for effective management and recovery. By recognizing its causes, symptoms, and treatment options, you can take proactive steps toward better mental health. 

At The Forge Recovery Center, we offer comprehensive support tailored to your unique needs, helping you navigate the complexities of bipolar anxiety. Whether you or a loved one is facing this challenge, our dedicated team is here to provide the necessary guidance and treatment. Reach out to us today to begin your journey toward a healthier, more balanced life.

Written by

The Forge Recovery Center

Reviewed by

Jeremy Arzt

Chief Clinical Officer

January 4, 2025