Living at the crossroads of bipolar disorder and anxiety

Bipolar disorder is a mental health condition characterized by severe mood swings. It causes a combination of depressive and manic episodes. 

In a depressive episode, a person may experience symptoms like fatigue, sadness, hopelessness, social withdrawal, or a loss of motivation. During a manic episode, a person may feel a sense of euphoria and a burst of energy. They might also be more likely to feel anxiety during these types.

Anxiety disorders are mental health conditions characterized by excessive fear and worry about things that could happen. They can cause worries that are so intense they interrupt your ability to function in everyday life. 

Bipolar disorder and anxiety are distinct concerns. However, they frequently occur at the same time. Research shows that over 50% of people with bipolar disorder ^[1] will develop an anxiety disorder at some point. Experts are still working to understand this overlap. But learning more about the connection between these conditions can help you get the right care for your needs.

Four ways bipolar disorder and anxiety are connected

Having a mental health concern can put you at greater risk for developing another one. This is called having co-occurring conditions. Some conditions are more likely to co-occur than others. We don’t yet fully understand why bipolar disorder and anxiety co-occur so often. 

But a few factors might explain their connection:

1. They may have a genetic component

Bipolar disorder and anxiety disorders are heritable conditions. This means that they tend to run in families. If you have a close relative (like a sibling or parent) with bipolar disorder and anxiety, it may increase your risk of developing one or both concerns.

2. They can make it harder to emotionally regulate

Both of these conditions can create unwanted feelings that can be difficult to control. Anxiety can cause intense fears and worry. With bipolar disorder, you may experience sadness or hopelessness during depressive episodes along with irritability or excitement during manic episodes.

3. They can reinforce each other

Research ^[2] shows that living with anxiety and bipolar disorder can intensify a person’s symptoms. It can also increase their risk of suicide and decrease their functioning and quality of life.* While living with co-occurring conditions isn’t uncommon, it typically requires lifelong care.

4. They can make it harder to get a diagnosis

Bipolar disorder isn’t a stand-alone cause of an anxiety disorder (or vice versa). But there’s evidence to suggest ^[3] that people who experience manic episodes may be more likely to develop anxiety.

This is why some experts recommend ^[3] assessing people whose main symptom is anxiety for a history of mania before starting treatment. Otherwise, someone with bipolar disorder could be misdiagnosed with an anxiety disorder. 

*A note on safety: If you or a loved one is experiencing suicidal thoughts or thoughts about harming themself or others, please call or text 988 on any phone for the Suicide & Crisis lifeline, contact a local crisis line, or head to the emergency room immediately. Any of these resources will ensure that the person in crisis receives support right away. For more information on getting help, go to 988lifeline.org

If experiencing a life-threatening emergency or you need immediate help, please call 911. 

Differences between bipolar disorder and anxiety

Anxiety disorders are a unique category of mental health concerns characterized by fear and worry. Bipolar disorder (there are a few different types ^[4]) isn’t an anxiety disorder. Rather, it’s considered a mood disorder. 

Another important distinction to be aware of is that bipolar disorder and anxiety disorder symptoms follow different patterns. In bipolar disorder, your mood might swing between depression and euphoria. With anxiety, symptoms tend to remain consistent. A person with an anxiety disorder may have periods when their symptoms are better controlled or nonexistent. But they typically won’t experience the “ups and downs” or “highs and lows” of bipolar disorder.

Symptoms of bipolar disorder and anxiety together

Co-occurring bipolar disorder and anxiety can show up differently for different people. 

But here’s what this combination of conditions might look like in real life:

Anxiety during a manic episode 

Instead of the euphoria many people experience during a manic episode, you tend to feel anxious and irritable. It’s almost like an anxiety attack. You want to sleep, but you can’t, and that makes your anxiety even worse. You feel trapped in a mind and body that just won’t power down.

Anxiety during a depressive episode

During depressive episodes, you don’t feel like doing much of anything. All you want to do is sleep, and you don’t want to be around people. At the same time, you have a pit in your stomach because you feel anxious about the future. You can’t stop worrying that things aren’t going to get any better. 

Coping with anxiety in bipolar disorder

If you’re living with complex mental health needs due to co-occurring conditions, treatment can help. Therapy and medication can make a world of difference for people with anxiety and bipolar disorder. 

You can also support your well-being through:

• Practicing good sleep hygiene: Support your mood through going to sleep and waking up at the same time each day, making your bedroom comfortable, and avoiding screens before bedtime. Getting enough sleep can help calm your mood and reduce anxiety.

• Managing your stress level: Whether it’s going for a walk, journaling, or breathing exercises, try to do at least one thing every day to keep your stress level in check. Stress management is important because stress can trigger mood episodes ^[5].

• Learning to spot the warning signs: Try to pay attention to what happens right before a mood or anxiety episode. You may not always be able to identify an exact trigger. But having a general idea of what to look for can give you a chance to prepare and access the support you need. 

Treating anxiety and bipolar disorder

If you have co-occurring conditions, it’s important to access treatment for both concerns at the same time. Talk therapy is considered one of the most effective treatments for anxiety and bipolar disorder. Cognitive behavioral therapy (CBT) can be especially helpful for people living with these two conditions. 

There are no medications designed specifically for co-occurring anxiety and bipolar disorder. However, medications can treat these conditions individually. If you have anxiety and bipolar disorder, you may need to take multiple medications ^[2] to experience relief. You can talk to your provider about whether this approach is right for you.

Clinician’s take

Anxiety can make manic episodes feel more frantic and out of control, rather than just energetic or confident. It can also make depressive episodes feel more tense and stuck, instead of only sad or low.

Ashley Ayala, LMFT

Clinical reviewer