I have been diagnosed with bipolar disorder and anxiety.  How is the combination of conditions treated?

Anxiety is a condition that commonly occurs with bipolar disorder, particularly in the manic phase of the illness, but can also occur in the depressive phase of the illness, but can also occur in the depressive phse or co-occur as an independent condition.  The easiest way to think about this is that if you only have anxiety in the manic or depressive phase of the illness and it abates when your mood stabilizes, then it is a symptom of the bipolar disorder and not an independent condition.  They type of anxiety associated with mania is on a level far more extreme than generalized anxiety.  People commonly describe it as a restless energy that will not allow them to sit still.  It is often accompanied by irritability and racing or disorganized thoughts.  Sometimes the anxiety results because your ambitious grandiose schemes are being thwarted by others who cannot understand the vast rewards completion of such schemes will bring.

Some anxiety conditions, such as social phobia, panic disorder, and generalized anxiety disorder, can cycle with your moods, essentially abating during the hypomanic or manic phase but returning during euthymia and even worsening during the depressive phase.  The treatment for anxiety in the context of bipolar disorder is tricky.  The SSRIs are a very useful treatment for many anxiety disorders but are less than ideal in persons who suffer from both anxiety and bipolar disorder.  The benzodiazepines, which can be very beneficial in aborting panic attacks, are also tricky because the rate of alcoholism and drug abuse is high among bipolar individuals.

The first task in treatment is to control the bipolar disorder as best as possible.  Fortunately, many of the anticonvulsant agents affect GABA, the major neurotransmitter implicated in many anxiety disorders, and therefore they can have anxiolytic and antipanic effects independent of their mood-stabilizing properties.  If the anxiety abates with mood stabilization you are in luck.  If not, the problem is a bit trickier.  Some anxiety conditions, such as posttraumatic stress disorder and obsessive-compulsive disorder, respond preferentially to SSRIs, and SSRIs are clearly trickier to use in bipolar disorder, as mentioned previously.  If the symptoms are generally in check, cognitive-behavioral therapy is the treatment of choice.  If an SSRI is warranted, remaining on an antimanic agent is imperative prior to its initiation.  A combination of therapy and medication is typically the best treatment approach for a variety of anxiety disorders, such as generalized anxiety disorder, panic disorder, social anxiety disorder, and obsessive-compulsive disorder.