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Anxiety and Bipolar Disorder

Authors: S. Nassir Ghaemi, MD, MPHFaculty and Disclosures

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Introduction

Anxiety and mood go together. Most patients treated by mental health professionals are the worried well; they experience some combination of depression and anxiety, which used to be called "neurotic depression," a label later divided among a number of different categories: major depressive disorder, bipolar disorder, dysthymia, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). These patients present with symptoms of anxiety and mood; clinicians then categorize them into those DSM categories. Because the categories divide mood and anxiety into different disorders, clinicians then are left to diagnose the "comorbidity" of anxiety and mood disorders at the same time. Thus, it may not be surprising that of persons who are diagnosed with major depressive disorder, approximately half meet diagnostic criteria for an anxiety disorder;[1] nor that antidepressants can have antianxiety effects; nor that antianxiety agents can have antidepressant effects. This comorbidity is even higher for bipolar disorder: Approximately half of those with bipolar disorder also meet diagnostic criteria for GAD, the most common kind of anxiety syndrome in persons with bipolar disorder; about 20% meet diagnostic criteria at some point in their lives for OCD, and 20% or more for panic disorder.[2,3] The vast majority of persons with bipolar disorder -- over 90% according to the National Comorbidity Survey[4] -- meet diagnostic criteria for at least 1 anxiety disorder at some point in life. Whether these persons have more than 1 illness or the same syndrome that is divided by our diagnostic schema into multiple labels is an unanswered question. Clearly, however, anxiety symptoms are common in persons with bipolar disorder and need attention.