Bipolar Anxiety

I’ve been without my medication for my bipolar for a few weeks now. Currently I don’t have a doctor and I’m not scheduled to see one until the 14th of this month. I ran out of my medication. As far as depression or mania goes I’m still stable which is a surprise to me. The last time I went without my lithium I was depressed and back on my antidepressant within a week. Unfortunately I can’t say the same for my anxiety.
Anxiety is a common symptom of bipolar disorder itself, but about half of those with the condition have a co-existing anxiety disorder. Since my anxiety has been high I’m crossing my fingers I don’t slip into a depression or slide into a mania phase. Anxiety with depression greatly increases the risk of suicidal ideation. And mania with anxiety is marked with severe agitation. Psychosis for both phases is known to be increased. Treatment for both is severely diminished. Having both depression or mania with anxiety can be a living hell.
People with bipolar often experience anxiety as a symptom of their condition. Anxiety accompanies the deep depressions and the manic highs, prompting symptoms that include:
• Compulsive behavior
• Panic attacks
• Overwhelming fears and worries
• Feelings of terror
• Restlessness
• Avoiding people and places
• Physical distress such as shortness of breath, racing heart, nausea, sweating, shaking
• Having a hard time concentrating
However, many people with bipolar also have distinct anxiety disorder. Anxiety disorder occur when your worries or fears go on for months or even years. They continue whether or not there is any logical or sensible reason for them. You can become anxious just thinking about ordinary daily responsibilities and how you’re going to get through the day. This is what I tend to do. I ruminate on daily task and obsess of why am I wasting the day away as well as my life. My mind races with should I be doing this or that. I used to be severely obsessive compulsive with living with my wife and learning to give and take and compromise with her I have mellowed out fairly well in that area.
The combination of bipolar and anxiety can be difficult for patients. Bipolar patients with anxiety disorder are more likely to engage in substance abuse and suicidal behavior. Mood swings are much deeper and more pronounced, and intervals when a “normal” mood is present are briefer. Anxiety makes patients in manic phases more likely to engage in impulsive, self-destructive behavior. It’s also been shown that anxiety makes successful treatment of bipolar disorder much less likely.
Although research is continuing, doctors have found that anxiety disorder has some elements in common with bipolar disorder. Both have been linked to low levels of the neurotransmitter serotonin in the brain. Also, bipolar disorder treatments such as antipsychotic medications have been shown to relieve symptoms in patients with anxiety disorder. Triggers for different symptoms in each disorder also appear to cross over into the other. For example, insomnia is a common symptom of anxiety disorder and also has been shown to trigger manic episodes in bipolar patients. I for one have suffered from insomnia since childhood and frequently triggers psychosis after a prolong period of time without sleep.
Successful treatment must target both the anxiety and the bipolar disorders, but the co-existence of both makes the treatment plan much more complex. In general, doctors will begin addressing the bipolar disorder through a mood stabilizer like lithium which I take.
Once the bipolar symptoms have stabilized, then the doctor can prescribe medications for treating the anxiety disorder. Benzodiazepines are often used, as they appear to treat the anxiety without negatively affecting the bipolar disorder. If the person has a history of addiction then alternative medications tends to be used but then there are risks of complications to the bipolar disorder as well as being non-affective. Doctors usually don’t use antidepressants, a common class of anxiety medication, because they have been shown to destabilize and worsen bipolar symptoms.
Along with medication, doctors may also recommend therapy to address both bipolar disorder and anxiety; approaches include cognitive-behavioral therapy, family therapy, and relaxation therapy.