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Treatment for co-occurring anxiety and bipolar disorder is more complex than treatment of one of these disorders alone. With advice from your doctor or mental health provider, you may choose medication, therapy or a combination of both to treat their condition.

Medication
Most doctors will prescribe a "mood stabilizer" first to address the bipolar disorder. Starting an antidepressant, which are commonly used to treat anxiety disorders, before mood stabilization is achieved can worsen the symptoms associated with an individual's bipolar disorder. Even when initiated after a mood stabilizer, antidepressants can sometimes trigger manic episodes in someone with bipolar disorder. Therefore, doctors sometimes avoid prescribing antidepressants or prescribe them at lower doses in patients with co-occurring anxiety and bipolar disorder than someone with an anxiety disorder alone.

Another class of drugs used to treat anxiety disorders, benzodiazepines, do not appear to have negative effects on bipolar disorder and are thus sometimes used for anxiety in patients with co-occurring bipolar disorder. However, benzodiazepines also may cause some side effects, such as physical dependence and tolerance (meaning there is a need for more and more of the medication over time), and there is some risk of abuse, particularly for people who have had problems with alcohol or substance abuse..

Therapy
Research and clinical experience support that for the best outcome, it is important that people with bipolar disorder receive medication to help with "mood stabilization," but therapy also has an important role. Anxiety disorders can be treated either with therapy, medication or a combination of both. Some forms of therapy are cognitive therapy, family therapy, behavior therapy and relaxation techniques. The Anxiety Disorders Association of America (ADAA) has more information about treatment options.

How do I find a therapist to treat anxiety and bipolar disorder?

ADAA offers a searchable listing of mental health providers nationwide. http://www.adaa.org   Read about how to choose a therapist .

What else can I do and how can friends and family help?>>

Related articles
Anxiety or anxiety disorder?
Understanding anxiety
Understanding bipolar disorder
Bipolar II and the bipolar spectrum

Excerpted and adapted with permission from the Anxiety Disorders Association of America

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