Throughout our lives, many of us experience anxiety. For people living with bipolar 1 disorder, these anxious feelings may come about more frequently. This can make it tough to get through each day.

Fortunately, both anxiety and bipolar 1 disorder can be managed with proper therapy, medication, and lifestyle adjustments. These help prevent and balance manic episodes. Understanding the relationship between the two disorders and learning the signs of anxiety can help you know when to seek treatment.

Bipolar 1 Disorder and Anxiety

Bipolar 1 disorder is a mood disorder in which a person experiences manic and depressive episodes. In bipolar 1 disorder, the manic episodes last at least one week. You don’t technically have to experience a depressive mood episode to qualify for a diagnosis. Some people may also have manic and depressive episodes occurring at the same time. This is known as experiencing mixed states. Anxiety can show up during both manic and depressive episodes.

When a person has more than one disorder at the same time, those disorders are known as comorbidities. Nearly two-thirds of people living with bipolar 1 disorder have mental health comorbidities that interfere with their quality of life. These can include mental health conditions like anxiety disorders, obsessive-compulsive disorder (OCD), and substance use disorders.

Anxiety disorders are the most common co-occurring disorder in those with bipolar 1 disorder. Research shows that around 34 percent of people with bipolar 1 disorder will develop an anxiety disorder. These disorders have also been shown to make bipolar 1 disorder symptoms worse. They also reduce your overall quality of life and well-being.

Research shows that around 34 percent of people with bipolar 1 disorder will develop an anxiety disorder.

Bipolar 1 Disorder and Manic Anxiety

One study found that people are at significantly higher risk of developing anxiety after episodes of mania. Those with bipolar 1 disorder and depression are even more likely to develop anxiety.

Anxiety symptoms are also common in people with bipolar 1 disorder. It can be accompanied by agitation and irritability. This is known as manic anxiety. It’s more common in people who have mixed features in bipolar 1 disorder.

For those with bipolar 1 disorder, manic episodes can be extremely stressful. You may take risks you normally wouldn’t, act out in social situations, or feel too energized. All of this can make you feel out of control. This may cause manic anxiety during or after an episode.

It may also be difficult to tell the symptoms of mania apart from those of anxiety. There’s some overlap between the two conditions. For example, you may notice you have spiraling or racing thoughts, or you may have trouble concentrating. However, mania is much more severe, and you may experience a “high” or some personality changes that aren’t usually seen with anxiety.

Treating Anxiety and Bipolar 1 Disorder

There are a few treatment options healthcare providers use for anxiety and bipolar 1 disorder when they occur together. Your treatment plan should be comprehensive. This means that there should be several different aspects of your treatment plan to effectively treat you for anxiety and bipolar 1, no matter how they show up together. You should see a psychiatrist for treatment for both conditions. Here are a few treatment options they may recommend.

1. Medications

There are medications available to treat both anxiety and bipolar 1. Bipolar 1 medications usually fall into one of three categories: mood stabilizers, antidepressants, or antipsychotics. Healthcare providers typically recommend finding treatment for this before treating anxiety.

If your anxiety doesn’t stabilize after you’ve found an effective treatment for bipolar 1, your doctor may add other medications, like SSRIs, to see if they help. All of these medications have side effects. Your doctor should monitor you for these and help you manage any that show up.

Healthcare providers typically recommend finding treatment for bipolar 1 disorder before treating anxiety.

2. Psychotherapy

Therapy is often used to treat both bipolar 1 and anxiety disorders. In psychotherapy, you’ll work with a licensed mental health professional (such as a psychologist or a psychiatrist) to talk through your diagnoses, causes, and symptoms. They can help you learn to manage your conditions.

The most popular and effective therapy used to treat anxiety disorders is cognitive behavioral therapy (CBT). It is often used for the management of bipolar 1 disorder, too. In CBT, your therapist will help you find the thoughts driving your mental health issues. Then, they’ll give you the tools to replace them with helpful thoughts based on logic. You may also try exposure therapy for anxiety. This helps you learn to confront triggering situations with more confidence.

Cognitive behavioral therapy (CBT) is often used to treat anxiety disorder and bipolar 1 disorder.

Dialectical behavior therapy (DBT) is a specific type of CBT. It helps people learn to accept aspects of their lives. It also provides coping skills to help them regulate their emotions. In addition, people with bipolar 1 may find that therapy focused on learning more about the diagnosis, working with their families on how to respond to it, and paying attention to their biological rhythms (internal cycles like sleep and hormones) and social rhythms (cycle of day-to-day activities) might help.

Your therapist will work with you to determine which type of therapy is best to address your anxiety and bipolar 1 disorder.

3. Lifestyle Changes

You may also make some lifestyle changes to help you manage underlying anxiety that can contribute to mania in bipolar 1 disorder:

• Get plenty of rest.
• Exercise regularly.
• Eat less fat, sugar, and salt.
• Eat more vegetables, whole grains, and lean protein.
• Practice relaxation techniques, like deep breathing exercises.

Lifestyle changes can help you manage bipolar 1 disorder, too. Some of these overlap with changes recommended for anxiety, while some of them are separate.

• Quit using any substances you may be relying on, like tobacco, recreational drugs, and alcohol.
• Get plenty of exercise.
• Set a sleeping schedule and stick with it.
• Meditate.
• Track your mood daily.
• Learn how to manage your stress.

4. Coping Skills

Learning how to cope with manic episodes, especially when they include anxiety, can be a helpful part of treatment, too. While you may not want to rely on these skills alone, they’re an important part of your plan since mood swings into mania can happen at any time. Work with anxiety and mania by:

• Understanding what your manic symptoms look like when they start, which may help you feel like you need less sleep or feel much happier than usual
• Following a consistent daily routine
• Working to lower your stress levels
• Attending therapy appointments
• Sticking with your medication routine
• Tracking your mood, including when you feel anxious, to identify what triggers anxiety
• Learning and practicing grounding techniques to help you think clearly

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and their loved ones. On MyDepressionTeam, more than 150,000 members come together to ask questions, give advice, and share their stories with others who understand life with depression and bipolar disorder.

Are you or a loved one living with bipolar 1 disorder and anxiety? How do you manage both conditions? Share your experience in the comments below, or start a conversation by posting on your Activities page.