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Epidemiology and Management of Anxiety in Patients with Bipolar Disorder

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Abstract

Epidemiological and clinical studies have reported a high prevalence of anxiety symptoms in bipolar disorder, either in manic or depressive episodes, although these symptoms do not always meet criteria for a specific anxiety disorder. In addition to anxiety symptoms, bipolar disorder frequently presents with co-morbid axis I conditions, with anxiety disorders being the most common co-morbidity. Therefore, the objective of this article is to review clinical and epidemiological studies that have investigated the association between bipolar disorder and anxiety. Available data on the efficacy of treatments for bipolar disorder and co-morbid anxiety disorders are also reviewed. Existing guidelines do recognize that co-morbid anxiety has a negative impact on the course and outcome of bipolar disorder; however, there have been very few double-blind, controlled trials examining the treatment response of patients with bipolar disorder and co-occurring anxiety disorders. There is some positive evidence for quetiapine, olanzapine in combination with fluoxetine or lithium, and lamotrigine with lithium, and negative evidence for risperidone. Other therapies used for bipolar disorder, including several mood stabilizers, antidepressants, atypical antipsychotics and benzodiazepines, have been shown to reduce anxiety symptoms, but specific data for their effects in patients with anxiety symptoms co-morbid with bipolar disorder are not available. The co-occurrence of anxiety and bipolar disorder has implications for diagnosis, clinical outcome, treatment and prognosis. Careful screening for co-morbid anxiety symptoms and disorders is warranted when diagnosing and treating patients with bipolar disorder.

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Acknowledgements

Dr Kauer-Sant’Anna has been an investigator in clinical trials sponsored by the CNPq, Canadian Institutes of Health Research and Stanley Foundation; has received salary support from an APA/AstraZeneca unrestricted educational grant; and is a NARSAD Young Investigator. Dr Kapczinski is a NARSAD Independent Investigator and has been an investigator in clinical trials sponsored by CNPq, Canadian Institutes of Health Research, Stanley Medical Research Institute, AstraZeneca and Servier. He has worked as a consultant/speaker for Servier, AstraZeneca, Eli Lilly and Abbott. Dr Vieta has acted as a consultant, received grants or been hired as a speaker by the following companies: Almirall, AstraZeneca, Bial, Bristol-Myers-Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Merck Sharp & Dohme, Novartis, Organon, Otsuka, Pfizer, Sanofi Aventis, Servier and UBC. He has acted as a consultant and has received grants from the Spanish Ministry of Health, Instituto de Salud Carlos III, CIBERSAM and from the Stanley Medical Research Institute. No sources of funding were used to assist in the preparation of this review, other than Instituto Carlos III, CIBERSAM, Madrid, Spain.

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Authors and Affiliations

  1. Bipolar Disorders Program and Molecular Psychiatry Unit, INCT-Translational Medicine, Hospital de Clinicas (HCPA), Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Marcia Kauer-Sant’ Anna & Flavio Kapczinski

  2. Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, Villarroel 170, Barcelona, 08036, Spain

    Eduard Vieta

  3. Centro de Investigación Biomèdica En Red de Salud Mental (CIBERSAM), Institut D’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Eduard Vieta

  4. McLean Hospital, Harvard University, Belmont, Massachusetts, USA

    Eduard Vieta

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  1. Marcia Kauer-Sant’ Anna
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Correspondence to Eduard Vieta.

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Anna, M.KS., Kapczinski, F. & Vieta, E. Epidemiology and Management of Anxiety in Patients with Bipolar Disorder. CNS Drugs 23, 953–964 (2009). https://doi.org/10.2165/11310850-000000000-00000

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