Many people experience anxiety at times. For people living with bipolar 1 disorder, however, anxious feelings may happen more often and make daily life harder.

The good news is that both anxiety and bipolar 1 disorder can be managed with the right mix of therapy, medication, and lifestyle changes. These approaches can help manage symptoms of bipolar 1 episodes and support more stable mood patterns. Learning how these conditions are connected and recognizing signs of anxiety can help you know when to seek care.

How Anxiety Shows Up in Bipolar 1 Disorder

Bipolar 1 disorder is a mood disorder that involves manic and depressive episodes. During a manic episode, a person may have very high energy, irritability, or drastic changes in emotions. In bipolar 1 disorder, manic episodes last at least one week. A depressive episode isn’t required for diagnosis, although many people experience both. Some may have symptoms of mania and depression at the same time. Anxiety can occur during both manic and depressive episodes.

Anxiety can occur during both manic and depressive episodes.

Health conditions that occur at the same time are called comorbidities. About half to two-thirds of people living with bipolar 1 disorder have mental health conditions that affect their quality of life. These comorbidities may include anxiety disorders, obsessive-compulsive disorder (OCD), and substance use disorders.

Anxiety disorders are the most common co-occurring disorder in people with bipolar 1 disorder. Research suggests that about 38 percent of people with bipolar 1 disorder have an anxiety disorder. Having anxiety can make bipolar 1 disorder symptoms more severe and can affect overall well-being.

People with bipolar 1 disorder and depression may be even more likely to develop anxiety.

Understanding Anxiety vs. Mania in Bipolar 1 Disorder

One study found that anxiety disorders often occur alongside manic and depressive episodes in bipolar disorder. For those with bipolar 1 disorder, manic episodes can feel very intense. You may take risks you normally wouldn’t, act differently in social situations, or feel overly energized. These experiences can leave you feeling out of control.

It may also be hard to tell the difference between mania and anxiety because some symptoms overlap. For example, you may have spiraling or racing thoughts or trouble concentrating. However, mania is more intense. You may feel an extreme “high” or notice changes in behavior or personality that aren’t typical of anxiety.

Treating Anxiety and Bipolar 1 Disorder

A psychiatrist is a mental health provider who can treat both anxiety and bipolar 1 disorder. When these conditions occur together, healthcare providers often recommend a mix of medication, therapy, lifestyle changes, and coping skills.

1. Medications

Medications are available to treat both anxiety and bipolar 1 disorder. Finding the right one can take time and may involve trying more than one option. Doctors often treat bipolar 1 disorder first, then address anxiety.

Doctors treat treat bipolar 1 disorder first, then address anxiety.

Bipolar 1 treatments include mood stabilizers and antipsychotics. If anxiety symptoms continue after bipolar 1 treatment is stable, your doctor may consider adding other medications.

Antidepressants may be recommended for treating anxiety with bipolar 1 disorder, but they carry risks. These medications can trigger a manic episode, cause moods to cycle faster, or make symptoms less stable — especially without a mood stabilizer. Because of this, antidepressants are often used with mood-stabilizing treatment and under close watch from a doctor. Antidepressants may not be the right choice for everyone.

All medications can cause side effects. Your doctor should monitor these and help you manage them.

2. Psychotherapy

Therapy is often used to treat both bipolar 1 and anxiety disorders. In psychotherapy, you work with a licensed mental health professional, such as a psychologist or a psychiatrist, to understand your symptoms and learn ways to manage them.

Therapy is often used to treat both bipolar 1 and anxiety disorders.

Cognitive behavioral therapy (CBT) is a widely used and effective option for anxiety and bipolar 1 disorder. CBT helps you identify unhelpful thought patterns and replace them with healthier ones. Exposure therapy may also help with anxiety by building confidence in stressful situations.

Dialectical behavior therapy (DBT), a type of CBT, focuses on accepting difficult emotions and building coping skills to manage them. Some people with bipolar 1 also benefit from learning more about their diagnosis, involving family in therapy, and keeping regular daily routines, including sleep and activity patterns.

Your therapist will work with you to determine which approach may best help manage your anxiety and bipolar 1 disorder.

3. Lifestyle Changes

You may also make some lifestyle changes to help manage anxiety that could contribute to mania in bipolar 1 disorder. Helpful steps include:

• Getting enough rest
• Exercising regularly
• Eating a balanced diet that focuses on vegetables, whole grains, and lean protein and limits fat, sugar, and salt
• Practicing relaxation techniques, such as deep breathing and meditation

Other healthy habits to help manage bipolar 1 disorder include:

• Avoiding substances like tobacco, recreational drugs, and alcohol
• Keeping a consistent sleep schedule
• Tracking your mood daily
• Finding ways to manage stress

4. Coping Skills

Learning coping skills can help you manage manic episodes, especially when you also have anxiety. These strategies work best as part of a broader treatment plan. You can try:

• Recognizing early signs of mania, such as needing less sleep or feeling unusually energized
• Following a consistent daily routine
• Working to lower stress levels when possible
• Attending therapy regularly
• Taking medications as prescribed
• Tracking triggers of anxiety and mood swings
• Using grounding techniques to help you stay focused and calm

Finding Balance With Bipolar 1 and Anxiety

Living with both bipolar 1 disorder and anxiety can feel overwhelming at times, but you don’t have to face it alone. Many people with both conditions find ways to manage their symptoms and live full, meaningful lives. With the right mix of medication, therapy, and lifestyle habits, it’s possible to feel more in control each day.

Progress can take time, so try to be patient with yourself and stay connected with your healthcare team. Don’t hesitate to reach out to others who understand what you’re going through.

Join the Conversation

On MyDepressionTeam, people share their experiences with depression and other mental health conditions, get advice, and find support from others who understand.

What tips do you have for managing bipolar 1 disorder and anxiety? Let others know in the comments below.