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Manic Anxiety: How To Cope With Anxiety and Bipolar Mania

Medically reviewed by Paul Ballas, D.O.
Written by Emily Wagner, M.S.
Posted on February 1, 2023

  • More than one-third of people with bipolar 1 disorder will develop an anxiety disorder as well.
  • People with bipolar 1 disorder who experience manic and depressive symptoms at the same time are at higher risk for anxiety.
  • Several tools are available to help with anxiety and bipolar 1, including talk therapy, medications, and lifestyle changes.

Throughout our lives, many of us experience anxiety at some point. For many people living with bipolar 1 disorder, these anxious feelings may come about more frequently, making their day-to-day lives difficult. Fortunately, both anxiety and bipolar 1 disorder can be managed with therapy, medication, and lifestyle habits to help prevent and balance manic episodes. Learning the signs of anxiety that occur alongside mania can help you know when to seek treatment.

What Is Bipolar 1 Disorder?

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, and depressive episodes last at least two weeks. Some people may also have symptoms of manic and depressive episodes at the same time — this is known as having depressive (or manic) episodes with mixed features.

Symptoms of mania include:

  • Having racing thoughts
  • Feeling extremely elated or energetic
  • Needing less sleep than you usually do
  • Talking quickly about many different ideas at once
  • Overindulging in food, alcohol, or sexual activities
  • Having the sense of being unusually important or powerful

Symptoms of depression include:

  • Having difficulty concentrating or making decisions
  • Feeling extremely sad, down, or anxious
  • Sleeping too much or not being able to fall asleep
  • Forgetting things
  • Talking extremely slowly
  • Losing interest in activities you usually enjoy
  • Feeling worthless or hopeless
  • Thinking about suicide or death

Bipolar 1 Disorder and Anxiety

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

Anxiety disorders are the most common co-occurring health issue for people with bipolar 1 disorder. Research shows around 38 percent of people with bipolar 1 disorder will develop an anxiety disorder at some point in their lives. These disorders have also been shown to worsen bipolar 1 disorder symptoms and reduce overall quality of life.

Bipolar 1 Disorder and Manic Anxiety

Research shows anxiety is associated with certain episodes of bipolar 1 disorder. For example, one study found people are at significantly higher risk of developing anxiety after episodes of mania. Those with bipolar 1 disorder and depression are more likely to develop anxiety than those without depression.

Anxiety in people with bipolar 1 disorder can be accompanied by agitation and irritability. All three of these symptoms tend to be more common in people who have mixed features in bipolar 1 disorder.

For people with bipolar 1 disorder, manic episodes can be extremely stressful. They may take risks they normally wouldn’t, act out in social situations, or have the sensation of being too energetic and feeling out of control. This can cause manic anxiety during or after an episode.

Distinguishing the symptoms of a manic episode and anxiety may be difficult due to some overlap between the two. For example, a person may notice they have racing thoughts or trouble concentrating. These are symptoms of both anxiety and manic episodes. However, mania is generally more severe, and a person may experience a “high” or some personality changes — which aren’t usually seen with anxiety.

Types of Anxiety in Bipolar 1 Disorder

Anxiety is a generalized term used to describe feelings of worry or dread. However, anxiety disorders involve much more intense feelings that worsen over time and may not go away on their own. According to the National Institute of Mental Health, there are several types of anxiety disorders, each associated with anxiety around a specific aspect of life.

People with bipolar 1 disorder may also develop generalized anxiety disorder (GAD), panic disorder, or social anxiety disorder.

Generalized Anxiety Disorder

GAD is an anxiety disorder characterized by feelings of persistent worry, dread, or anxiousness. This type of anxiety is much more intense than feeling nervous about stressful life events. People with GAD have symptoms that last for several months or years and can interfere with work, school, and relationships. Studies show that around 14 percent of people with bipolar 1 disorder have GAD.

Symptoms of GAD include:

  • Anxiety or dread that’s out of proportion with the events you’re worrying about
  • Trouble dealing with uncertainty
  • Sleep difficulties, leading to fatigue
  • Irritability
  • Trouble concentrating
  • Unexplained stomach aches, headaches, or muscle aches and pains
  • Feelings of restlessness and inability to relax

Panic Disorder

Panic disorder is an anxiety disorder involving panic attacks. These attacks can last for several minutes, bringing out sudden waves of panic, loss of control, and fear — even when there’s no real threat. Those with panic disorder find themselves worrying about when they may have another panic attack, and they may go out of their way to avoid triggers. It’s possible to have panic attacks without being diagnosed with panic disorder. Studies show that around 15 percent of people with bipolar 1 disorder have panic disorder as well.

Symptoms of a panic attack include:

  • Overwhelming fear
  • Breathing difficulties
  • Sweating and shaking
  • Racing heartbeat
  • Chest pain
  • Nausea or stomach aches
  • Chills
  • Dizziness
  • Tingling or numbness in your hands

Social Anxiety Disorder

Social anxiety disorder is a fear of other people watching and judging you in social situations. People with social anxiety disorder often find ways to avoid social gatherings. This may interfere with everyday tasks, like going to work or school or having conversations with others. Social anxiety may make you afraid to meet strangers or worry about embarrassing yourself in front of others. Around 8 percent of people with bipolar 1 disorder have social anxiety disorder.

Physical symptoms you may experience with social anxiety disorder include:

  • Shaking
  • Blushing
  • Sweating
  • Dizziness
  • Nausea
  • Rapid heartbeat

Coping With Anxiety and Bipolar 1 Disorder

The main treatments for anxiety include psychotherapy (talk therapy) and medications. You may also make some lifestyle changes to help you manage underlying anxiety that can contribute to mania in bipolar 1 disorder.

Psychotherapy

In psychotherapy, you’ll work with a licensed mental health professional (such as a psychologist or a psychiatrist) to talk through the causes and symptoms of anxiety. The most popular and effective psychotherapy used to treat anxiety disorders is cognitive behavioral therapy (CBT). In CBT, your therapist will help you find the thoughts driving your anxiety and give you the tools to replace them with helpful thoughts based on logic. You may also do exposure therapy, which helps you learn to confront triggering situations with more confidence.

Dialectical behavior therapy (DBT) is a specific type of CBT that helps people learn to accept aspects of their lives while also providing coping skills to help them regulate their emotions. Your therapist will work with you to determine which type of therapy is best to address your anxiety and bipolar 1 disorder.

Medications

Your doctor or psychiatrist may also recommend medications — such as antidepressants — as a way to help treat anxiety. You may also be taking mood stabilizers or antipsychotics to help treat your bipolar 1 disorder. Living with the two conditions may change how well you respond to certain medications, so your doctor may have to adjust dosing or find the right combination that works for you. Fortunately, there are several treatment options available.

Managing Manic Episodes

If you start to notice some early signs of a manic episode, you can take steps to help avoid your triggers and keep your mood stable. Avoiding or limiting manic episodes can help prevent the anxiety symptoms you may experience during or after them.

Some steps you can take include:

  • Setting and maintaining a daily routine, such as eating meals at the same time, and exercising or meditating daily
  • Following a regular sleep schedule to make sure you’re getting enough sleep
  • Asking for support from your friends and family members
  • Avoiding alcohol and illicit substances
  • Monitoring your mood daily and noting your symptoms
  • Sticking to your treatment plan

If you have any questions or concerns about anxiety with bipolar 1 disorder, especially related to mania, talk to your health care providers. They may change your treatment plan or recommend psychotherapy to help you address your anxiety and any other issues related to bipolar 1 disorder. Together, managing your condition with therapy and medication can improve your overall quality of life.

Talk With Others Who Understand

On MyDepressionTeam, more than 142,000 members come together to ask questions, give advice, and share their stories with others who understand life with anxiety, depression, or bipolar 1 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.

Posted on February 1, 2023
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Paul Ballas, D.O. is an attending psychiatrist at Friends Hospital in Philadelphia, Pennsylvania. Review provided by VeriMed Healthcare Network. Learn more about him here
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here

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