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

Fortunately, both anxiety and bipolar 1 disorder can be managed with therapy, medication, and lifestyle adjustments to help prevent and balance manic episodes. Learning the signs of anxiety that occur with 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:

• Experiencing 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 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

Anxiety in Bipolar 1 Disorder

When a person has more than one health condition at the same time, the other conditions are known as comorbidities. At least one-half to two-thirds of people living with bipolar 1 disorder have psychiatric 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 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.

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 also experience an anxiety disorder at some point in their lives. These disorders also have been shown to worsen bipolar 1 disorder symptoms and reduce overall quality of life.

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

1. 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 stomachaches, headaches, or muscle aches and pains
• Feelings of restlessness and inability to relax

2. Panic Disorder

Panic disorder is an anxiety disorder involving panic attacks. These attacks can last 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 around 15 percent of people with bipolar 1 disorder also have panic disorder.

Symptoms of a panic attack include:

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

3. 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

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.

People with bipolar 1 disorder might feel extra anxious, and that anxiety often comes with feeling agitated or irritable. 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 feel too energetic and 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.

Treating 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:

• Try to get enough sleep.
• Exercise regularly to promote overall well-being.
• Cut down on fat, salt, and sugar.
• Eat vegetables, lean protein, and whole grains.
• Practice relaxation techniques such as deep breathing exercises.
• Be mindful of triggers or situations that may worsen anxiety or mood symptoms and develop coping strategies.

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.

Dialectical behavior therapy is a specific type of CBT that helps you manage intense emotions and develop healthier ways to cope with life’s challenges. 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
• Avoiding substance use
• Asking for support from your friends and family members
• 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. Managing your condition with therapy and medication can improve your overall quality of life.

Talk With Others Who Understand

On MyDepressionTeam, more than 146,000 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 an anxiety disorder? How do you manage both conditions? Share your experience in the comments below, or start a conversation by posting on your Activities page.