After an episode of mania, patients with bipolar disorder are just as likely to experience a period of anxiety as they are depression, according to new study by researchers at Columbia University Medical Center.
The new findings reveal that many bipolar patients suffer not only from severe bouts of depression, but anxiety as well. In fact, patients whose main symptom is anxiety should be carefully assessed for a history of mania before starting treatment, suggest the researchers.
Approximately 5.7 million Americans suffer with bipolar disorder, a serious mental illness that involves recurrent episodes of mania and depression.
For the study, participants were interviewed to determine the incidence of manic episodes. A second interview was conducted three years later to determine the subsequent incidence of depression or anxiety.
Participants with mania had an approximately equal risk of developing depression or anxiety. Both depression and anxiety were far more common among participants with mania than those without mania. Furthermore, participants with depression had a significantly higher risk of developing mania or anxiety compared to those without depression.
The new findings align with earlier research showing that depression and anxiety commonly co-occur. They also confirm earlier studies indicating that depression and a common form of anxiety, known as generalized anxiety disorder, behave virtually as the same genetic condition.
The findings also extend the well-known link between depression and anxiety to bipolar patients with mania.
“Although it has long been widely assumed that bipolar disorder represents repeated episodes of mania and depression as poles along a single continuum of mood, the clinical reality is often far more complex,” said Mark Olfson, M.D., MPH, professor of psychiatry at Columbia University Medical Center, research psychiatrist at New York State Psychiatric Institute, and lead author of the report.
“The link between mania and anxiety suggests that patients whose main symptom is anxiety should be carefully assessed for a history of mania before starting treatment.”
A broader clinical definition of bipolar disorder that includes episodes of mania along with anxiety or depression might lead to an earlier diagnosis of bipolar disorder and allow for different approaches to treatment.
“For years, we may have missed opportunities to evaluate the effects of treatments for bipolar disorder on anxiety,” said Olfson. “The results of our study suggest that researchers should begin to ask whether, and to what extent, treatments for bipolar disorder relieve anxiety as well as mania and depression.”
The findings are published in the journal Molecular Psychiatry.