Following an Episode of Mania, Adults With Bipolar Disorder at Equal Risk for Depression or Anxiety

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Bipolar disorder (BD) is typically characterized by recurrent episodes of mania and depression, but the connection between BD and anxiety needs to be considered.
Bipolar disorder (BD) is typically characterized by recurrent episodes of mania and depression, but the connection between BD and anxiety needs to be considered.

After an episode of mania, adults diagnosed with bipolar disorder are just as likely to experience anxiety as depression, according to data from a longitudinal nationally representative survey (National Epidemiologic Survey on Alcohol and Related Conditions) of 34 653 adults in the United States.

Researchers affiliated with the Columbia University Medical Center, New York State Psychiatric Institute, the Johns Hopkins University, the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism, published their findings in Molecular Psychiatry.1

Bipolar disorder is a severe mood disorder that is difficult to diagnose, and is frequently underdiagnosed. The prevalence of bipolar I and II in the general population is approximately 3% (5.7 million Americans), but this estimate is likely too low.2

In the present study, sociodemographic measures included sex, age, gender, race/ethnicity, marital status, employment, household income, and functional status. Researchers used logistic regression to assess the strength of associations between Wave 1 past-year manic episodes and Wave 2 past-year neuropsychiatric conditions including depressive, anxiety, and substance use disorders.

Data indicate that the “association of manic episodes with any depressive disorder (OR: 1.70, 95% CI 1.33-2.19) was no significantly stronger that the associations of manic episodes with the anxiety disorders (OR: 1.76, 95% CI 0.63-1.94) although it was significantly stronger than the associations of manic episodes with any substance use disorder (OR: 1.17, 95% CI 0.94-1.46), nicotine dependence (OR: 0.93, 95% CI 0.70-1.24), or alcohol dependence (OR: 1.34, 95% CI 0.96-1.88),” the authors reported.

The findings are in line with previous reports that indicate that clinically significant depression and anxiety are highly comorbid. Although the present study does not establish a causal relationship between mania and anxiety, results extend the well-described, significant association between depression and anxiety to patients who are diagnosed with bipolar disorder and have experienced episodes of mania.

More “clinical research is needed to assess whether interventions that are effective in manic episodes tend to reduce comorbid anxiety states,” and these new “findings that anxiety disorders are equally common as those of depression among individuals with mania suggest that expansion of the current unitary mood conceptualization may inform nosology, treatment and etiology of these conditions,” the investigators concluded in their publication.

References

1. Olfosn M, Mojtabai R, Merikangas KR, et al. Reexamining associations between mania, depression, anxiety and substance use disorders: results from a prospective national cohort. Mol Psychiatry. 2016. doi: 10.1038/mp.2016.64.

2. Fagiolini A, Forgione R, Maccari M, et al. Prevalence, chronicity, burden and borders of bipolar disorder. J Affect Disord. 2013;148:161-169.

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