Should Bipolar Disorder Be Redefined?

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An adult with bipolar disorder is just as likely to develop anxiety as depression, following an episode of mania, according to new data from a national survey of more than 34,000 adults. The finding was published in May 2016, in Molecular Psychiatry and it could expand our understanding of bipolar disorder to include anxiety.

The Study

An estimated 5.7 million people in the United States suffer from bipolar disorder, which is a serious mental illness that’s been characterized by recurrent periods of manic behavior and depression. Because mania, which involves having an elevated or irritable mood, and depression are mood disturbances, bipolar disorder is considered a type of mood disorder.

The participants in the study were interviewed to determine the incidence of manic episodes. A second interview was conducted three years later to find out the subsequent incidence of depression or anxiety. Participants with manic episodes an approximately equal risk of developing depression or anxiety. Both of these conditions were significantly more commonplace among participants with than without mania. Additionally, participants with depression had a significantly higher risk of developing mania compared to those without depression.

Results of the report align with earlier research that demonstrated depression and anxiety commonly occurred together, and with two studies backing up the information and showed that depression and a common type of anxiety known as generalized anxiety disorder behave much as the same genetic condition. The new findings extend the close connection between depression and anxiety to people with anxiety disorder who have experienced episodes of mania.
Dr. Mark Olfson, MD, MPH, professor of psychiatry at Columbia University Medical Center said, “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.”

He further states, “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 could lead to earlier identification of individuals with bipolar disorder and different treatment approaches.

In conclusion, Dr. Olfson said, “For years, we have missed opportunities to evaluate the effects of treatments for bipolar disorder on anxiety. 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.”


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