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People with bipolar disorder often experience social anxiety. Learn why this can be a dangerous combination and how it changes your treatment.

Bipolar disorder, which is sometimes called manic-depressive illness, causes severe mood swings that can make daily functioning difficult. At times, these shifts in mood and energy level can be overwhelming. Extreme social anxiety, the fear of being criticized or embarrassed in social situations, can be a separate anxiety disorder, or it can occur with bipolar disorder. When they exist together, they can be a dangerous mix.

People with bipolar disorder experience mood swings that range from severe sadness and hopelessness to overly high levels of energy, restlessness, and irritability, known as mania. Here are some clues that suggest you may have social anxiety along with bipolar disorder:

• Presence of panic attacks and fear of social situations along with mania or depression
• Symptoms that started during childhood or early adulthood
• Symptoms of anxiety and sleep problems that are present when you are no longer in a manic mood
• Poor response to the usual treatments for bipolar disorder

Impact of Social Anxiety on Bipolar Disorder

Research shows that about 20 percent of people with bipolar disorder experience panic attacks, compared with less than 1 percent of people without a mood disorder. Research also shows that social anxiety rarely exists by itself. Various studies have found that about 80 percent of people with social anxiety have at least one other mental disorder during their lifetime.

These are some of the dangers of having both bipolar disorder and social anxiety:

• A recent study found that people with both anxiety and bipolar disorder are more likely to display suicidal behaviors than people with bipolar disorder alone.
• People with both bipolar disorder and social anxiety are more likely to abuse alcohol and drugs, which may make symptoms of both disorders worse.
• Social anxiety makes bipolar disease more difficult to treat.
• People with both disorders score worse on measurements of daily life functioning than people with bipolar disorder alone.

Why Do Social Anxiety and Bipolar Disorder Occur Together?

It is clear that there is a relationship between social anxiety and bipolar disorder, but it is not clear whether one leads to the other, or if they have common causes and exist together.

Here is what some research shows:

• People with bipolar disorder may have traumatic experiences caused by their mania early in life that lead to a fear of social situations.
• People who have bipolar disorder may abuse alcohol or drugs to control some of their symptoms. Abuse and addiction can make social anxiety disorder worse.
• Both disorders may run in families, since studies show that family members of people with bipolar disorder also have a higher rate of anxiety disorders.

Treatment of Bipolar Disorder With Social Anxiety

If you have social anxiety and bipolar disorder, both disorders need to be addressed for treatment to be successful. This often requires a combination of drug treatment and talk therapy. In most cases, treatment of both disorders can be successful.

Treatment options include:

• Mood-stabilizing medications. These drugs are usually used first to treat the bipolar part of the disorder. Examples of mood stabilizers used for bipolar disorder include lithium, valproate, and olanzapine.
• Antidepressants. These medications work well for social anxiety disorders, but they must be used very carefully with bipolar disorder, since they can make some bipolar symptoms worse. For this reason, doctors may avoid antidepressants or use them only in lower doses.
• Benzodiazepines. These drugs may work well for anxiety and are safe for bipolar disorder, but can cause physical dependence and must be used with caution by anyone who has a history of substance abuse.
• Psychotherapy. Talk therapy has been shown to be very effective for treating social anxiety disorder, so one option may be to use a mood stabilizer along with cognitive-behavioral therapy (CBT). CBT teaches people with social anxiety to change their thought patterns and to replace poor responses with more healthy responses. Other types of talk therapy that may help include family therapy and relaxation training.
• Lifestyle changes. Keeping a regular schedule, getting enough sleep, and avoiding events that cause stress can be helpful for both disorders. Getting regular exercise and avoiding alcohol and drugs are also very important.

Bipolar disorder and social anxiety disorder frequently occur together. The addition of social anxiety causes an increased risk of suicide and of alcohol and drug abuse, and generally makes dealing with bipolar more difficult. The good news is that both disorders can be treated. With the right combination of drugs, lifestyle changes, and psychotherapy, most people with these disorders do recover.

Angry calls by actor Mel Gibson to his ex-girlfriend made headlines when excerpts were made public. They also opened up a dialogue about bipolar disorder.

In summer 2010, the actor Mel Gibson was front-page news, and not because of a new movie role. Two audiotapes, purportedly of the Hollywood star threatening his ex-girlfriend Oksana Grigorieva, were made public. In them, Gibson can be heard using profane language, insulting Grigorieva, and threatening her life.

This isn’t the first time Gibson’s reputation has come under fire. In 2006, he made headlines after he launched an anti-Semitic tirade toward a police officer arresting him on a charge of drunken driving. Given Gibson’s stormy past, there has been much media speculation on whether a mental health condition could be behind his behavior.

Mel Gibson is actually the one who started the speculation. In a 2008 documentary, Gibson himself said that he had been diagnosed with bipolar disorder. Some of his rage-filled behavior is consistent with that of a person who has bipolar disorder, says Douglas Bey Jr., MD, a psychiatrist in Normal, Ill., and author of the upcoming book Loving a Depressed Man.

“Irritability is a primary symptom in bipolar disorder,” says Dr. Bey, who has not examined or treated Gibson. “If Mel Gibson was off his [bipolar] medicine or wasn’t being controlled by his medicine — his mood stabilizer — then he’s likely to be quite irritable.”

Non-compliance with medication is a common problem among bipolar patients, Bey says, especially when they are in their “high” phase, also known as mania. People in creative fields like Gibson’s are particularly susceptible to this phenomenon, since the medication may make them feel less on top of their game.

“When people are depressed, they seek help, but when they’re high, they have tremendous energy and feel slowed down by their medication,” Bey says. “When you have patients who are artists or writers, you have to watch them and moderate their medications because they feel like it stifles their creativity.”

Mel Gibson: No Clear-Cut Diagnosis

There has also been a fair amount of doubt as to the cause of Mel Gibson’s behavior, because there simply aren’t enough details to know for sure whether Gibson is bipolar, says Carole Lieberman, MD, a psychiatrist in Beverly Hills, Calif.

“[Gibson] did not say who told him” that he had bipolar disorder, Dr. Lieberman says. “It was not definite that it was a psychiatrist, nor was it definite that any psychiatrist had done a thorough evaluation of him.”

Angry tirades could also be exacerbated by alcohol use. In 2006, after his drunken driving arrest, Gibson admitted that he is an alcoholic. If Gibson has begun abusing alcohol again, it could be making his already unstable behavior even worse.

“A lot of times, people with bipolar disorder try to self-medicate with alcohol or drugs,” Bey says. “But that just leads to less inhibition. It aggravates the whole thing. If you’ve got a guy who’s already irritated and then drunk on top of it, you’ve got more of a problem.”

With Gibson’s high-profile status, one might think that his much-publicized bad behavior could worsen the significant stigma already associated with mental illnesses like bipolar disorder. But it could actually be a good thing for people who live with this condition.

“On the positive side, it probably raises awareness of the illness, and people with bipolar disorder might feel better knowing it can happen to anyone, including the rich and famous,” Bey says.

The bipolar disorder treatment lithium can cause acne. Find out why, and get tips to manage your complexion.

The medication lithium is a commonly prescribed bipolar disorder treatment, but you may not be prepared for the negative effects it can have on your complexion. Up to one-third of patients who take lithium will find that the medication causes frequent breakouts of acne, or pimples, says Amy Derick, MD, a dermatologist in Barrington, Ill.

These breakouts can occur on the face, around the hairline, and even on the arms and legs. But unlike typical teenage acne, the blemishes that occur usually don’t have whiteheads or blackheads. “It’s more like pustules, which are little red bumps,” says Dr. Derick.

Doctors aren’t sure exactly why lithium causes chronic acne, but some theorize that it has to do with the activity of neutrophils in the body. Neutrophils are white blood cells that fight infection. When lithium is taken, many neutrophils move from the bloodstream to the skin, where they can cause inflammation and increase the likelihood of pimples.

“When an infection occurs, neutrophils are usually the first blood cells on the scene that cause inflammation and kill bacteria,” Derick says. “Lithium probably simulates in some way what the skin would experience when it has a bacterial infection.”

Skin Strategies for Chronic Acne

If your acne is bothersome, decreasing your lithium dosage with your doctor’s consent can often help your skin improve. If that’s not possible, it’s best to consult a dermatologist about acne treatments, since lithium-induced pimples are generally harder to get rid of than other types of blemishes.

One possible treatment for this type of acne is tretinoin (Retin-A, Renova, Atralin), a topical drug that works by unclogging pores and promoting peeling of the affected skin. However, it is important to talk to your doctor about possible side effects before using this medication.

The drug isotretinoin (previously marketed as Accutane, but now available only as a generic) should be considered only if absolutely necessary, since its reported side effects include birth defects, depression, and psychosis (feelings of delusion and hallucination). This can be especially dangerous for someone with bipolar disorder. “You should proceed with caution so you don’t have some sort of manic or depressive episode,” Derick says.

Having a good anti-acne skin care routine can also be helpful in fighting breakouts while you are taking lithium. An over-the-counter cleansing product that contains salicylic acid, which reduces swelling and unclogs pores, should be used twice a day for optimum results.

When buying beauty products, such as moisturizer or foundation, be sure that the label says that the formula is “non-comedogenic,” meaning it has been formulated to not clog pores, which can lead to breakouts. Also, choose a sunscreen that uses titanium dioxide or zinc oxide as a physical barrier against the sun, rather than chemicals that absorb UV rays. “Those types of sunscreens are usually better for people who have acne problems,” Derick says.

Finally, try not to get too down about your acne. Some patients on lithium have found that their skin problems decrease after about six months of treatment, as their bodies adjust to the new medicine. “It can get better,” Derick says.

The highs and lows of bipolar disorder can often be accompanied by clutter and, in extreme cases, hoarding.

For some people living with bipolar disorder, keeping order around their house may be a struggle. Cycles of mania and depression can make it very difficult to keep a handle on household clutter. In extreme cases, people with bipolar might begin exhibiting signs of hoarding behavior, being unable to part with anything even as their homes fill up with new purchases.

There’s no need for despair, however. People fighting clutter as a result of bipolar disorder have a number of options available to them. Getting the right treatment for bipolar disorder will help, along with adopting a few simple habits that, over time, will result in clear spaces and a happier, healthier home.

Understanding the Links to Clutter and Hoarding

Research has linked bipolar disorder to hoarding behavior in a couple of ways. People with bipolar disorder are more likely to hoard, and the severity of their bipolar symptoms are directly tied to the severity of their hoarding behavior. These links usually occur in the context of another anxiety disorder, obsessive-compulsive disorder (OCD).

The manic highs and depressive lows of bipolar disorder both lend themselves to clutter and hoarding:

• Depression. People with depression can find themselves too lethargic and listless to clean up around the house. You may attempt to self-medicate through consumerism — purchasing items you don’t really need to make yourself feel better. As a result, piles of possessions can begin to build up around your home during a depressive episode.
• Mania. People who experience mania can become too distracted to properly clean up their homes or pick up after themselves. You might begin a household task, only to move onto something else before the chore is completed. You also might find it too hard to concentrate properly when it comes to organizing your belongings. Manic feelings can lead to extreme anxiety when faced with having to throw something away.

Getting Help to Deal With Clutter

The first step in dealing with clutter should involve getting help for your bipolar disorder. Treatments include:

• Therapy. Working with a therapist can help you better understand how bipolar disorder leads to clutter and disarray. Cognitive-behavioral therapy in particular is extremely helpful. In this form of therapy, you learn about the mechanisms through which the disorder forces behavior, and then about practical steps to change those behaviors. For example, a person who self-medicates by shopping while depressed will be taught to recognize when this is happening and head it off. A manic person can be taught methods for calming down enough to focus on a cleaning task.
• Medication. Mood stabilizers can work to even out mood swings. Some options include lithium and anti-psychotic medications like haloperidol (Haldol) or clozapine (Clozaril).

Try these practical tips for combating clutter as well:

• Break down the task. Focus on one room when cleaning, and then break down the tasks within that room. For example, first pick up belongings and put them away, then switch your attention to dusting.
• Force yourself into consistency. Make certain chores part of your daily ritual. Go through your mail every morning. Clean and wipe down kitchen counters every time you cook.
• Get tough on your stuff. When you buy one new item, throw away two old ones. Pare down your mementos, considering the nostalgic value of each and tossing away those that are redundant or meaningless.

By getting the right treatment and practicing small but important clutter-busting steps, you can take control of disorder and better organize your home and your life.