New research shows that people with bipolar disorder who also suffer from an anxiety disorder are more likely to consider and attempt suicide, experience psycho-social problems and abuse drugs.
Published in the Journal of Psychiatric Research, the study also revealed that bipolar patients who experienced comorbid anxiety disorders had double the rate of emergency room admissions for depression related to their primary condition than their counterparts.
Bipolar disorder is characterized by a fluctuation between periods of mania and episodes of depression. The severity ranges, with the unpredictable mood swings varying in duration and triggered by different factors. The cause is unknown, though the condition tends to occur more frequently in families with histories of the disease.
Examining the relationship between the two psychological disorders, bipolar disorder and anxiety, lead researcher Regina Sala, MD of the New York State Psychiatric Institute at Columbia University, and her colleagues evaluated the symptoms and treatments of 1600 bipolar adults registered with the National Epidemiologic Survey on Alcohol and Related Conditions. Of the total 1600 patients, 1172 met the criteria for bipolar disorder type I and 428 for bipolar disorder type II, with the first type indicating a greater severity of the disorder than the second.
The scientists found that roughly 60% of individuals with a primary diagnosis of either bipolar disorder type I or type II also experienced an anxiety disorder once in their lifetime, and 40% suffered from two or more throughout their lives. Bipolar patients who suffered from an anxiety disorder had a much higher likelihood of suffering from psychosocial problems, such as work-related issues and interpersonal relationships, and substance-abuse problems.
This group also experienced a higher lifetime risk factor for more severe bipolar symptoms, such as more depressive and manic episodes and more suicidal thoughts and attempts. They also were more likely to seek treatment and mental health services that those with bipolar disorder alone.
Anxiety disorders account for a host of conditions marked by excessive stress that interferes with daily life. While certain traumatic events may trigger the emergence of an anxiety disorder, sometimes the onset is not clearly definable. Research is ongoing to determine biological and environmental factors that make some individuals more prone to developing the condition than others.
Given the results of this study, the authors recommend early detection and treatment of anxiety disorders in patients with bipolar disorder to improve the overall outcomes for these patients.
Elevated or low levels of the stress hormone cortisol are associated with depression and lower quality of life in bipolar patients, a new study from Umeå University in Sweden announced. The study found that depression is almost twice as common and poor quality of life is five times as common in people with bipolar disorder.
Bipolar disorder affects approximately 5.7 million adults in the US every year. People with bipolar disorder experience unusual shifts in mood, energy, activity levels, and ability to carry out day-to-day tasks. Previous studies confirmed that stress triggers bipolar episodes in patients. Mania and depression further contribute to the stress load experienced by people with bipolar disorder. The relationship between the stress system, depression, and quality of life, however, had not been examined until this study.
“In bipolar depression the stress system is often activated, which means that the affected individuals have elevated cortisol levels in the blood. We have now been able to show that both over- and underactivity in the stress system, with corresponding elevated or reduced cortisol levels, can impair mental health in terms of depression and poor quality of life in these patients,” said Umeå University PhD student Martin Maripuu.
The study examined the cortisol levels in 145 type one and two bipolar patients and matched them with 145 controls. Researchers used the Dexamethasone Suppression Test (DST) to measure cortisol levels in patients, the Beck Depression Inventory (BDI) and the Montgomery-Åsberg Depression Rating Scale (MADRS-S) to measure self-reported depression, and the World Health Organization Quality of Life Assessment–100 and the Global Assessment of Functioning to measure self-reported quality of life.
Depression was twice as common in bipolar patients with high and low cortisol levels, as compared to people with normal cortisol levels in their blood. Low quality of life was six times more common in patients with bipolar and low cortisol levels. It was five times more common in patients with bipolar and high cortisol levels. Additionally, patients with low cortisol have, on average, had their disorder for a longer period of time. This could mean that people with bipolar disorder experience chronic stress, which causes an “exhaustion” of the stress system, resulting in reduced cortisol levels.
Though these new breakthroughs need additional research, this information could lead to a better understanding and better treatment of bipolar disorder. These researchers have shifted the focus of bipolar disorder treatment by suggesting that effective treatment of bipolar disorder should involve regulating and researching the stress system.
“The results may also ultimately lead to the development of new drugs that work by normalizing the stress system and cortisol levels,” said Maripuu.
