When anxiety symptoms, or full-fledged disorders, co-exist with bipolar disorder, there are a number of pharmacological and nonmedication approaches that can be tried.
The challenge in bipolar disorder is that the mainstay of drug treatment for OCD and panic disorder is antidepressants, often in higher doses than one usually uses in depression. The difficulty is that this may trigger a manic or mixed episode. If someone is already struggling with symptoms of anxiety and/or panic attacks, this is moving things in the wrong direction.
There’s tremendous variability here, and what people will often say is that while antidepressant A made them “go crazy,” antidepressant B seemed to help and didn’t cause those same feelings.
If antidepressants are used to target panic and OCD, the first line treatment will be with an SSRI. Of all the antidepressants these are also the ones that seem to be associated with a lower rate of triggering manic, hypomanic, and mixed episodes, especially when combined with a mood stabilizer.
Another group of medications that has a role in the treatment of anxiety disorders are the benzodiazepines (clonazepam (Klonopin), lorazepam (Ativan), etc.. The downside here is that when used on an ongoing basis these are habit forming and can be difficult to manage in someone with a history of substance abuse. That said, the near-immediate relief people receive from these agents can’t be discounted.
Buspirone (Buspar) has an FDA indication for the treatment of generalized anxiety disorder, although clinical response with this medication is not robust.
Finally, many medications are being evaluated in an off label way for their usefulness in the anxiety disorders. Included in this group are mood stabilizers and the atypical antipsychotics, which are already widely prescribed in bipolar disorder.