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Anxiety disorders and bipolar disorder: a review


  • RSMcI is a consultant for and/or has received speaker fees from Janssen, Eli Lilly & Co., AstraZeneca, Pfizer, Wyeth, GlaxoSmithKline, Bristol-Myers Squibb, Merck and Bioavail. JKS has received grant support from Janssen Ortho, Organon and Wyeth. AB has served on the speakers bureau of Eli Lilly, Canada and AstraZeneca. JZK has received grant support from Wyeth and Eli Lilly & Co. SHK has received research support from Pfizer, AstraZeneca, Organon and Boehringer Ingelheim; has served on the speakers bureau of Lundbeck, Organon, Wyeth-Ayerst and GlaxoSmithKline; and has served on the advisory boards of Pfizer, the Lundbeck Foundation, Eli Lilly & Co., GlaxoSmithKline and Servier. KB has no reported conflict of interest.

Roger S. McIntyre, MD, FRCPC, Department of Psychiatry and Pharmacology, University of Toronto, Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. Fax: +1 416 603 5368; e-mail:


Context:  Epidemiological, clinical and familial studies indicate that anxiety disorders (ADs) are highly comorbid in persons with bipolar disorder (BPD). The phenomenological overlap between ADs and BPD is reported more frequently in individuals with female predominant bipolar presentations (e.g., bipolar II disorder). Anxiety comorbidity in the BPD population poses a serious hazard. For example, it is associated with an intensification of symptoms, non-recovery, substance use comorbidity and harmful dysfunction (e.g., suicidality).

Objective:  The evidentiary base informing treatment decisions for the anxious bipolar patient is woefully inadequate. Several expert consensus and evidence-based treatment guidelines for BPD suggest various treatment avenues, although these have been insufficiently studied. The encompassing aim of this paper is to synthesize extant studies reporting on the co-occurrence of AD and BPD. Taken together, a compelling basis emerges for prioritizing the identification and management of anxiety symptomatology in the BPD population.