Comorbid anxiety ‘a crucial target’ for treatment in bipolar disorder

By Lucy Piper, Senior medwireNews Reporter

Almost half of patients with bipolar disorder will have comorbid anxiety disorder in their lifetime, show the findings of a systematic review and meta-analysis.

The finding “brings home a key message for planning of clinical services”, say Barbara Pavlova (Dalhousie University, Halifax, Nova Scotia, Canada) and fellow researchers in The Lancet Psychiatry.

“Comorbid anxiety disorders increase the likelihood and degree of adverse outcomes in people with bipolar disorder, including time spent unwell, suicidal behaviour, drug or alcohol misuse, and impaired functioning.”

They therefore recommend routine assessment and treatment of anxiety in people presenting with bipolar disorder, but also acknowledge that the treatment of comorbid anxiety has been under-researched.

This sentiment was echoed by Philip Mitchell (University of New South Wales, Sydney, Australia) in a related comment, who says: “By focusing on these issues, Pavlova and colleagues provide a much needed and urgent wake-up call for this field.”

He describes the findings as “strong and striking” and says they are timely given the “growing interest in the nature and effects of this comorbidity”.

The researchers carried out a literature search and identified 40 eligible studies – 29 clinical studies, seven community samples and four mixed samples – including 14,914 individuals aged an average of 43.2 years.

Across all the studies, the lifetime prevalence of comorbid anxiety disorders among patients with bipolar disorder was 45%, although the researchers note that it ranged from 8% to 88% and there was significant heterogeneity between studies, most of which was unexplained. The most common types of anxiety disorder were generalised anxiety disorder (20%), social phobia (20%), panic disorder (19%) and post-traumatic stress disorder (17%).

Whether a patient had bipolar I or II disorder had no significant effect on the lifetime prevalence of any anxiety disorder, the researchers report.

Rates of comorbid anxiety were increased threefold compared with those for individuals without bipolar disorder, according to data from five of the studies involving 1378 people with and 56,812 without the condition, giving a significant risk ratio of 3.22.

Several explanations for this increased risk of anxiety in bipolar disorder exist, including childhood trauma, stressful life events, low self-esteem and common genetic susceptibility, say the researchers.

And given the impact of untreated anxiety on a patient’s disease course, they conclude that “the treatment of anxiety disorders in bipolar disorder is a crucial target.”

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