Anxiety Medications Used for Bipolar Disorder

Anxiolytics and Other Medications

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What is the most important information I should know about bipolar anxiety medications?

  • Mood stabilization should be the primary focus before medications are added to manage symptoms of an anxiety disorder. Psychotherapy is also recommended.
  • Antidepressants and benzodiazepines be used with caution and close monitoring; antidepressants may exacerbate mood cycling, and benzodiazepines carry a risk for dependence and withdrawal.

Research has found that anxiety is common in people with bipolar disorder, with more than half experiencing one or more anxiety disorders. Other people may not have enough anxiety symptoms to be formally diagnosed with an anxiety disorder but still need medication to manage symptoms.

For example, anxiety, worry, agitation, and insomnia are often experienced during bipolar depression and mixed episodes. Anxiety symptoms such as restlessness, worry, and irritability may occur during mania and hypomania. Thus, it's common for bipolar people to have anti-anxiety medications prescribed.

Anxiety medications, also called anti-anxiety medications or anxiolytics, are prescribed for anxiety disorders and for people with anxiety along with bipolar disorder or major depression. Anxiety medications help to make people less anxious and also help to ease restlessness and worry. Many of these medications also help people to sleep better.

Let's look at the different categories of medications used to treat anxiety and how they may be used for people with bipolar disorder.

Benzodiazepines

Benzodiazepines are one type of bipolar anxiety medication that might be prescribed. Many of these anxiety medications are also utilized for other conditions as well such as:

  • Agitation
  • Insomnia
  • Chemotherapy-induced nausea and vomiting
  • Alcohol withdrawal
  • Seizures

Some of these medications are used primarily for their sedative effects, either to help with insomnia or as relaxation medications before surgery.

Benzodiazepine medications include:

  • Valium (diazepam)
  • Ativan (lorazepam)
  • Klonopin (clonazepam)
  • Serax (oxazepam)
  • Librium (chlordiazepoxide)
  • Xanax (alprazolam)
  • Halcion (triazolam)
  • Restoril (temazepam)

Risk for Dependence and Withdrawal

Side effects of benzodiazepines are numerous, but of most concern is the issue of dependence. People can develop dependence after only a few weeks, but the risk is greatest for people who take high doses for long periods. If you are taking benzodiazepines for anxiety, never stop taking your medication without talking to your doctor first.

Antidepressants

Many antidepressant medications have been found to have a beneficial effect on anxiety, and unlike benzodiazepines, do not carry the same types of risks for dependence, abuse, and overdose. For this reason, these drugs are often the mainstay of treatment of anxiety of any form.

While antidepressants are often prescribed for bipolar disorder, a randomized controlled trial found that these medications worsen depression episodes and mood cycling in bipolar disorder.

Drugs from different classes of antidepressants are commonly used, including:

Selective Serotonin Reuptake Inhibitors (SSRIs)

Some of the drugs in this category are mentioned below along with some of the indications. All of these may be considered for treatment of anxiety depending on your particular symptoms.

  • Paxil (paroxetine): Paxil has many uses, including major depressive disorder, obsessive-compulsive disorder (OCD), panic disorder with or without agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD).
  • Zoloft (sertraline): Zoloft is approved for the treatment of a number of disorders including major depressive disorder, OCD, panic disorder, premenstrual dysphoric disorder, and social anxiety disorder.
  • Prozac (fluoxetine): Prozac is approved for treating depression, OCD, and panic disorder.
  • Luvox (fluvoxamine): Luvox is commonly used to treat obsessive-compulsive disorder (OCD).

Selective Norepinephrine Reuptake Inhibitors (SNRIs)

Drugs that inhibit the reuptake of both the neurotransmitters serotonin and norepinephrine may also be used to treat anxiety. SNRIs include:

  • Cymbalta (duloxetine)
  • Effexor (venlafaxine)
  • Pristiq (desvenlafaxine)

Tricyclic Antidepressants

The older tricyclic antidepressants are used less often for treating anxiety with bipolar disorder but may be helpful in certain circumstances.

Antidepressants and Mood Cycling

SSRIs, SNRIs, and tricyclic antidepressants are associated with an increased risk for mood destabilization and manic episodes. They may also increase the risk for rapid cycling, which involves having four or more mood episodes within 12 months and is considered one of the more severe forms of bipolar disorder.

Buspar (Buspirone)

Buspar (buspirone) is unrelated to the medications above but may be helpful for anxiety with bipolar disorder, especially when combined with an antidepressant. Buspirone may be prescribed alongside mood stabilizers to help manage symptoms of anxiety associated with bipolar disorder.

The brand name BuSpar was discontinued, but the medication is still available in its generic form known as buspirone HCL.

While this medication generally has few side effects, there are some reports of mania on this drug, especially when combined with other medications.

You should not take buspirone if you have taken a monoamine oxidase inhibitor (MAOI) in the previous 14 days. Taking the two medications together can lead to a dangerous increase in serotonin levels, known as serotonin syndrome.

Non-Medicinal Therapies

There are several other ways to approach the treatment of anxiety in addition to medications, and, in fact, a combination of treatments is most often the best approach. Other treatments may include:

  • Psychotherapy, such as cognitive-behavioral therapy (CBT); CBT is considered one of the most effective treatments for anxiety
  • Coping and relaxation techniques, such as deep breathing, progressive muscle relaxation, and meditation

Interpersonal therapy, cognitive-behavioral therapy, and relaxation therapy can effectively treat anxiety symptoms in those with bipolar disorder.

Keep in mind that all anxiety is not bad. Some anxiety, or "eustress" ("good stress"), can help motivate people to perform better. However, excessive anxiety that leads to distress and disrupts your ability to function should be discussed with your doctor.

If you or a loved one are struggling with anxiety, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. El-Mallakh RS, Vöhringer PA, Ostacher MM, et al. Antidepressants worsen rapid-cycling course in bipolar depression: A STEP-BD randomized clinical trial. Journal of Affective Disorders. 2015;184:318-321. doi:10.1016/j.jad.2015.04.054

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Additional Reading

By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.