Comorbid anxiety in bipolar disorder alters treatment and prognosis.

Mood disorders in general, and bipolar disorder in particular, are unique among the psychiatric conditions in that they are associated with extraordinarily high rates of comorbidity with a multitude of psychiatric and medical conditions. Among all the potential comorbidities, co-occurring anxiety disorders stand out due to their very high prevalence. Outcome in bipolar illness is worse in the presence of a comorbid anxiety disorder. The coexistence of an anxiety disorder presents a particularly difficult challenge in the treatment of bipolar illness since antidepressants, the mainstay of pharmacologic treatments for anxiety, may adversely alter the course of manic-depression. Identification of anxiety disorders in bipolar patients is important. The treatment plan needs to balance the potential benefit and harm of antidepressant administration.