Public Release: 

Adults with bipolar disorder at equal risk for anxiety or depression following mania

Study suggests re-thinking definition of bipolar disorder to include anxiety

Columbia University Medical Center

NEW YORK, NY (May 3, 2016)--Adults with bipolar disorder are just as likely to develop anxiety as depression following an episode of mania, according to data from a national survey of more than 34,000 adults. This finding, published today in Molecular Psychiatry, may expand our understanding of bipolar disorder to include anxiety.

An estimated 5.7 million Americans have bipolar disorder, a serious mental illness that has been characterized by recurrent periods of mania and depression. Because mania, which involves having an elevated or irritable mood, and depression are mood disturbances, bipolar disorder is considered a type of mood disorder.

Study participants were interviewed to determine the incidence of manic episodes. A second interview was conducted three years later to determine the subsequent incidence of depression or anxiety. Participants with mania had an approximately equal risk of developing depression (odds ratio of 1.7) or anxiety (odds ratio of 1.8). Both conditions were significantly more common among participants with than without mania. In addition, participants with depression had a significantly higher risk of developing mania (odds ratio of 2.2) or anxiety (odds ratio of 1.7) compared to those without depression.

Results of the report align with earlier research demonstrating that depression and anxiety commonly co-occur, and with twin studies indicating that depression and a common form of anxiety known as generalized anxiety disorder behave virtually as the same genetic condition. The new findings extend the close connection between depression and anxiety to individuals with bipolar disorder who have experienced episodes of mania.

"Although it has long been widely assumed that bipolar disorder represents repeated episodes of mania and depression as poles along a single continuum of mood, the clinical reality is often far more complex," said Mark Olfson, MD, MPH, professor of psychiatry at Columbia University Medical Center, research psychiatrist at New York State Psychiatric Institute, and lead author of the report. "The link between mania and anxiety suggests that patients whose main symptom is anxiety should be carefully assessed for a history of mania before starting treatment."

A broader clinical definition of bipolar disorder that includes episodes of mania along with anxiety or depression might lead to earlier identification of individuals with bipolar disorder and different approaches to treatment.

"For years, we may have missed opportunities to evaluate the effects of treatments for bipolar disorder on anxiety," said Dr. Olfson. "The results of our study suggest that researchers should begin to ask whether, and to what extent, treatments for bipolar disorder relieve anxiety as well as mania and depression."

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The study, titled "Reexamining associations between mania, depression, anxiety and substance use disorders: results from a prospective national cohort," was published in Molecular Psychiatry, May 3, 2016. The authors are M Olfson (Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY), R Mojtabai (Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, MD), KR Merikangas (National Institute of Mental Health, Bethesda, MD), WM Compton (National Institute on Drug Abuse, Bethesda, MD), S Wang (Columbia University Medical Center and New York State Psychiatric Center), BF Grant (National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD), and C Blanco (National Institute on Drug Abuse).

Dr. Compton reports ownership of stock in General Electric, 3M and Pfizer, unrelated to the submitted work. The other authors declare no conflict of interest.

Work on this manuscript was supported by Grant U18 HS021112 from the Agency for Healthcare Research and Quality grant (Dr. Olfson) and the New York State Psychiatric Institute (Drs. Olfson and Wang). Work by Drs. Blanco and Compton was supported by the National Institute on Drug Abuse. Work by Dr. Merikangas was supported by the National Institute of Mental Health. Work by Dr. Grant was supported by the National Institute on Alcohol Abuse and Alcoholism.

New York State Psychiatric Institute and Columbia University Department of Psychiatry (NYSPI/Columbia Psychiatry).

New York State Psychiatric Institute (founded in 1896) and the Columbia University Department of Psychiatry have been closely affiliated since 1925. Their co-location in a New York State facility on the New York-Presbyterian/Columbia University Medical Center campus provides the setting for a rich and productive collaborative relationship among scientists and physicians in a variety of disciplines. NYSPI/Columbia Psychiatry is ranked among the best departments and psychiatric research facilities in the nation and has contributed greatly to the understanding of and current treatment for psychiatric disorders. The Department and Institute are home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders and childhood psychiatric disorders. Their combined expertise provides state of the art clinical care for patients, and training for the next generation of psychiatrists and psychiatric researchers.

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.

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