Anxiolytics And Other Medications
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Research has found that anxiety is common in people with bipolar disorder, with more than half of people 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 their symptoms. Anxiousness, worry, agitation, and insomnia, for example, 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 as well as for people who have anxiety along with bipolar disorder or major depression. Anxiety medications help to make people less anxious and also help to ease restlessness and worrying. Many of these medications also help people to sleep better. Let’s take a look at the different categories of medications which are used to treat anxiety and how they may be used for people with bipolar disorder.
How Anxiety Affects Bipolar Disorder
Bipolar disorders and anxiety are frequent bedfellows. In fact, anxiety and anxiety disorders occur in more than half of those with bipolar type I, according to the paper, âThe Importance of Anxiety States in Bipolar Disorder.â1 And I am one of those who experience anxiety in bipolar disorder. Whether your anxiety comes in the form of a specific disorder, or itâs just symptoms of anxiety, I can attest to the fact that anxiety affects bipolar disorder, and itâs not in good ways.
Treating Bipolar Disorder With All Its Comorbid Symptoms Can Be A Delicate Process
Some people suffer tragically when alls right with the world. The COVID-19 changes have made the last 5 months especially difficult for them. Those who suffer severely lack the medications and treatments to help them function during this period of isolation and quarantine. For example, bipolar disorder treatment for depression, anxiety, and suicidal thoughts is all the harder in crises like these.
Many people suffer with these symptoms when the world is balanced and functioning. However, during this period of crisis their difficulties torment them mercilessly.
Bipolar disorder is one of the most severe psychiatric disorders, but unfortunately it has not received the most attention for studies, breakthroughs, and relief. Not even close.
This serious disorder plays a significant role in the lives of people who live in shelters, in jail, or who commit suicide.
To take it a step further, some doctors warn that no one should still be prescribing antidepressants for bipolar disorder.
Im not one of thembut more on that in a bit.
Its true that depression is a terrible symptom of bipolar disorder. In most cases, it dominates many more of your days compared to mania or hypomania. And its vital to find a way to treat the depression while also avoiding the mania .
If you or someone you care about has bipolar disorder, you know what I mean. The meds that are supposed to help can be hellish.
Then, theres another point to be aware of
The stakes are high.
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Why Is Bipolar Disorder No Longer Called Manic
In the last few decades, the medical world, especially the field of psychiatry, has intentionally made a shift from using manic-depressive illness or manic depression to describe bipolar disorder. There are several reasons for this shift, including:
- Healthcare providers used to use manic depression to describe a wide range of mental health conditions. As mental health condition classification systems, including the Diagnostic and Statistical Manual of Mental Disorders , have become more sophisticated, the new term bipolar disorder allows for more clarity in diagnosis.
- Theres a lot of stigma and negativity associated with the terms manic and mania, especially due to the use of maniac. Similarly, people use the term depression casually to describe periods of sadness that dont qualify as clinical depression. Using bipolar disorder takes the focus away from these two words. Bipolar disorder is more of a clinical, medical term and less emotionally loaded than manic depression.
- The term manic depression excludes the cyclothymic or hypomanic versions of the condition.
Tms Therapy Success Rates: Anxiety
TMS is effective for various anxiety disorders, as we have already seen. In one study, anxiety scores after TMS treatment. In the same study, depression also decreased by 40 percent. This is important, too, as anxiety and depression often go hand-in-hand.
A separate study found that rTMS offered 23.3 percent of patients with depression and a comorbid anxiety disorder remission, while 39.5 percent experienced a reduction in symptoms.
In another study, 11 of 13 patients diagnosed with GAD responded to the rTSM treatment and were in remission. And in a case study, low-frequency TMS was able to decrease anxiety and panic symptoms in a patient by up to 78 percent.
Using benzodiazepines for anxiety can have high success rates, too, but it is estimated that 10-25 percent of chronic benzodiazepine users experience long-lasting withdrawal symptoms when they stop taking the drug.
Professor Malcolm Lader, a leader in addictions research, estimates that about 20-30 percent of people who are on a benzodiazepine like diazepam have trouble coming off and of those about a third have very distressing symptoms. These downsides dont apply to TMS therapy for anxiety, yet the latter treatment still has high success rates.
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How To Treat Anxiety In Bipolar Disorder
Naturally, if you suffer from anxiety and bipolar disorder, your treatment considerations become more complex. And itâs important to know that anxiety actually worsens treatment outcomes in bipolar disorder, so ignoring it just isnât an option.
The typical treatment for anxiety is certain antidepressants. However, those may not be an option in bipolar disorder as antidepressants can induce mood-switching, and, of course, this is always to be avoided. Additionally, doctors generally want to avoid dependence on benzodiazepines as they are considered addictive.3
That leaves us with, yup, atypical antipsychotics and anticonvulsants. One 2013 paper notes that there is emerging evidence for olanzapine and lamotrigine in the treatment of anxiety in bipolar disorder.3
Additionally, therapies like cognitive behavioral therapy and psychoeducation also appear to help.
No matter what, though, if youâre experiencing anxiety with bipolar disorder, make sure to discuss it with your doctor. Itis a big deal, can hugely affect you, and absolutely needs treatment.
Seeking Treatment For Bipolar Disorder
The primary treatment plan for bipolar disorder usually consists of a combination of mood stabilizers and individual therapy. Talk therapy, particularly cognitive behavioral therapy or dialectical behavior therapy, can help individuals with mood disorders like bipolar disorder make improvements in the severity of their symptoms and the length of their episodes.
Mood stabilizers also play a critical role. These are medications that help bring down the severity of manic symptoms and significantly reduce the suicide risk for patients with bipolar disorder. Lithium is a common mood stabilizer, but others include valproic acid and multiple different antiepileptic drugs. In some cases, people with bipolar disorder are also prescribed antidepressants, such as SSRIs.
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What If I Dont Feel Better
If you dont feel better right away, remember that it isnt your fault and you havent failed. Never be afraid to get a second opinion if you dont feel your treatment is working as well as it should be. Here are some reasons the medication you are taking may be not be giving you the results you seek.
Not enough time
Often a medication may not appear to work when the reality is that it may not have had enough time to take effect. Most medications for mood disorders must be taken for a few weeks before you begin to see results. The length of time will vary by medication, taking between 2 and eight weeks before the full effect is felt. So, though it may not be easy, give your medication time to start working. Whenever your doctor prescribes a new medication or changes the dose of old medication, be sure to ask when you should judge whether its helping or not.
Dosage too low
With most medications used to treat mood disorders, the actual amount reaching the brain can be very different from one person to the next. A medication must reach the brain to be effective, so if your dose is too low and not enough reaches your brain, you might incorrectly assume the medication doesnt work when you just need your doctor to adjust your dosage.
Different type of medication needed
Not taking medications as prescribed
The Rationale For 2 Ligands In Psychiatry
Neurobiological and pharmacological considerations supporting the candidacy of a drug target should never trump the empirical clinical evidence regarding efficacy and safety. Nevertheless, they may be useful when evaluating the potential for further investigations of the target where evidence is limited.
As outlined earlier, a role for VGCCs in psychiatric disorders is supported by genomic data. The evidence includes both common and rare variants and is most robust for schizophrenia and BD , but VGCC associations are observed across a range of psychiatric disorders , albeit not for anxiety disorders . However, the genetic associations to VGCCs are primarily with -1 and subunits we are unaware of robust evidence directly implicating 2 subunit genes.
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Tms Therapy Success Rates: Ptsd
Per one study, about 33 percent of people who have PTSD dont respond to treatment. The non-response rates for cognitive behavioral therapy may be as high as 50 percent and for SSRIs, its about 20-40 percent. The success rates of conventional treatments for PTSD are therefore not very high. But TMS can help many individuals who dont see success with medication or talk therapy.
Since PTSD has close ties with depression and anxiety, it makes sense that many patients experiencing PTSD will benefit from TMS. Indeed, a study published in Biological Psychiatry found that TMS led to a 39.3 percent reduction on a PTSD scale containing avoidance symptoms.
Selective Serotonin Reuptake Inhibitors
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 : Paxil has many uses, including major depressive disorder, obsessive-compulsive disorder , panic disorder with or without agoraphobia, social anxiety disorder, generalized anxiety disorder , and post-traumatic stress disorder .
- Zoloft : 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 : Prozac is approved for treating depression, OCD, and panic disorder.
- Luvox : Luvox is commonly used to treat obsessive-compulsive disorder .
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What Meds Treat Bipolar
Several types of medications can be used to treat bipolar disorder. The most common ones are generally called mood stabilizers. They work by restoring the balance of the chemicals in your brain.
Mood stabilizers work best if you take them consistently. Sometimes people stop taking them during a manic episode becauselets face itmanic episodes can feel great, and who wants to miss that? If you stop taking your meds though, it will take longer for them to kick in once another depressive episode hits.
Here are some of the most popular mood stabilizers:
Medication For Bipolar Depression With Anxiety
Medication is almost always the starting point. Your doctor might begin by prescribing a mood stabilizer. Next, they might prescribe an antidepressant to treat anxiety, although in bipolar disorder, antidepressants can trigger mania or induce a chronic state of depression. If you do use an antidepressant, your doctor will monitor you carefully and adjust your medications as needed.
As an alternative to antidepressants, your doctor may have you try benzodiazepines to treat your anxiety. Benzodiazepines dont aggravate depression or mania, but they do carry the risk of tolerance and dependence. Finally, you might also receive a prescription for an atypical antipsychotic.
If one medication doesnt work, you dont have to feel defeated. Each class of medication used has numerous medications within it. Finding the right combination is often a matter of trial and error.
You might want to talk to your doctor about side effects. Having both disorders can make you more sensitive to medication side effects, especially when the medication is new for you. Being aware and communicating with your doctor will help you find a medication that works without intolerable side effects.
Medication is almost always the first line of treatment for bipolar depression with anxiety. In addition to medication, therapy can be very effective in decreasing symptoms and improving lives.
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The Importance Of Regular Blood Tests
If you take lithium, its important to have regular blood tests to make sure your dose is in the effective range. Doses that are too high can be toxic. When you first start taking it, your doctor may check your blood levels once or twice a week. When the right dose has been determined and your levels are steady, its still important to get blood tests every two to three months, since many things can cause your lithium levels to change. Even taking a different brand of lithium can lead to different blood levels.
Treatment And Support At Priory Hospitals And Wellbeing Centres
At Priory, we support people with bipolar and anxiety disorders in many ways. Our outpatient services give you the opportunity to set up a series of hourly sessions with an experienced consultant, psychologist or therapist to help you better manage your symptoms in everyday life.
Our inpatient options are also available for those finding their co-morbid bipolar and anxiety symptoms particularly debilitating. During a hospital stay, you take part in a psychological group programme and attend regular sessions with an experienced consultant to help you learn ways to better manage the co-occurring disorders going forward.
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Natural Remedies For Bipolar Disorder
Treatment for mood swings might require changes in lifestyle and attitudes for those already active in a healthy balanced diet, sleep, relaxation, and exercise.
Many professionals have begun suggesting the use of natural herbal supplements over synthetic medication due to their lack of side effects.
I personally helped my sister rid herself of the horrible side-effects from taking Lamotrigine for bipolar disorder and BPD and later Wellbutrin.
I started looking into Lamictal and Wellbutrin alternatives and was very intrigued by the solutions I found among practitioners of homeopathic medicine.
Many of these herbs are taken from the vast centuries-old knowledge storehouses of Oriental medicines from China, India, and Korea where they have been practicing natural medicine for centuries.
Stabilization of ones mood through the use of herbs, tonics, and other natural over-the-counter products is common in alternative Ayurveda, Traditional Chinese Medicine and Korean medicinal cultures that might include Moxibustion, Acupuncture, medicinal mushrooms, roots, herbalism, Bach flower therapy, Craniosacral therapy, emotional release therapy, Amanae and others.
Some of these alternative homeopathic treatments and therapies might have wonderful benefits for you as well!
And the discussion of nootropics as mood stabilizers is a whole other subject entirely.
What Medications Are Used To Treat Bipolar Disorder
Certain medications can help manage symptoms of bipolar disorder. You may need to try several different medications, with guidance from your healthcare provider, before finding what works best.
Medications healthcare providers generally prescribe to treat bipolar disorder include:
- Mood stabilizers.
- Second-generation neuroleptics .
- Antidepressants.
If youre taking medication for bipolar disorder, you should:
- Talk with your healthcare provider to understand the risks, side effects and benefits of the medication.
- Tell your healthcare provider about any prescription drugs, over-the-counter medications or supplements youre already taking.
- Tell your healthcare provider right away if youre experiencing concerning side effects. They may need to change your dose or try a different medication.
- Remember that medication for bipolar disorder must be taken consistently, as prescribed.
Mood stabilizers for bipolar disorder
People with bipolar disorder typically need mood-stabilizing medication to manage manic or hypomanic episodes.
Types of mood stabilizers and their brand names include:
- Lithium .
- Lamotrigine .
Thyroid gland and kidney problems can sometimes develop when taking lithium, so your healthcare provider will monitor the function of your thyroid and kidneys, as well as monitor the levels of lithium in your blood, as levels can easily become too high.
However, other medications, such as olanzapine , risperidone and aripiprazole , are commonly prescribed as well.
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What Is Samhsa’s National Helpline
SAMHSAs National Helpline, , or TTY: is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.
Also visit the online treatment locator, or send your zip code via text message: 435748 to find help near you. Read more about the HELP4U text messaging service.
Best Treatment For Bipolar Depression: Therapy
While medication works at the neurological level to ease mood swings and depression symptoms, therapy allows you to process the frustrations of living with bipolar depression and to develop tools and coping skills to move forward.
Some of the helpful aspects of therapy include:
- Identifying negative thought patterns and replacing them with more positive ones
- Learning stress management skills
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Tms Treatment For Migraines
If youve experienced a migraine before, then you know its not just a headache. This is a type of headache that can cause severe throbbing pain . But there can be other unpleasant symptoms, too, such as feeling sick, increased sensitivity to light, and migraine aura .
Migraine affects an estimated 12 percent of the worlds population. In some individuals, the condition is chronic, which can be debilitating and lead to a significantly lower quality of life. Chronic migraine affects 1-2 percent of the global population. It is associated with cardiovascular disease, severe emotional distress, and sleep disorders.
Standard treatments for migraines include over-the-counter painkillers, such as paracetamol, aspirin, and ibuprofen. These can effectively reduce symptoms and tend to be most effective if taken at the first signs of a migraine attack.
However, people who struggle with severe migraines might find that painkillers dont offer the relief theyre looking for. Also, those with chronic migraine might not want to continually use these drugs, as doing so can lead to side effects, including making headaches worse.
TMS treatment for migraines can be effective, although not for everyone. A meta-analysis of five randomized controlled trials found that TMS is effective for the acute treatment of migraine with aura after the first attack.
However, the efficacy of TMS on chronic migraine was not significant.