Comorbid anxiety problematic for adolescents with bipolar disorder

Nov 5 2013

By Ingrid Grasmo, medwireNews Reporter

Anxiety disorders are common in children and adolescents with bipolar disorder and adversely affect their outcomes, suggest study findings.

The 5-year follow-up study found that 62% of 413 children and adolescents aged 7–17 years with confirmed bipolar disorder had at least one anxiety disorder. Of these, about half were diagnosed with two or more anxiety disorders.

"Our findings are consistent with prior clinical and epidemiologic studies in which anxiety disorders have been reported at high rates among youth with [bipolar disorder],” Regina Sala (King's College London, UK) and co-authors report in the Journal of the American Academy of Child & Adolescent Psychiatry.

They add that “[bipolar disorder] youth with anxiety have significantly longer time to recovery from the index episode and more mood recurrences."

Specifically, they found that bipolar disorder patients with anxiety had a significantly higher rate of any mood recurrences (76.0% vs 56.4%) and particularly depressive recurrences (64.9% vs 49.4%), as well as a longer median time to recovery (138.3 vs 86.6 weeks) compared with bipolar disorder patients without comorbid anxiety.

The effect of anxiety on recovery time disappeared, however, when the researchers controlled for the severity of depression at enrollment.

The study also revealed that adolescents with bipolar disorder and comorbid anxiety were asymptomatic for just 37.5% of weeks during follow-up, whereas those without comorbid anxiety were asymptomatic for 55.2% of weeks.

This effect on outcome was greatest for those with two or more anxiety disorders, who were asymptomatic for 33.2% of weeks during following-up, compared with 42.7% of weeks for those with one anxiety disorder. They also spent a greater percentage of weeks with mood symptomatology (21.8 vs 15.1%), syndromal depression (8.7 vs 4.5%), and subsyndromal mixed cycling (19.4 vs 13.2%) compared with bipolar disorder adolescents with one comorbid anxiety disorder.

Bipolar disorder patients with comorbid anxiety also spent a significantly greater proportion of time with syndromal mixed/cycling (18.8 vs 10.2%) and subsyndromal depressive symptoms (43.7 vs 34.6%) compared with those without comorbid anxiety.

Sala and team comment that despite the high rates of comorbid anxiety disorders in bipolar disorder, no studies have been conducted to identify the correct management of comorbid anxiety in this patient population.

"Prompt recognition and the development of treatments for anxious [bipolar disorder] youth are warranted," they conclude.

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