Q. I am bipolar and have great amounts of anxiety. What suggestions do you have to control the high level of anxiety?

A. That all depends on the source of the anxiety. If it is stemming from incompletely or sub-optimally treated bipolar disorder, then that needs to be treated. If the anxiety is due to an independent anxiety disorder-such as social phobic disorder, panic disorder, or generalized anxiety disorder-that, too, must be effectively treated. If the anxiety is due to psychosocial stressors, such as your job or personal life, then that must be dealt with. If the anxiety is related to an underlying physical problem-such as excessive thyroid function or caffeine intake-that must be diagnosed and treated. If the anxiety is actually a "side effect" of some medication you are taking, then that needs to be addressed.

Depending on the nature of the anxiety, a variety of medications may be worth considering, including gabapentin [Neurontin], which is also used adjunctively in bipolar disorder. In short, talking about "anxiety" is like talking about "engine trouble"-it's a problem in search of a diagnosis. It is therefore critical that you speak with your psychiatrist about your anxiety, so that he or she can perform a careful evaluation. Remember: there is no successful treatment without successful diagnosis!

In the mean time, it certainly wouldn't hurt to learn some simple relaxation techniques, involving muscle relaxation, deep breathing, and meditation. A good reference for this is The Anxiety and Phobia Workbook, by E. J. Bourne, PhD. You may also want to speak with your doctor about joining a stress-reduction support group, if that seems to be the underlying problem. I hope you feel better soon.

July 2001

Disclaimer Back to Ask the Expert