Having a mental illness can change your life. Major depressive disorder, bipolar disorder, or any other mental illness can alter the way you live every day. While this can certainly be hard, perhaps even more difficult is a diagnosis of two or more mental illnesses.
Having more than one medical illness is known as a comorbid condition. Unfortunately, comorbid mental illnesses are more common than most people think.
Comorbidity in Major Depression
The most common comorbidity with major depression is an anxiety condition. The comorbidity rate can be up to 60%. It’s so prevalent that the appearance of one disorder is often considered a predisposing factor for the other. Approximately 5-9% of the general adult population has an anxiety and depression diagnosis.
Patients with major depressive disorder also have higher rates of psychotic disorders and suicidal risk. Those with a higher suicide risk may have a higher risk of anxiety or psychotic disorder.
Comorbidity in Bipolar Disorder
Comorbidity in bipolar disorder is the rule rather than the exception. In fact, 95% of people with bipolar disorder in the National Comorbidity Survey met criteria for three or more lifetime psychiatric disorders. In a Stanley Foundation Bipolar Treatment Outcome Network, 65% met the Diagnostic and Statistical Mental Illness, Version IV criteria for at least one other mental disorder.
Common comorbid conditions in bipolar disorder include:
- Anxiety disorders such as generalized anxiety disorder, obsessive-compulsive disorder and others; panic disorder being the most common
- Alcohol and substance use disorders
- Attention-deficit/hyperactivity disorder (ADHD)
- Personality disorders such as borderline personality disorder
- Eating disorders
I have bipolar disorder and have high anxiety symptoms. As the research suggests, this creates a worse illness course and a more complex treatment regimen. For example, if I take a medication designed to address bipolar depression (a common mood state for me), it’s often what is called “activating.” In other words, it can give me extra energy. Instead of that being a good thing, this tends to increase my anxiety.
Anxiety is particularly prevalent during the mixed states of bipolar disorder, and I find these to be the worst. In a mixed state I experience depression and hypomania symptoms at the same time and then, on top of that, generalized anxiety. This makes me especially tricky to treat.
It should be noted that dual diagnosis with substance use disorders are more common in bipolar disorder than in any other psychiatric disorder. Comorbid substance use disorder has been found in 61% of patients with bipolar I disorder and 48% of bipolar II patients.
Dealing with Multiple Mental Illnesses
Dealing with multiple, simultaneous mental illnesses makes treatment more challenging. People in this group tend to require higher doses of medication, longer-term medication and may be more resistant to treatment altogether. Nonetheless, the good news is that when one condition improves, the other usually does as well.
According to Psychiatric Times, when treating depression and comorbid anxiety:
- General medical conditions that could mimic anxiety need to be ruled out.
- A low-dose antidepressant that has shown to be useful in depression with anxiety should be started, gradually increasing to an optimum dose. This should be done slowly as people with anxiety and depression are more sensitive to side effects.
- Antidepressants can induce anxiety in some, so this should be watched for, particularly in the early stages of treatment.
- Benzodiazepines can be used for a short period while treatment is beginning and symptoms are severe.
Therapy alongside pharmaceuticals can also be very helpful for these people.
Treating comorbidity in bipolar disorder is more complex because more illnesses tend to co-occur. While antidepressants are indicated for some comorbid conditions like anxiety, they are counterproductive for bipolar disorder. Therefore, mood stabilization tends to be the first priority in treatment. Doing this may improve the comorbid condition.
When treating bipolar and comorbid anxiety:
- Mood stabilization should be achieved before any type of antidepressant is considered. This strategy reduces the risk of antidepressant-induced mania or cycling.
- Appropriate medications that may stabilize bipolar and reduce anxiety include:
- Benzodiazepines (other than alprazolam)
As for the additional conditions that typically occur alongside bipolar disorder, little data on that is available. When people have bipolar and one of these other illnesses, they are typically treated using clinical experience as guidance.
Coping with multiple mental illnesses can seem like an impossible feat. With help from mental health professionals and support from loved ones, however, you can live a full life and work a more peaceful life.