Comorbidity of bipolar and anxiety disorders: An overview of trends in research

Table 6 Treatment of anxiety disorder comorbidity in bipolar disorder

	Findings	Ref.
Pharmacotherapy
Evidence base	Few RCTs of treatment of comorbid anxiety disorders in BD	[7-10,15,22,26,49,55,60,141,142,157-162]
	RCTs of treatment of BD reporting change in anxiety symptoms as secondary outcomes	[6,10,26,15,16,25,33,49,162]
Principles of treatment	Mood stabilization is the first priority	[3,6,7,9,10,12,15,48,49,55,128,157-159,162]
Add-on treatments	SGAs e.g., quetiapine and olanzapine first line choices	[6,7,9,10,12,15,17,22,26,33,48,55,128,141,142,158-162]
	SSRIs e.g., paroxetine but risk of mood destabilization	[6,7,9,10,12,15-17,22,25,26,33,48,55,128,157-159,162]
	Anticonvulsants e.g., valproate, lamotrigine and gabapentin but no strong evidence	[6, 7, 9, 10, 12, 15, 17, 22, 25, 48, 55, 60, 67, 158, 159, 162]
	Benzodiazepines only for short-term treatment because of risk of abuse and dependence	[6,7,9,10,15-17,22,33,48,162,163]
Psychotherapy
Evidence base	Psychotherapy such as CBT may be effective in promoting recovery in those with comorbid anxiety and BD but there are only a few RCTs	[10,22,25,26,162,164-171]
Principles of treatment	Psychotherapy such as CBT is a first-line add-on treatment option	[6,7,9,12,10,15,17,22,25,26,67,128,157-159,162,164,165]

BD: Bipolar disorder; RCTs: Randomized controlled trials; SGAs: Second generation antipsychotics; SSRIs: Specific serotonergic reuptake inhibitors; CBT: Cognitive behavioural treatment.