Antipsychotics in the Treatment of Comorbid Anxiety in Bipolar Disorder

The comorbidity of anxiety disorders with bipolar disorder is a rule, not an exception, with a negative impact on both course and treatment outcome. So far, there are no guidelines or consensus for the treatment of this comorbidity. There are also no efficacy data that support the use of antidepressants or benzodiazepines in the treatment of anxiety disorder in this population. Benzodiazepines, the second-line agents for some primary anxiety disorders, may be riskier for patients with bipolar disorder because they are associated with a high rate of comorbid substance use disorder. Some preliminary data have shown that antipsychotics, especially atypical anti- psychotics, may be a viable alternative for patients with comorbid bipolar and anxiety disorders with or without substance use disorder.

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