Anxiety,Insomnia Related to BP II? Treatment?
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Q:  Anxiety, Insomnia Related to BP II?  Treatment?

Hi -

I scanned the archives and didn't find anything that covered exactly what I wanted to ask, so here goes.

Is chronic, serious insomnia a problem that could be related to my bipolar II (and more importantly, treated in some way)?  I have both chronic anxiety that is absolutly paralyzing at times, and great difficulty falling asleep and these days even staying asleep when I do.

Last week I finally ended up in psychiatric emergency due to disorientation from lack of sleep. The doctor there was not very helpful - they simply made me sleep for a night in the psych ward and released me in the morning with a handful of Kolonopin.

I had always thought of my anxiety and insomnia as something seperate from Bipolar II, which I understood as just depression and hypomania. But  have seen a few hint s on your site that they might actually be related. I really want to know if they are, and if so, what's the treatment that has worked for others?

Finally, I'll leave with a brief background in case it helps.

I have had a mood disorder since at least puberty. My first diagnosis was borderline personality along with major depression. For the last five years it has been Bipolar II. I have tried many medications, but nothing seemed to work well. The last doctor I had put me on prozac, celexa and seroquel.

I currently do not have a psychiatrist and am having great difficulty finding one that understands Bipolar  II. By now, my illness has progressed to the point I have great difficulty working and sometimes contemplate suicide because its so hard to live like this.


ps - I really appreciate your site. Its been very helpful.

Dear Kim -- 
You're right, there's not much detail on my site about how anxiety can be a symptom of bipolar disorder.  I haven't found much on that subject in the literature either.  But I can tell you for sure that I see this all the time amongst my patients (and I think far more often in women than in men, almost exclusively, in fact).  And similarly surely, it gets better when I treat the mood cycling -- that's how I came to think they were related, you see.  I didn't start out to treat the anxiety, but rather the mood symptoms, and then lo, the "anxiety" was getting better too.  And getting worse, often the only symptom really, besides sleep problems, when I added an antidepressant (which I don't do anymore, ok hardly ever anyway, as a result).  

Quick, go to some doc' somewhere and ask for a trial of mood stabilizers (maybe several at low dose if that's what it takes to avoid side effects) without antidepressants.  (If you're on an antidepressant now, don't stop it, but wait until the mood stabilizers are getting going and then gradually taper, taking as much as 4 months if things are going a lot better).  You have highly treatable symptoms!  Go to an ER if the suicidal stuff gets too bad (and there are some nice resources on the net for that too, but stay safe!). 

Dr. Phelps

Published September, 2001



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