Comorbidities and Bipolar Disorder

Doctors use the term "comorbidity" to describe a health condition that occurs at the same time as another condition. Comorbid illnesses can interact in ways that make both worse. Morbidity is not the same thing as mortality. Morbidity means disease or illness, while mortality means death.¹

Bipolar disorder (BPD) tends to have many co-occurring mental and physical health conditions. In fact, most people with bipolar 1 disorder have 3 or more other health conditions. These comorbidities complicate treatment plans and often go untreated.²

Some of the most common comorbidities of bipolar 1 disorder are:^2-4

• Heart (cardiovascular) disease
• Overweight and obesity
• Anxiety
• Attention-deficit/hyperactivity disorder (ADHD)
• Post-traumatic stress disorder (PTSD)
• Substance use disorders
• Combined high blood pressure, high cholesterol, and high blood sugar (metabolic syndrome)
• Type 2 diabetes

Bipolar 2 disorder tends to come with slightly different comorbidities. Over half of people with bipolar 2 disorder live with 3 or more other mental health conditions, primarily anxiety. Other comorbidities include eating disorders and premenstrual syndrome.²

Since co-occurring conditions are so often untreated in people with BPD, they tend to lead to shorter life spans. On average, people with BPD live 10 years less than people without the condition.^2,4

Heart disease and metabolic syndrome

Heart disease is also called cardiovascular disease. “Cardio” means heart, and “vascular” means blood vessels. Heart disease is closely linked to metabolic syndrome and type 2 diabetes, since those conditions put extra strain on the heart and blood vessels.^4-6

Metabolic syndrome is a group of conditions that increase your risk of heart disease, stroke, and type 2 diabetes. The conditions that make up metabolic syndrome are:⁶

• High blood pressure
• High blood sugar
• Extra fat around the waist
• High cholesterol levels

People with BPD have almost double the risk of death from heart attacks and strokes. These are conditions of the heart and blood vessels.³

Doctors do not fully understand why BPD leads to more heart disease and metabolic syndrome. However, obesity and inflammation in the body seem to play a role. The medicines used for bipolar are also associated with the development of metabolic syndrome. Also, bipolar depression in particular may contribute to unhealthy lifestyle habits such as poor diet, lack of exercise, alcohol use, and smoking.^4,5

Overweight and obesity

Many of the prescription drugs used to treat BPD can lead to weight gain. Being overweight or obese increases a person’s risk of developing metabolic syndrome, heart disease, and stroke. Also, an unhealthy body weight is linked to:³

• More – and more severe – bipolar episodes
• Higher doses of medicines are necessary to achieve the same result
• Higher risk of suicide

Other mental health conditions

Studies show that people with BPD have higher rates of several other mental health conditions. Experts do not understand why this is. But having multiple mental health conditions is linked to more severe and frequent episodes as well as a lower quality of life.³

Half to two-thirds of people with BPD also have one or more of these mental health issues:^2,3

• Anxiety disorders such as general anxiety, social anxiety, or panic disorder
• ADHD
• PTSD
• Alcohol or other substance use disorder
• Borderline personality disorder
• Eating disorders, especially binge eating disorder
• Schizophrenia
• Antisocial personality disorder
• Premenstrual syndrome

Anxiety

Anxiety disorders are common in people with BPD. They also commonly occur with several of its comorbidities, like PTSD. The good news is that antianxiety medicines work well to treat symptoms of both conditions. Antidepressants generally should not be used.⁷

ADHD

ADHD can lead to long-term (chronic) overreaction to stress. This is easy to confuse with the irritability that comes with bipolar mania. Stimulants may help treat both conditions but will be monitored closely due to risk of causing mania.⁷

PTSD

PTSD is common in people with bipolar disorder, especially veterans. It can be hard to diagnose and properly treat both conditions because the irritability of PTSD and mania may look similar.⁷

A typical bipolar medicine like valproate may help with bipolar symptoms but not PTSD. It may be necessary to take different medicines to treat both conditions properly.⁷

A leading cause of disability

The symptoms and comorbidities of BPD make it one of the top 10 leading causes of disability worldwide. To properly treat bipolar and its many comorbidities, a healthcare team must address both mental and physical symptoms. Early diagnosis and management of all of a person’s health challenges will improve their quality of life.^3,4