Fibromyalgia and Bipolar Disorder: Overlap, Therapy, Prognosis
In a noted association, both bipolar disorder and fibromyalgia have been found to share common ground, with many patients experiencing these conditions concurrently [1][2]. This co-occurrence complicates diagnosis and treatment due to overlapping symptoms such as sleep disturbances, fatigue, cognitive difficulties, mood fluctuations, anxiety, depression, and physical pain.
Fibromyalgia, a chronic pain condition involving central nervous system pain amplification, is often accompanied by mental health issues including bipolar disorder, depression, and anxiety [1]. Approximately one third of fibromyalgia patients may meet criteria for bipolar disorder or other psychiatric conditions [1]. The overlap suggests shared neurobiological mechanisms related to mood regulation, pain processing, and neurochemical imbalances.
Managing both conditions simultaneously requires careful approaches. Medication management is crucial, as some treatments for fibromyalgia (like antidepressants or SNRIs such as Savella/duloxetine) may worsen bipolar symptoms (e.g., agitation, irritability) [5][2]. Mood stabilizers are, therefore, critical for bipolar patients also treated for fibromyalgia.
Non-pharmacological strategies also play a significant role. These include gentle exercise, cognitive behavioral therapy, mindfulness, stress management, and sleep hygiene [2].
Both conditions have difficulty managing stress. Alterations in monoamine neurotransmission pathways have been found in both bipolar disorder and fibromyalgia [3]. Impairment in how the brain adapts to experiences and changes has also been observed in both conditions [4].
The exact causes of both bipolar disorder and fibromyalgia remain unknown. The cause of fibromyalgia is currently unknown, but it is thought that issues with a person's central nervous system may be responsible, and fibromyalgia seems to run in families, which could mean that genetics play a role in its development [6]. The exact cause of bipolar disorder is unknown, but it is thought to result from a combination of genetics, stress, and brain function or structure [7].
During manic periods, a person with bipolar disorder may feel very high, jumpy, more active, less need for sleep, extremely irritable, have an intense desire for pleasurable activities, feel unusually important, and talk quickly and erratically [2]. During depressive episodes, a person with bipolar disorder may experience extreme sadness, anxiety, restlessness, trouble concentrating, sleeping issues, slowed speech, forgetfulness, lack of interest in activities, difficulty completing simple tasks, feelings of hopelessness or worthlessness, and thoughts of death or suicide [8].
The symptoms of fibromyalgia include pain and stiffness all around the body, fatigue, tiredness, depression, anxiety, sleep problems, problems with memory, concentration, or thinking, headaches, migraines, tingling or numbness in the hands or feet, pain in the face or jaw, digestive problems, and irritable bowel syndrome (IBS) [2].
Environmental risk factors, such as trauma during childhood, may affect people with bipolar disorder or fibromyalgia more than the general population [9]. A 2015 review found that among participants with fibromyalgia, 21% also had bipolar disorder [10]. The authors of a 2016 study believe that the causes of bipolar disorder and fibromyalgia may overlap [11]. Metabolic and cardiovascular issues have also been associated with both conditions [2].
In summary, bipolar disorder and fibromyalgia frequently co-occur, sharing symptoms and possibly underlying mechanisms, necessitating integrated treatment plans that address both pain and mood regulation [2][1][5].
Fibromyalgia, often accompanied by mental health issues, may show a shared neurobiological basis with bipolar disorder, as both conditions have been observed to involve impairments in monoamine neurotransmission pathways and altered brain responses to stress [3]. Consequently, managing symptoms of both disorders requires a comprehensive health-and-wellness approach that includes mental-health considerations, non-pharmacological strategies, and careful medication management.
