Bipolar disorder and PTSD often show up in the same person. When they do, each one makes the other harder to manage. The racing thoughts that come with mania can feel like flashbacks. Poor sleep feeds both conditions. Something that looks like depression might actually be avoidance, or the other way around.
This happens more often than you’d think. A comprehensive review of comorbid bipolar disorder and PTSD found that about 16 percent of people with bipolar disorder also have PTSD at some point in their lives. In some groups, that number jumps to 40 percent.
Why These Conditions Happen Together
Some of the reasons are obvious. Both mess with your sleep. Both make it hard to focus. Both can lead to using drugs or alcohol to cope. But there’s more going on underneath.
Sleep is where things get complicated. Research tracking sleep loss as a trigger of mood episodes in bipolar disorder followed over 3,000 adults and found that losing sleep often triggered mood episodes, especially mania. If you already wake up from nightmares or can’t sleep because of hypervigilance, that risk gets worse. You’re working with less room for error.
The symptoms can look alike, too. PTSD hyperarousal can look like mania. Feeling numb from trauma can look like bipolar depression. Both conditions can make you irritable. Even doctors with years of experience have to look closely at when symptoms happen and what triggers them. Does your mood shift after something reminds you of trauma? Or does it seem to come from nowhere, maybe linked to changes in your sleep schedule or the season? That difference matters for treatment.
It helps to know what sets them apart. PTSD brings specific memories back through flashbacks and nightmares. Bipolar disorder moves through mood episodes that might not need an outside trigger. But when you have both, the lines blur. A flashback during a manic phase feels different than one when your mood is stable. Trying to process trauma when your mood is unstable can stir up more than you can safely handle.
Getting Treatment in the Right Order
Treatment works better when it happens in a specific order. First, get your mood stable. Then work on the trauma.
A recent JAMA review of bipolar disorder diagnosis and treatment recommends starting with mood stabilizers like lithium, valproate, or lamotrigine. Sometimes doctors add certain antipsychotics. Using an antidepressant by itself is risky. The NIMH bipolar disorder brochure explains that antidepressants might help with bipolar depression, but you need a mood stabilizer alongside them. An antidepressant alone can flip you into mania or make your moods cycle faster. That’s especially dangerous when PTSD is already making sleep fragile.
Once your mood steadies, trauma therapy becomes safer. The VA’s overview of psychotherapy for PTSD explains that individual trauma-focused therapy works best. This includes Cognitive Processing Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing. These therapies help, but they bring up strong emotions. You need a stable baseline to handle that.
Some people also use medications for PTSD symptoms. The clinician’s guide to medications for PTSD lists options and cautions. Doctors think carefully about each choice when you have bipolar disorder. Prazosin might help with nightmares without messing up your mood. Antidepressants need close watching. The wrong medication at the wrong time can erase months of progress.
This order isn’t set in stone. Some people need immediate help with trauma symptoms even while their mood is still shaky. Learning to ground yourself, planning for safety, and fixing your sleep can all happen while you’re getting mood stable. What matters is waiting to dig into deep trauma work until your nervous system is ready.
How We Put It All Together
We look at everything happening for you through our dual diagnosis program. When someone comes to us with both conditions, we build a single plan that covers both instead of treating each problem separately.
We start by figuring out what needs attention first. If mood swings threaten your safety, we focus there. We use medication, sleep support, and close check-ins. If trauma symptoms are the bigger problem but your mood is steady enough, we might start with PTSD treatment while watching carefully for mood changes.
Many people do well with EMDR therapy, once things stabilize. Our therapists adjust how fast we go, check in often about sleep and energy, and stay in touch with your prescriber. If a session brings up too much and your mood starts shifting, we pause the trauma work and focus on stability again. This isn’t failure. It’s being careful with real risk.
When bipolar symptoms mix with substance use, the integrated approach at The Differents dual diagnosis program brings together psychiatric care, trauma therapy, and support for staying sober. Often people start using drugs or alcohol to manage either the mood swings or the trauma symptoms. It makes both worse. Treatment has to address all three.
What To Do Next
If you’re dealing with both conditions at the same time, you don’t have to figure this out alone. Our admissions team will listen to what’s happening now and help you figure out a safe next step that fits your life.
To learn more about how we address mood disorders, visit our page on bipolar disorder treatment. If you’d rather talk it through with someone, you can contact The Differents today.
FAQs: Bipolar Disorder and PTSD
How common is it to have both conditions?
More common than most people think. Large studies show PTSD happens more often in people with bipolar disorder than in the general population. When you have both, getting treatment in the right order really matters.
Can trauma therapy make mania worse?
Any therapy that brings up strong emotions can be hard if your sleep and energy are shaky. Doctors usually get mood stable first and then pace trauma work based on what you can handle. If you notice you’re sleeping less, your thoughts are racing, or you’re taking bigger risks, tell your treatment team right away.
Are there medications that help both conditions?
Some medications help bipolar symptoms and sleep, which can support PTSD recovery too. Other medications target specific PTSD symptoms. What works varies from person to person. You need to work with a prescriber who understands both conditions.
What can I do to help myself?
Protect your sleep by going to bed and waking up at the same time every day. Keep a simple daily routine. Notice early warning signs that your mood is shifting. Even small improvements in sleep can make both trauma reactions and mood swings less intense.
When should I get urgent help?
If you’re thinking about suicide, seeing or hearing things that aren’t there, your mood is getting worse fast, or you can’t keep yourself safe, you need evaluation now. For immediate danger, call or text 988 in the United States, or call 911.
