The Links Between Bipolar Disorder and Fibromyalgia

A statue holding its head. Credit to user leadfoot. Used with permission under a Creative Commons license.

On the surface, fibromyalgia and bipolar disorders aren’t very similar diseases. Fibromyalgia is a physical illness that causes joint and muscle aches, and fatigue, as well as depression for up to 90% of patients. Bipolar disorder is a mental illness with symptoms of extreme ups and downs, known respectively as mania and depression.

Fibromyalgia and bipolar disorder appear to be linked in several different ways. Up to 25% of patients with fibromyalgia show bipolar symptoms, and the two diseases share many characteristics.

A new study out of the Federal University of Ceará in Brazil examined the shared pathophysiology–how the diseases work in the body–of fibromyalgia and bipolar disorder. The researchers found that there were “remarkable” similarities between the two sicknesses.

In the study, the scientists discovered that the brains of people with either disease are very, very similar. While the causes of bipolar disorder are numerous–ranging from environmental to genetic–and the causes of fibromyalgia aren’t known, the researchers found that both bipolar disorder and fibromyalgia shared brain structures that might contribute to the cause of other illnesses.

The study also found that both bipolar disorder and fibromyalgia are characterized by “functional abnormalities in the hypothalamic-pituitary-adrenal axis.” This means that patients of both illnesses suffer from difficulties managing their hypothalamus, pituitary gland, and adrenal glands. These abnormalities can cause depressive symptoms, as well as other symptoms like cold intolerance.

Both fibromyalgia and bipolar disorder are associated with increased markers of inflammation in the blood and the brain. This causes a dysfunction in the cells of your nervous system, hormonal abnormalities, and leads to changes in your brain’s ability to regulate moods. Higher levels of inflammation also contributes to sleep disturbances.

Bipolar disorder and fibromyalgia patients both suffer from mitochondrial dysfunction. The mitochondrion, an organelle found in every cell in the human body–except red blood cells–that produces the power needed for growth and cell division, is also affected in both disorders. Because mitochondria perform so many different functions in different tissues, there are literally hundreds of different mitochondrial diseases. Dysfunction in them–found in bipolar disorder and fibromyalgia–can cause fatigue, among other abnormalities.

In addition, patients with either bipolar disorder or fibromyalgia have difficulties producing serotonin and melatonin, feel-good chemicals which help with sleep and the ability to handle pain. Bipolar disorder and fibromyalgia are also both associated with impaired neuroplasticity, which is the brain’s ability to handle new information and adapt to circumstances.

Fibromyalgia and bipolar disorder share a number of characteristics–mostly negative ones for the people who have to endure either disease. The researchers of the study urge that future studies explore these similarities, in the hopes that both sicknesses can be treated with targeted medications.

This all means that if you have bipolar disorder, you share characteristics with fibromyalgia patients–enough so that you might want to get checked out for the latter disorder. Similarly, if you have fibromyalgia, you may want to talk to your doctor about bipolar disorder. Medications which treat fibromyalgia have been found to trigger mania in bipolar patients, which means that you need to be cautious in taking medications to treat the former disease.


A Quarter of People With Fibromyalgia Show Bipolar Disorder Symptoms

Fibromyalgia and bipolar disorder appear to be connected. New research shows that a quarter of fibromyalgia patients who were screened tested positive for bipolar symptoms. Because these diseases are found in tandem, it’s known as comorbidity. If you have one disorder going on, despite their differences, you might have both.

Credit to user CJS*64. Used with permission under a Creative Commons license.

The causes of fibromyalgia are yet to be discovered, and up to 5% of the population may be affected. More common in women, fibromyalgia is a disorder that causes muscle and joint aches. Other symptoms are fatigue, and, occasionally, depression.

Dr. William Wilke from the Cleveland Clinic in Ohio and his colleagues gave 128 patients with fibromyalgia four questionnaires. The first was the Mood Disorder Questionnaire (MDQ) for bipolar disorder, to determine the link between bipolar and fibromyalgia. Next was the Beck Depression Inventory (BDI) for depression. The scientists also used the Epworth Sleepiness Scale (ESS) for daytime sleepiness, and the Fibromyalgia Impact Questionnaire Disability Index (FIQ‐DI) to assess for functional capacity.

According to the MDQ screen, just over 25% of the patients were likely to have bipolar disorder, demonstrating a clear link between fibromyalgia and bipolar disorder. People who showed symptoms of bipolar also suffered from more severe depressions than people who didn’t show symptoms of bipolar disorder, which is really no surprise, given bipolar disorder’s depressions.

The BDI’s results were also of interest: 79% of the fibromyalgia patients were clinically depressed. Of those people, up to a third of the people who suffered from depression also reported symptoms of bipolar disorder.

The ESS showed that 52% of the patients with fibromyalgia–just over half–experienced daytime sleepiness, which doesn’t relate to bipolar disorder, but is interesting nonetheless.

Wilke’s team pointed out that some medications that treat fibromyalgia may also trigger mania in bipolar patients, and therefore doctors are urged to be cautious.

So, if you have fibromyalgia, you might want to talk to your doctor about the potential for bipolar disorder before you take medications to treat the disease, because those medications can trigger manic episodes. Similarly, if you have bipolar disorder, those muscle aches and fatigue might be something more; get screened for fibromyalgia.

What Does High Functioning Depression Look Like?

Individuals with high functioning depression suffer greatly–and their pain is often undetected. The people at have put together the following infographic to explain what high functioning depression looks like, and have chosen to share the picture with The Bipolar Parent. Enjoy!