Patient description: A 26-year-old obese woman with a history of bipolar disorder complains that her recent struggles with her weight and eating have caused her to feel depressed. She states that she has recently had difficulty sleeping and feels excessively anxious and agitated. She also states that she has had thoughts of suicide. She often finds herself fidgety and unable to sit still for extended periods of time. Her family tells her that she is increasingly irritable. Her current medications include lithium carbonate and zolpidem.

Clinical trial eligibility criteria: eligible ages (years): 18.0-65.0,  Bipolar Disorder Panic Disorder Generalized Anxiety Disorder Subjects must be at least 18 years of age and not older than 65 Subjects must have lifetime bipolar I, II, or NOS disorder as defined by DSM-IV TR Subjects must have lifetime panic disorder or generalized anxiety disorder (GAD) as defined by DSM-IV (except clause "does not occur exclusively during a mood disorder" of Criterion F for GAD) Subjects' bipolar symptoms must be no more than moderate in severity, defined as a CGI-BP< 4 Subjects' anxiety symptoms must be at least moderate in severity, defined as a CGI-S > 4 Subjects must not be receiving regular mood stabilizing, antidepressant, antipsychotic, or anxiolytic medication for at least one week prior to baseline. Patients receiving fluoxetine or depot antipsychotics should be off these medications for at least four weeks prior to baseline Subjects or their legally authorized representative must sign the Informed Consent Document after the nature of the trial has been fully explained If female, subjects must be: postmenopausal, surgically incapable of childbearing, or practicing medically acceptable effective method(s) of contraception (e.g., hormonal methods, barrier methods, intrauterine device) for at least one month prior to study entry and throughout the study  Subjects who do not have lifetime bipolar disorder by DSM-IV-TR Subjects who do not have lifetime panic disorder or generalized anxiety disorder by DSM-IV-TR Subjects who are receiving treatment with an anti-manic or mood stabilizing medication (lithium, valproate, carbamazepine, or an antipsychotic), and in the investigators' judgment, require ongoing treatment with that medication Subjects whose bipolar symptoms are presently more than moderately severe (CGI-BP>5) Subjects whose anxiety symptoms are presently less than moderately severe (CGI-S<3) Subjects with clinically significant suicidal or homicidal ideation Subjects with a current DSM-IV TR Axis I diagnosis of delirium, dementia, amnesia, or other cognitive disorders; a DSM-IV TR diagnosis of a substance dependence disorder within the past six months; a lifetime DSM-IV TR psychotic disorder (e.g., schizophrenia or schizoaffective disorder) Subjects with serious general medical illnesses including hepatic, renal, respiratory, cardiovascular, endocrine, neurological, or hematological disease as determined by the clinical judgment of the clinical investigator. Subjects with hypo-or hyperthyroidism unless stabilized on thyroid replacement > 3 months Subjects with a clinically significant abnormality in their pre-study physical exam, vital signs, EKG, or laboratory tests Subjects who are allergic to or who have demonstrated hypersensitivity or intolerance to either of the active study medications