Bipolar II is a mood disorder on the bipolar spectrum. It is diagnosed after at least one episode of hypomania (a very elevated, almost euphoric mood) and at least one episode of major depression, usually with periods of normal mood between. It is treated using antidepressants, mood stabilizers, and antipsychotics, as well as therapeutic methods. [1]

Bipolar II symptoms

People with bipolar II experience periods of hypomania and major depression, sometimes with month-long periods of normal mood between these highs and lows. These periods vary in time and do not have to be in any specific order. However, bipolar II usually has longer and more severe periods of depression than hypomania. [2]

Hypomanic symptoms include:

  • A very cheerful and elevated mood
  • High self-esteem
  • Talkative
  • Rapid cycling of thoughts
  • Easily distractable
  • Making rash and foolish decisions like unaffordable shopping sprees and unprotected sex with multiple partners

Hypomania is different from mania. Symptoms do not go far enough to constitute a full manic episode. People experiencing hypomania may be very enthusiastic and talkative; however, they do not become delusional or aimless, and you can still interrupt them. [2] Hypomanic episodes can go unnoticed, and people are more likely to seek treatment during episodes of depression.

Symptoms of depression include: [3]

  • Hopelessness
  • Low energylevels and lack of motivation
  • Little interest in hobbies or normally enjoyable activities
  • Reduced concentration
  • Helplessness
  • Lack of care for personal hygiene and health

Depressive symptoms in bipolar II disorder can be longer lasting than the hypomanic episodes and can follow immediately after a hypomanic episode or a while after. [2]

People who have bipolar II disorder are twice as likely to experience comorbid symptoms [4]. Comorbid symptoms are commonly experienced by those with the disorder but are not direct symptoms of the disorder itself.

Comorbid symptoms include:

  • Anxiety disorders
  • Eating disorders
  • Personality disorder
  • Substance use disorders

What causes bipolar II?

The exact cause of bipolar II is unknown. Bipolar spectrum disorders are thought to be caused by specific misfiring neurotransmitters in the brain, causing emotional overstimulation, which the brain cannot handle. [5] This overstimulation is what causes episodes of hypomania and depression.

Bipolar II diagnosis

The diagnostic criteria laid out in the DSM-5 [6] requires that someone diagnosed with bipolar II should have experienced at least one hypomanic episode, at least one depressive episode, and no manic episode. Additionally, the symptoms experienced shouldn’t be due to another mental health condition, and symptoms should cause significant distress and inconvenience in all aspects of life.

For a hypomanic episode, at least 3 of the following symptoms should be present for most of the day for at least four days.

  • Inflated self-esteem
  • Feeling well rested despite low amounts of sleep
  • Very talkative
  • Racing thoughts
  • Distractibility
  • Increase in goal-oriented activities
  • Doing things that are high risk

For a depressive episode, you must be experiencing low mood and at least five of the following symptoms for at least two weeks.

  • Weight loss/gain
  • Insomnia or hypersomnia
  • High agitation
  • Feelings ofworthlessness
  • Inappropriate guilt
  • Fatigue
  • Low concentration
  • Thoughts of death or suicide

Your doctor will ask you about your mood since you started noticing the symptoms and anything earlier in your life that may help with diagnosis. It may be helpful to ask family and friends if they have noticed any symptoms to tell your doctor. They may wish to ask you questions or run some tests to rule out any other causes of your symptoms.

How is bipolar II treated?

As bipolar II is a chronic disorder, treatment focuses on reducing the impact of symptoms on your quality of life and the number of episodes you experience. [3] Treatment can be given to treat either the hypomanic or depressive episodes or just to regulate mood in general.

Effective treatment for bipolar II includes medication and therapeutic methods. Your doctor or mental health professional will advise which is best for you and can give a combination of treatments to reduce your symptoms.

Medication

  • Mood stabilizers can be used to treat hypomanic and depressive episodes and include drugs such as valproate, lamotrigine, topiramate, and carbamazepine [2]. They work by reducing overstimulation in your brain and regulating normal brain functions.
  • Antipsychotics can be used as a second-line treatment for hypomanic episodes in patients who do not respond well to mood stabiliz [7]
  • Antidepressants can benefit people using mood stabilizers and antipsychotics; however, they are rarely used in isolation to treat bipolar disorders. This is because antidepressants may cause what is known as ‘switching,’ where mood swings quickly between hypomanic and depressive episodes. [7]

Therapies

Therapeutic methods are used alongside medication for the treatment of bipolar II. Therapies include cognitive behavioral therapy (CBT), mindfulness, family therapy, and interpersonal therapy. Research shows that patients who use both therapies and medication for the treatment of bipolar II are less likely to relapse than patients using medication alone [8].

How is bipolar II different from bipolar I?

Bipolar I disorder causes full manic episodes. These are more severe than the hypomanic episodes of bipolar II. A person experiencing an episode of mania can become delusional and often display self-destructive behavior with little regard for their safety or consequences.

Depressive episodes are more severe, frequent, and longer lasting in bipolar II disorder [4]. Additionally, someone with bipolar II disorder will cycle through episodes more often than someone with bipolar I.

It is a common misconception that bipolar II is a less severe form of bipolar disorder. However, this is not true. Severe manic episodes characterize bipolar I disorder, while patients with bipolar II tend to experience more severe depressive episodes. Both types can put severe burdens on people’s lives, especially if left untreated.

For more information on the differences between the two, see our page on bipolar 1 vs. bipolar 2.

Resources:

  1. Benazzi, F. (2007) Bipolar II Disorder. CNS Drugs, 21(9),727–740. https://doi.org/10.2165/00023210-200721090-00003
  2. Black, D.W., Andreasen, N.C. (2014). Introductory Textbook of Psychiatry (6th). American Psychiatric Publishing. 
  3. Benazzi, F.(2007). Bipolar disorder—focus on bipolar II disorder and mixed depression. The Lancet, 369(9565), 935–945. https://doi.org/10.1016/s0140-6736(07)60453-x
  4. Berk M., & Dodd,S. (2005). Bipolar II disorder: a review. Bipolar Disorders, 7(1), 11–21. https://doi.org/10.1111/j.1399-5618.2004.00152.x
  5. Almeida, S.,Mitjans, M., Arias, B., Vieta, E., Ríos, J., & Benabarre, A. (2020). Genetic differences between bipolar disorder subtypes: A systematic review focused in bipolar disorder type II. Neuroscience and Biobehavioral Reviews, 118, 623–630. https://doi.org/10.1016/j.neubiorev.2020.07.033
  6. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5thEdition: DSM-5 (5th ed.). American Psychiatric Publishing.
  7. Bobo, V. (2017). The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update. Mayo Clinic Proceedings, 92(10), 1532–1551. https://doi.org/10.1016/j.mayocp.2017.06.022
  8. Scott, J.,Colom, F., & Vieta, E. (2007). A meta-analysis of relapse rates with adjunctive psychological therapies compared to usual psychiatric treatment for bipolar disorders. The International Journal of Neuropsychopharmacology, 10(1): 123–129. https://doi.org/10.1017/S1461145706006900