What is Bipolar II Disorder?

Bipolar disorder is a condition that causes unusual shifts in mood, energy, activity levels and the ability to carry out day-to-day tasks. Bipolar II disorder is diagnosed when a person experiences a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes found in bipolar I disorder. However, some Bipolar II patients may have longer lasting and more severe bouts of depression.

Bipolar II Signs & Symptoms

For a diagnosis of bipolar II disorder, a person must have experienced at least one hypomanic episode, during which he or she may feel euphoric or irritable and exhibit abnormal behaviors. Symptoms of these episodes include:

• Decreased need for sleep
• Excessive spending
• Flying quickly from one idea to the next
• Hypersexuality
• Increased energy and hyperactivity
• Inflated self-image
• Making and pursuing grandiose, unrealistic plans
• Rapid, uninterruptable and/or loud speech
• Substance abuse

A hypomanic episode is characterized by higher-than-usual energy levels. These episodes will be noticeable to others but are not as extreme as manic episodes, which may include hospitalization, hallucinations, paranoid thoughts, or other breaks with reality. 

Most people with this disorder have also experienced periods of depression. Depressive episodes in bipolar II disorder may include:

• Depressed mood (persistent sadness)
• Feelings of guilt or worthlessness
• Loss of interest or pleasure in activities
• Low energy and activity

How is Bipolar II Diagnosed?

Diagnosing bipolar II disorder requires thorough physical and psychological evaluation. Your behavioral health physician will use the criteria for bipolar II disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to determine if your symptoms indicate the condition.

Diagnostic tests include:

Physical examination: Your physician will perform a physical exam and ask questions about your health to determine if your symptoms could be linked to an underlying physical health problem.

Psychiatric evaluation: Your behavioral health physician will ask about your symptoms, thoughts, feelings and behavior patterns. You will be asked about your personal and family history of mental illness, bipolar disorder and other mood disorders – as bipolar disorder often has a genetic component. Your behavioral health physician may also ask questions to test your reasoning, memory and ability to express yourself.

How Do You Get Bipolar II Disorder?

The cause of bipolar II disorder is unknown, but research has shown that it can have a genetic component and run in families. Multiple factors – including stress, lack of sleep, and alcohol or substance abuse – may interact to trigger abnormal brain circuit function. People with both types of bipolar disorder appear to have physical changes in their brains, and researchers are investigating their significance.

Risk Factors

Risk factors that could contribute to bipolar II disorder include:

Family history: Many studies have found that people with bipolar II disorder often have at least one close relative with bipolar disorder or depression. 

Excessive alcohol or drug use: Though these behaviors are not thought to cause bipolar II disorder, substance abuse can trigger bipolar symptoms.

Lack of sleep: Though not thought to be a causative factor on its own, lack of sleep increases the risk of hypomanic episodes in a person with bipolar II disorder.

Stress: While a stressful event does not cause bipolar II disorder, it can trigger hypomanic or depressive episodes in people biologically vulnerable to bipolar disorder.

Prevention

Bipolar II disorder cannot be prevented. Seeking treatment at the earliest sign can help prevent the condition from getting worse or interfering with your life. 

If you’ve been diagnosed with bipolar II disorder, these strategies can help you reduce the number or severity of hypomanic or depressive episodes:

Don’t abuse alcohol or recreational drugs: These substances have a mood-altering effect that could trigger symptoms.

Seek help at the first warning signs: Call your behavioral health physician if you feel symptoms of a hypomanic episode or depression coming on. 

Seek support for stress: Lean on family and friends, if possible, during stressful situations. Talking to a behavioral health professional can also help you develop effective coping strategies.

Take your medications as directed: Never abruptly stop taking a medication, as it can make symptoms worse. Always talk to your physician if you feel your medication is causing side effects. 

Prognosis

Proper diagnosis and treatment help people with bipolar II disorder lead healthy and productive lives.

Bipolar II Treatment

Most people with bipolar II disorder benefit most from a combination of medication and psychotherapy delivered by a psychiatrist, psychologist or other behavioral health professional.

Bipolar II Medication

You may need to try a few different medications, or medication combinations, before you find the one that’s right for you. Some medications take a few weeks before their full effect is obvious. Some cause side effects for certain patients. If you experience any side effects, it’s important to talk to your physician immediately but not to abruptly stop taking the medication, which could cause a worsening of symptoms.

Common medications prescribed for bipolar II disorder include:

• Antidepressants: These medications may be prescribed to help manage depression, but – because they can sometimes trigger hypomanic episodes –they’re often prescribed along with a mood stabilizer or antipsychotic medication. An antidepressant's goal is often to lessen the depression enough for a patient to feel able to employ healthy coping skills. 
• Antipsychotics: While psychotic episodes are not present in bipolar II disorder, these drugs are sometimes prescribed when hypomanic or depressive symptoms persist despite treatment with mood stabilizers.
• Benzodiazepines: These drugs are used for short-term control of acute symptoms associated with hypomania such as insomnia or agitation.
• Mood stabilizers: These medications control hypomanic episodes and seek to assist patients in more even mood modulation. 

Psychotherapy

Also known as talk therapy or psychological therapy, this involves talking about your condition, symptoms, mental health history and life with a mental or behavioral health professional. This type of therapy can help you establish consistent and healthy routines, identify negative behaviors and beliefs and replace them with positive ones, learn about your disorder and educate your loved ones, and improve family support and communication to better manage manic symptoms. 

Other Treatment Options

• Electroconvulsive therapy (ECT): Usually reserved for people who don’t improve with medication, this therapy involves electrical currents passed through the brain to impact the function and effects of neurotransmitters.
• Alternative medicine: These approaches aren’t a replacement for medical treatment or psychotherapy, but can sometimes serve as complementary therapies. Nonmedical treatments like acupuncture, meditation, massage therapy, yoga or tai chi may be helpful – when combined with medication and psychotherapy – for some people.

Complications

Early and ongoing treatment is key for managing bipolar II disorder. Left untreated, the disorder can be disruptive to a person’s life, leading to:

• Damaged or difficult relationships
• Drug and alcohol abuse (self-medicating)
• Full-blown manic episodes
• Poor physical health
• Reduced work or school performance
• Legal and financial problems
• Suicide attempts or suicide (stemming from depression)

Some people with bipolar II disorder also have other physical or behavioral health conditions that can make the disorder worse or harder to treat. It’s important to seek treatment for these conditions as you seek treatment for bipolar II disorder:

• Anxiety disorders
• Attention-deficit/hyperactivity disorders
• Alcohol or drug abuse
• Chronic health conditions like heart disease, thyroid problems or obesity
• Eating disorders