Bipolar II Disorder might be more common than you realize.
Bipolar II is diagnosed when a person experiences episodes of hypomania and depression. Since the “highs” are not a full manic episode it is also referred to as “soft bipolar”, though this term is a little misleading.
The term was coined because the symptoms in Bipolar II are usually perceived as being less severe, especially regarding the absence of “highs” as severe as those that occur during manic episodes.
A good example of this common stereotype about Bipolar II being ‘not as bad as” Bipolar I is that psychosis is not a symptom of Bipolar II.
Bipolar II is still a troubling mood disorder and sufferers may be subject to classic Bipolar symptoms such as serious and recurring depression, as well as subtler ones. Confusing periods of irritability, impulsiveness and agitation are a few examples.1
On the other hand, the milder “highs” can be enjoyable and energizing and are less likely to lead to the terrible repercussions of full-blown mania.
Bipolar II Disorder is more common than you may realize.
What is Bipolar Disorder 2 Disorder?
What differentiates Bipolar II from other classifications of this disorder is the mania. This is why it is referred to as “hypomania”. It is a less intense form of the mania that people with Bipolar I suffer with.
When it comes to the depressive episodes, these can be more intense and even longer lasting. While it is might be considered the “milder form of Bipolar”, if you’ve been through one these “lows” then you know that there is nothing “less intense” about them.
This is also part of the difference between Cyclothymia Disorder and Bipolar II. Cyclothymia Disorder is a rare disorder, though it is similar to Bipolar Disorder. While the highs and lows might be milder, just like Bipolar II, the episodes are more frequent. Cyclothymia Disorder is not to be confused with any of the Bipolar Disorders, as in this disorder, the person never experiences a full hypomanic or depressive episode, but they do experience some hypomanic symptoms and/or some depressive symptoms.
Many people read about Bipolar II in the mass media and self-diagnose when they should see a qualified mental health professional and undergo a formal evaluation. Only then will they understand if they truly experience bipolar symptoms and what the appropriate treatments may be.
What is the difference between Bipolar I and Bipolar II? Let’s look at some definitions:
Bipolar I: The individual has experienced episode(s) of mania, with or without a history of depressive disorders.
Bipolar II: The individual has experienced episode(s) of both hypomania and depression (and has never experienced an episode of mania or had psychotic episodes/symptoms).
Due to the absence of full manic episodes and no experience with psychotic symptoms, Bipolar II disorder is sometimes known as “soft bipolar”. It is assumed that if you don’t have mania or psychosis, then you’re not so bad off. However, depression is still present in Bipolar II, instead of mania and the depression can be severe and debilitating. The person suffers from hypomania – a milder form of mania.
So, one way of understanding the differences between hard and soft Bipolar, or Bipolar I and Bipolar II, is to understand the differences between MANIA and HYPOMANIA.
“Mania” is a high mood that is of distinct severity and where the individual is often psychotic in the sense of having delusions (e.g., unusual beliefs) and/or hallucinations (i.e., perceptual disturbance, such as hearing, seeing, smelling, or feeling things that are not there).
“Hypomania” comes from Greek word and means “less than mania.” It describes a high that is less severe than a manic episode and without any psychotic features.
Bipolar I Disorder is a more severe disorder, with longer and more debilitating “highs,” which may involve psychosis. People experiencing a manic episode are far more likely to require hospitalization.
Bipolar 2 Symptoms
The symptoms for Bipolar II have some similarities with Bipolar I, but for lesser severity of mania. only without the intense mania. People with Bipolar II Disorder can typically fulfill the duties of their everyday life (e.g., the person can usually go to work, interact with others, etc. With a manic episode in people with Bipolar I, things like socializing, working, or interacting with others are difficult or impossible. During hypomania you might feel,
- Overly self-confident
- ‘Flight of ideas’ where you feel your thoughts are racing
- More talkative or feel pressured to keep talking
- Boost in energy causing you to become more involved in work, organizing your home or office, or get more engaged in other projects/tasks
- Feel rested after only a few hours of sleep
- Spend more money or take risks
The depression in Bipolar I and Bipolar II is the same as any depressive episode. Symptoms like low energy, feeling sad all the time and losing pleasure in things that you used to love are all symptoms of depression that can occur in both types of Bipolar Disorder. Sometimes these feelings can last for weeks or even months.
Since mania isn’t present, diagnosing Bipolar II can be difficult. Often it is mistaken for unipolar depression, which is regular depression with no manic episodes. This means that you are only being treated for depression and not the hypomania.
See here for a complete list of Bipolar symptoms.
Bipolar 2 and Women
Another interesting difference is that while women and men develop Bipolar I Disorder at equal rates, rates for Bipolar II Disorder are higher for women. Also, men and women experience Bipolar II in different ways.
When men are affected, they tend to have roughly equal numbers of hypomanic and depressive episodes.
However, for women, depression tends to dominate. Unfortunately, this often leads to misdiagnoses that can have lasting effects on their lives. As mentioned earlier, unipolar depression is the most common diagnosis, NOT Bipolar Disorder. This means that it could take several visits to various doctors before you are properly diagnosed.
Rapid cycling occurs when your moods swing from mania to depression very frequently. This is something that you should discuss with your psychiatrist. It is believed that rapid cycling can occur with both types of the disorder.
Who’s at Risk for Bipolar II?
So, scientists are looking at what could cause Bipolar Disorder and they’ve agreed that there isn’t one single underlying factor. Instead there are several that when combined could increase your chances of getting the disorder.
If these risk factors apply to you it doesn’t necessarily mean that you will end up being diagnosed as bipolar, and if you have been diagnosed this might help explain how you ended up with this condition.
Some of the risk factors that have been identified are summarized below:
- Genetics can play a role, but just because there is someone in your family with the disorder it doesn’t mean that you are destined to be Bipolar. There are twin studies, where one twin was diagnosed with Bipolar Disorder and the other was not.
- Brain function and structure are studied, on continuous basis, and further research on the neurological factors associated with the disorder will hopefully shed some light on risk factors, causes, and treatment. Recent research has found that people with Bipolar Disorder have less brain volume (also known as gray matter) in the hippocampus3, which is the part of the brain that regulates mood and memory, and other prefrontal brain regions, which are responsible for regulating thinking/thought process, decision-making, and social behaviors.4 People with Bipolar I Disorder specifically have even less volume in these areas of the brain compared to people with other mood disorders. Decreased volume in the hippocampus is also related to people who have had the disorder for longer periods of time and among people who have had more manic episodes.3
- The brain chemicals, known as neurotransmitters, that are associated with Bipolar Disorder include noradrenaline (norepinephrine), serotonin, and dopamine.
- Noradrenaline might sound familiar since adrenaline is a hormone that is responsible for providing energy. A dysfunction in the body associated with noradrenaline could be associated with the excessive energy and hyperactivity displayed by people with Bipolar Disorder during a manic episode.
- Serotonin is a brain chemical that regulates sleep, wakefulness, appetite, sexual activity, impulsivity, learning, and memory. A dysregulation in serotonin levels in the brain could be associated with a Bipolar persons decreased need for sleep, hypersexuality, impulsivity, and concentration deficits.
- Dopamine is the brain chemical that regulates pleasure and emotional rewards. It is also most often associated with symptoms of psychosis when dopamine is excessively produced in the brain. This could explain the delusions, paranoia, hallucinations, separation from reality, and illogical thinking experienced by people with Bipolar Disorder.
- Research studies are geared towards seeing which medications work best. Identifying which part of the brain is affected is a major step forward, but it will take years before any concrete results are published.
- Family history does play a role, though it is not yet fully understood. Research studies on twins emphasizes this. The disorder does tend to run in families, but just because a close relative is Bipolar doesn’t mean that you will be too.
Basically, if you want to know your risk factors, look at your family’s mental health history. There are no real guidelines, so even if you don’t fall into these risk categories always speak to a counselor or mental health advisor if you feel like something is wrong.
Treatment for Bipolar II
If you were lucky, treatment was easy. You got the correct diagnosis and the right meds. For most of us, it doesn’t work this way. It is a combination of trial and error before anything makes us feel “right”.
Unfortunately, Bipolar II Disorder can be much harder to diagnose. This is a problem as the disorder may worsen overtime, and this could lead to the development of negative coping behaviors and consequences that could include suicidal thoughts.
Bipolar 2 may be up to 3-4 times more common than Bipolar 1, and for reasons that are still being studied, the disorder seems to be becoming more prevalent. This could indicate that mental health professionals are now more adept now at diagnosing the disorder, but more research is needed.2
Before you take any medication ensure that you are aware of all the risks and potential benefits. Sometimes the side effects can outweigh the “supposed” advantages of a medication, so always stay in touch with your doctor or pharmacist. The most commonly prescribed medications for Bipolar Disorder (both I and II) are mood stabilizers and anti-depressants. Atypical antipsychotics should not be included, unless you are experiencing psychotic symptoms (in the case of people with Bipolar I Disorder).
Below is a list of all possible medications used to treat Bipolar Disorder. Some may not apply to you and your symptoms specifically. Remember to always talk to your health care advisor to discuss medication options that are right for you.
- Mood stabilizers can control hypomania. These include Lithium, Depakenen, Depakote, Lamictal, Equestro and Tegretol, among others. These are only designed to stabilize mood, not to treat other aspects of the disorder.
- Antidepressants can help to treat depressive episodes that occur in Bipolar I and Bipolar II, but just be careful that it does not have an anti-psychotic agent. Symbyax works for many people with Bipolar I.
Often times it’s difficult to find the combination of meds that’s right for you. In Bipolar II, the depression, and hypomania must be treated and sometimes it’s not a straightforward combination of medications that will give you the best results.
Medication is not the only way to cope with Bipolar II. Therapy is also highly recommended, and for me it was a must. Sometimes talking about emotional concerns and stressors is the best remedy.
Support groups, one-on-one therapy sessions and online counselors are excellent resources. They can help you get through the rough patches and point out noticeable signs that an episode might be coming on.
If you are new to the disorder or think you have Bipolar II and can’t seem to get a definitive diagnosis, try keeping a journal. Write down any moods changes (e.g., instances when you’re feeling more upbeat versus moments when you become sad or feel down), emotions/feelings; and possible triggers. You can review your journal with a mental health professional and this could help coming up with a correct diagnosis.
Treatment can also involve taking part in a study, but DON’T sign up for just any research study. NIMH/NIH has additional information on their website that will ensure the study is safe. This is important since it could involve clinical trials.
Are There Benefits to having Bipolar Disorder II?
At least one expert has gone so far as to suggest hypomania can be an asset.
Psychologist John Gartner believes part of the reason America is so rich and powerful is the presence of so many hypomanic individuals. Gartner said:
“Hypomania, a genetically based form of mild mania, endows many of us with energy, creativity, enthusiasm, and a propensity for taking risks. America has an extraordinarily high number of hypomanics—grandiose types who leap on every wacky idea that occurs to them, utterly convinced it will change the world. Market bubbles and ill-considered messianic crusades can be the downside. But there is an enormous upside as well, in spectacular entrepreneurial zeal, drive for innovation and material success. Americans may have a lot of crazy ideas, but some of them prove to be brilliant inventions.” – John Gartner, Ph.D., The Hypomanic Edge
He is referring to the milder manifestations of hypomania that can make symptoms both a curse and a blessing.
Some people might agree with this, but remember that along with hypomania there is also the depression that kicks in at some point. You might get more tasks accomplished when you are running day and night, never feeling tired, but what about when you “come down” from this high energy, do-it-all state? Chances are, not a lot will be started or finished at this point. Even if you only have mild depression that lasts for a brief time, there is no guarantee that the depression won’t get worse over time.
Don’t ignore the depressive side simply because you like the hypomania. It could have disastrous consequences.
Key Points to Remember
- Bipolar Type 2 has its own, distinct Bipolar symptoms.
- You need an evaluation to assess for Bipolar Disorder by a competent professional experienced in diagnosing and treating people with the disorder. Do not self-diagnose.
- Treatments are slightly different for Bipolar II versus Bipolar I.
- Hypomania should not be considered a blessing
If you think that you have Bipolar II, make an appointment to discuss your concerns with a licensed mental health professional. Don’t just concentrate on describing your depressive symptoms. Make sure you are also discussing the hypomania. Leaving out those episodes is one reason misdiagnosis could occur. If they still won’t listen, don’t give up. For some people it takes years to be accurately diagnosed.