Once thought to be a milder form of bipolar I, bipolar II is now understood to be an equally serious condition. In fact, it tends to be more chronic than bipolar I, and can cause long periods of depression and instability of mood, which in turn can lead to problems at work, in social situations and in one’s home life.
Bipolar II disorder sometimes begins to emerge in adolescence and young adulthood, but the average age of onset is in the mid-20s. It usually begins with one or more depressive episodes before the first hypomanic episode.
What Is Bipolar II Disorder?
Bipolar II disorder is a form of mental illness. Similar to bipolar I disorder, individuals diagnosed with bipolar II disorder generally experience mood shifts that cycle over a period of time.
Unlike bipolar I disorder, however, those suffering from bipolar II disorder never experience mood elevations that reach full-on mania. People with bipolar II disorder will experience at least one “hypomanic” episode at some point in their lives, but often the real battle is with episodes of major depression.
Population at Risk
About 2.5 percent of the population of the United States suffers from some form of bipolar disorder, including bipolar II. That equates to six million people.
Bipolar II disorder tends to run in families. Children with a sibling who has bipolar II disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. Symptoms start to appear in the teenage years or early 20s. Almost all cases of bipolar II disorder develop before age 50.
What Does Bipolar II Disorder Look Like?
Some people with bipolar II cycle back and forth between hypomania and depression, while others experience long periods between episodes.
Symptoms of a depressive episode include:
- Depressed mood or sadness daily
- Difficulty concentrating, remembering, or making decisions
- Loss of pleasure in activities once found enjoyable
- Pulling away from friends
- Eating problems – loss of appetite or weight loss, or overeating and weight gain
- Trouble getting to sleep, or sleeping too much
- Feeling guilty, worthless, or hopeless
- Low energy
- Loss of self-esteem
- Thoughts of suicide and death
- Abuse of alcohol or substances, which may make the symptoms as well as suicide risk worse
Symptoms of a hypomanic episode include:
- A noticeable increase in energy, with hyperactivity and a decreased need for sleep
- Rushing from one activity or task to another, possibly without finishing one before going on to another
- Talking in a rapid, pressured, or loud manner
Left untreated, an episode of hypomania can last from a few days to several months.
What Can Be Done About Bipolar II Disorder
There are a number of treatments for bipolar disorder. The approach that’s effective for one person may not work for another person, so it’s important to try a number of options. Many people find that a blend of the following approaches helps them manage their symptoms:
Therapy is critical for managing symptoms of bipolar II disorder. The most effective therapies are cognitive-behavioral therapy, family-focused therapy and interpersonal therapy. Through regular sessions with an experienced therapist, people with bipolar II can better understand their illness, develop essential coping skills, solve day-to-day problems, regulate moods, rebuild their relationships, and manage difficult thoughts and emotions. Therapists may also recommend important self-care measures, such as exercising regularly, eating nutritious foods, and getting enough sleep, as well as alternative bipolar treatments like acupuncture, yoga, and mindfulness meditation.
A number of medications can help with bipolar II disorder, including mood stabilizers and antidepressants.
Among the mood stabilizers:
- Lithium is considered highly effective in controlling mood swings, particularly the highs. Lithium has been used for more than 60 years in the treatment of bipolar disorder. It can take a while for lithium to work, so it’s better used for long-term treatment than to treat acute hypomanic episodes. In addition, periodic monitoring is required of the lithium level in the blood and other laboratory tests of kidney and thyroid functioning in order to avoid side effects.
- Lamictal, approved by the FDA for maintenance treatment of bipolar disorder in adults, helps delay bouts of depression and hypomania, as well as mixed episodes in people being treated with standard therapy. It is considered to be stronger for the prevention of relapses than for treatment of acute episodes of bipolar depression.
- Depakote, an anti-seizure drug, works to level out moods. It works more rapidly than lithium and can also be used for prevention.
- Other anti-seizure medications sometimes prescribed include Trileptal and Tegretol.
Benzodiazepines, including Ativan, Xanax and Valium, are tranquilizers used for the short-term control of acute symptoms common with hypomania, such as agitation or insomnia.
Although the hypomanic episodes in bipolar II disorder do not interfere with functioning and do not involve psychosis, sometimes antipsychotic drugs, including Abilify, Risperdal, Seroquel, and others, are used to treat hypomania.
Seroquel and antidepressants such as Paxil, Prozac and Zoloft are sometimes used to treat bipolar II depression.
Family Treatment and Support Programs and Services
Family treatment programs that combine support and education about bipolar II disorder can help family members cope and help reduce the likelihood of some symptoms recurring. For individuals suffering from bipolar II disorder who do not have family and social support, community support and outreach service can be invaluable.
Here’s what family treatment and support programs and services do:
- Help family members cope with symptoms that are present even when medications are taken.
- Help family members stay on top of the individual with bipolar II disorder, reminding him or her to take the medications as the doctor prescribed and helping the individual to learn how to manage any side effects.
- Helping family members recognize that it is crucial that the individual with bipolar II disorder gets adequate sleep each night.
- Informing the family members that encouraging the person with bipolar II disorder to live a healthy lifestyle and stay away from recreational drugs is important in their overall recovery.
The person suffering from bipolar II disorder may not recognize or be able to tell a therapist or doctor about his or her symptoms, so having family members who know what to watch out for can be helpful. Support groups can help family members during stressful episodes.
Substance abuse is very common among people with bipolar disorder, according to the National Institute of Mental Health. Some individuals turn to alcohol or drugs to lessen their symptoms, but substance abuse can actually trigger or prolong bipolar II symptoms.
Other disorders that often co-occur with bipolar II disorder include post-traumatic stress disorder, social phobia and attention deficit hyperactivity disorder.
Bottom line: Episodes of hypomania and depression are warning signs that someone may need treatment. If you think or suspect that you, a member of your family, or a close friend or co-worker has bipolar II disorder, the best recommendation is to get that person to a doctor for a thorough evaluation.