Bipolar 2 Disorder: Symptoms, Medication & Treatment - The Ranch

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Bipolar 2 Disorder: Symptoms, Medication & Treatment

June 19, 2017 Mental Health
sad woman in counseling session

Once thought to be a milder form of bipolar disorder, bipolar 2 is now recognized by the American Psychiatric Association as a separate, equally serious mental illness. It tends to be more chronic than bipolar disorder, causing long periods of depression and instability of mood, which in turn can lead to social- and work-related issues and problems at home.

What Is Bipolar 1 Disorder?

This form of the disease is characterized by one or more manic episodes or mixed episodes (symptoms of both mania and depression) that last at least seven days. Typically, a person will also experience periods of depression with episodes lasting at least two weeks. It is common for episodes to be so severe that immediate hospitalization is required.1

What Is Bipolar 2 Disorder?

This is characterized by a pattern of one or more major depressive episodes and at least one hypomanic episode. Patients do not experience the full-blown manic episodes that are indicative of bipolar 1. Although people with this disorder typically experience at least one “hypomanic” episode at some point in their lives, they struggle far more often with episodes of major depression. As a result, bipolar 2 may be misdiagnosed as major depression because hypomanic episodes go unrecognized or unreported.1

Stats and Facts

  • Bipolar disorder affects an estimated 5.7 million people aged 18 and older, or about 2.6% of the U.S. population.2
  • According to the National Institute of Mental Health (NIMH), the median age of onset for bipolar disorder is 25, although the illness can start in early childhood or in an individual’s 40s to 50s.2
  • Statistics from the World Health Organization (WHO) indicate bipolar disorder is the sixth leading cause of disability in the world.3

Risk Factors

According to the NIMH, bipolar disease is an inherited disease. More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression. When one parent is affected, a child has a 15% to 30% risk of developing the disease. The risk this increases to 50% to 75% if both parents have it.3

Bipolar Symptoms

Some people with type 2 bipolar cycle back and forth between hypomania and depression, while others experience long periods between episodes. Symptoms of a depressive episode include:

  • Daily depressed mood or sadness
  • Difficulty concentrating, remembering or making decisions
  • Loss of pleasure from once enjoyable activities
  • Pulling away from friends
  • Eating problems (e.g. loss of appetite, weight loss, overeating or weight gain)
  • Trouble falling asleep or sleeping excessively
  • Feeling guilty, worthless or hopeless
  • Low energy
  • Restlessness and agitation
  • Reduced sex drive
  • Lack of motivation
  • Loss of self-esteem
  • Thoughts of suicide and death
  • Abuse of alcohol or substances, which may increase symptoms and the risk of suicide

Left untreated, an episode of hypomania can last from a few days to several months. Symptoms of a hypomanic episode are not as severe or numerous as those associated with full-blown mania. They may include:

  • A noticeable increase in energy, hyperactivity and a decreased need for sleep
  • Rapidly moving on from activity to activity without completion
  • Talking in a rapid, forced or loud manner
  • Inflated self-esteem or grandiosity

Gender Differences

There are key gender differences in manifestation of the disease, symptoms and comorbidities. Men experience earlier onset than women, more severe episodes, a higher incidence of manic episodes, are more prone to aggressive behavior during manic episodes and have a higher incidence of co-occurring drug or alcohol abuse. Women have a higher incidence of depressive episodes, greater likelihood of simultaneous or overlapping symptoms of mania and depression (mixed episodes), are more likely to experience seasonal episodes and have a higher incidence of comorbid conditions such as thyroid disease, eating disorders and anxiety disorders.4


There are a number of treatments available for bipolar disorder. An approach that is effective for one person may not work for another, so it is important to try a number of options. Many people find that a combination of the following therapies helps them manage their symptoms.


Therapy is critical for managing symptoms of bipolar 2 disorder. The most effective therapies are cognitive behavioral therapy, family-focused therapy and interpersonal therapy. Through regular sessions with an experienced therapist, people learn to better understand their illness, develop essential coping skills, solve day-to-day problems, regulate moods, rebuild relationships and manage difficult thoughts and emotions. Therapists may also recommend self-help measures such as exercising regularly, eating nutritious foods and getting enough sleep. Alternative treatments including acupuncture, yoga and mindfulness meditation may also be helpful.

Bipolar Medications

A number of medications can help people with bipolar 2 disorder. The three major types of medications used to treat bipolar disorder are mood stabilizers, antidepressants and atypical antipsychotics.

Lithium: Considered highly effective in controlling mood swings, particularly highs, lithium has been used for more than 60 years to treat bipolar disorder. It can take a while for lithium to work, so it is more effective for long-term treatment than for acute hypomanic episodes. Periodic testing is required to measure lithium levels in the blood and monitor potential side effects (e.g. checking to see if the kidneys and thyroid are functioning properly).

Lamictal: Approved by the FDA in 1994 to treat partial seizures in adults, a decade later the drug was approved for maintenance treatment of bipolar disorder. It delays the onset of episodes in patients treated for acute mood episodes with standard therapy.

Depakote: Valproate drugs such as Depakote are approved by the FDA to treat seizures and manic or mixed episodes associated with bipolar disorder. This drug works more rapidly than lithium and can also be used for prevention.

Other medications: Additional anti-seizure medications that may be prescribed for bipolar disorder include Trileptal and Tegretol. Benzodiazepines including Ativan, Xanax and Valium are tranquilizers used for the short-term control of acute symptoms commonly associated with hypomania, such as agitation or insomnia. Seroquel and antidepressants such as Paxil, Prozac and Zoloft are sometimes used to treat bipolar depression. Hypomanic episodes generally do not interfere with functioning or involve psychosis, although antipsychotic drugs may be recommended in some cases. Abilify, Risperdal, Seroquel and others may be prescribed, but are associated with serious health risks.

Family Treatment and Support Programs and Services

A person suffering from bipolar 2 disorder may not recognize or be able to report symptoms to a therapist or doctor, so it is important for family members to be cognizant of symptoms. Family treatment programs combine support and education. These programs help loved ones play an integral role in managing the disorder and may reduce the likelihood of symptom recurrence. The goal of treatment is to help family members:

  • Cope with symptoms that are present even when medications are taken
  • Stay on top of the individual, reminding him or her to take medications as prescribed and be proactively involved in management of side effects
  • Recognize and reinforce the importance of the individual getting adequate sleep each night
  • Encourage and reinforce a healthy lifestyle as key to overall recovery (e.g. staying away from recreational drugs)

For individuals suffering from bipolar 2 disorder who do not have family and social support, community support and outreach services can be invaluable.

Co-occurring Disorders

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 symptoms. However, substance abuse can actually trigger or prolong bipolar 2 symptoms. Other disorders that often co-occur with this disorder include post-traumatic stress disorder (PTSD), social phobia and attention-deficit hyperactivity disorder (ADHD).

Episodes of hypomania and depression are warning signs that someone may need treatment. If you, a family member or close friend is exhibiting potential signs of bipolar 2 disorder, we can help. For a confidential consultation, call The Ranch today at 888-545-4849.

  1. Bipolar Disorder Statistics. Depression and Bipolar Support Alliance website. Accessed October 24, 2016.
  2. Bipolar Disorder Statistics. Depression and Bipolar Support Alliance website.  Accessed October 24, 2016.
  3. Bipolar Disorder Statistics. Bipolar Lives website. Accessed October 24, 2016.
  4. Bipolar Disorder and Gender Differences. Everyday Health website.  Updated November 10, 2008. Accessed October 24, 2016.

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