Bipolar II disorder is a form of the psychiatric condition known as bipolar disorder. All forms of bipolar disorder cause unusual mood shifts and changes in energy and activity levels.

Bipolar II disorder is a form of this disorder characterized by cycles of depressive episodes followed by hypomanic periods. Hypomania is a period of mood and behavior that is elevated above normal behavior. It is not as extreme as a manic period.

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Bipolar II disorder is characterized by hypomanic periods preceded by depressive episodes.

The main difference between bipolar I disorder and bipolar II disorder has to do with the intensity of the manic period.

Bipolar I disorder is characterized by at least one episode of mania before or after a hypomanic or major depressive episode. Sometimes, the manic episodes that occur in bipolar I disorder may trigger a psychotic episode where the person disassociates from reality.

People with bipolar II disorder do not experience true manic episodes, where their mood and energy levels are so high that it causes trouble with work and socializing and may cause psychosis. Some individuals with bipolar I disorder have to be hospitalized during periods of mania.

However, this does not make bipolar II disorder less severe than bipolar I disorder. In bipolar II disorder, the depressive episodes are similar to those in bipolar I disorder and cause significant disruption to the person's daily life for an extended time.

Symptoms of bipolar II disorder include periods of hypomania followed by depressive episodes.

While it can be normal for people to experience periods of feeling upbeat followed by periods of sadness, in people with bipolar disorder, these mood changes are more extreme.

People experiencing hypomania may notice a combination of the following symptoms:

  • an increase in energy or feeling more agitated
  • feeling more upbeat or wired
  • increased self-confidence
  • decreased need or inability to sleep
  • racing thoughts
  • talking too fast or talking much more than normal
  • a tendency towards reckless behavior, such as spending too much, drinking or using drugs, or risk taking
  • impaired decision making

For these periods to be classified as true hypomanic episodes, they must last for at least 4 days and have at least three of the above symptoms.

People experiencing hypomania may feel very good during these periods, and may not know anything is wrong. However, loved ones watching a person with bipolar II disorder will notice abnormal changes in behavior during hypomanic episodes.

When people with bipolar II disorder are not in a hypomanic state, they may be in a major depressive state. Symptoms of major depressive episodes include the following:

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An inability to sleep may be a symptom of a major depressive episode.
  • feelings of sadness, emptiness, or hopelessness
  • loss of interest in activities
  • inability to sleep or sleeping too much
  • decreased energy
  • feelings of worthlessness and guilt
  • trouble concentrating or focusing
  • weight gain or weight loss without dieting
  • suicidal thoughts or tendencies

Other signs and symptoms of bipolar II disorder may occur during both periods of hypomania and major depressive episodes. These may include the following:

  • anxiety
  • melancholy
  • rapid cycling between states

Risk factors

There are no known risk factors for bipolar II disorders, although some studies suggest there may be a genetic component.

Having a first-degree relative with bipolar II disorder may increase a person's chances of being diagnosed with the same or a similar condition.

Bipolar II disorder can be hard to identify and is often misdiagnosed as major depressive disorder because symptoms of hypomanic periods are mild and unrecognized by the inidvidual.

When diagnosing bipolar II disorder, a doctor will do a physical exam and may order some blood tests to rule out physical causes of symptoms.

If a doctor does not find any physical causes for a person's symptoms, such as a hormonal imbalance, they may do a psychiatric evaluation or refer the person to a psychiatrist for further evaluation.

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The treatment of bipolar II disorder may be overseen by a psychiatrist.

A psychiatrist often oversees the treatment of bipolar II disorder. Treating bipolar II disorder is generally multifaceted, involving a combination of medication and psychotherapy.

Medications to treat bipolar disorder II disorder may include the following:

It may take a doctor some time to find the best combination and dosage of medication. It is important for the person to tell their doctor how the medications affect their mood and if there are any side effects.

Psychotherapy involves counseling services. It is centered on talking through emotions and problems associated with bipolar disorder and other life issues. It may also include behavioral management, such as creating action plans on what to do during mood alterations.

Occasionally, hospitalization or inpatient programs may be required to control depressive episodes or treat concurrent problems, such as alcohol or drug addiction.

Bipolar II disorder is a lifelong disease that may change over time. In some cases, a person may experience a reduction in symptoms as they age.

Many people with bipolar II disorder experience other conditions concurrently. These conditions may complicate or exacerbate bipolar II disorder. Some people with multiple diagnoses may struggle to maintain relationships and employment.

Finding treatment for bipolar II disorder that works for the individual may be a long process of trial and error. A person's needs may change and evolve over time. With effective treatment, a person may be able to minimize their symptoms.

Therapy can help people with bipolar II disorder deal with hypomania and depressive episodes in constructive ways.

Maintaining a healthy lifestyle, understanding and avoiding known triggers, and sticking with an effective treatment plan may help make the symptoms of bipolar II disorder manageable.