Bipolar II Disorder.

Bipolar disorder is a life-altering mental illness marked by notable and unpredictable mood fluctuations. These mood changes span from extreme highs, termed manic episodes, to deep lows, referred to as depressive episodes. Bipolar disorders are categorized into types 1 and 2 for diagnostic purposes.

What is Bipolar 2 Disorder?

Bipolar II disorder is characterized by pronounced depressive episodes and shorter, less severe hypomanic episodes. Due to the absence of full-blown manic episodes in Bipolar II, it’s sometimes misdiagnosed as a personality disorder or chronic depression. While bipolar can occur at any age, the first symptoms typically appear in the teenage years or early 20s.


The primary symptoms of bipolar II disorder are depressive episodes, though hypomanic episodes can also occur. While people with bipolar I disorder cycle between depression and mania, bipolar II sufferers experience mostly depression and hypomania.

Depressive Episodes

Depression is the primary mood in bipolar II disorder. To be diagnosed, one must experience at least one major depressive episode lasting at least two weeks. Symptoms during this phase include:

  • Persistent sadness
  • Feelings of guilt or worthlessness
  • Loss of interest or pleasure in activities
  • Low energy and activity


Hypomania is a milder form of mania. While elevated energy levels characterize both hyper and hypomania, hypomanic episodes are less severe and don’t necessitate hospitalization or present with psychotic symptoms like hallucinations. Symptoms include:

  • Excessive energy
  • Hyperactivity
  • Rapid, constant, and loud speech
  • Lack of judgment
  • Impulsivity

Mood Episodes

The DSM-5 acknowledges cyclothymic disorder as a less severe variant of bipolar disorder. Its symptoms mirror those of bipolar II. Cyclothymia is a mood disorder that involves quick shifts from one mood episode to another. Individuals go from hypomania to depression, with brief periods of normalcy (euthymia).


The exact causes of bipolar II disorder remain elusive. However, a blend of factors is believed to contribute to its onset:

  • Family History: Bipolar disorder has a strong genetic component. Those with a parent or sibling with bipolar disorder are at higher risk of developing one.
  • Brain Structure and Functioning: Although it is still under research, the brain structure of people with bipolar disorder may differ from those of people who do not have it. Mood shifts in bipolar disorder are believed to be linked to imbalances in neurotransmitters like norepinephrine and serotonin.
  • Excessive Alcohol or Drug Use: While not a direct cause, substance misuse can precipitate bipolar symptoms.
  • Lifestyle Factors: Situations causing hormonal imbalances, such as sleep deprivation and stress, can trigger episodes, especially in those genetically predisposed.


Bipolar disorders are diagnosed by qualified mental health professionals based on symptom severity, duration, and frequency.

DSM-5 Criteria

The DSM-5 categorizes bipolar disorder under “Bipolar and Related Disorders.” Bipolar II specifically involves:

  • Major depressive episodes lasting at least two weeks
  • Hypomanic episodes that are less intense than manic episodes

The DSM-5 also recognizes cyclothymic disorder as a milder form of bipolar disorder. It is diagnosed when a person experiences numerous periods of hypomanic symptoms and depressive symptoms over at least two years. However, the symptoms do not meet the criteria for a full major depressive episode, hypomanic episode, or manic episode.

ICD-11 Criteria

The 11th International Classification of Diseases (ICD-11) differentiates from the DSM-5. The ICD-11 offers a slightly varied classification approach but retains similar criteria. It differentiates between bipolar I and II, with the latter involving at least one hypomanic and one depressive episode.

Bipolar II Management and Treatment

While there’s no cure for bipolar disorder, effective management allows for a fulfilling life.


Medications are tailored to individual symptoms and may evolve over time. Commonly prescribed drugs include:


Antidepressants are mixed with mood stabilizers to prevent mood destabilization and trigger manic episodes. Examples of antidepressants include fluoxetine, citalopram, and paroxetine.

Mood stabilizers

These medications help correct imbalanced brain signaling. Each patient is prescribed a specific medication with a tailored dose based on their case. Examples include lithium, valproic acid, divalproex sodium, and lamotrigine.


They are recommended during episodes of psychosis related to bipolar disorder I. Examples include olanzapine, quetiapine, lurasidone, cariprazine, and risperidone.


Along with prescribed medication, psychotherapy is vital in managing bipolar disorder II. Options include:

Cognitive Behavioral Therapy (CBT)

CBT has been shown to be effective in mood stabilization in bipolar I patients. Here, the individual restructures maladaptive thoughts and behaviors and gains better control of emotions. This therapy reduces the recurrence of symptoms compared to prescription medication alone.

Family Therapy

In bipolar disorder, family therapy is important to learn about the condition and management tools.

Interpersonal and Social Rhythming Therapy

Focuses on stabilizing daily rhythms, such as sleeping, waking, and mealtimes, to prevent manic and depressive episodes.

Alternative Treatments

Alternative treatments might be considered when medications and psychotherapy haven’t been effective or can’t be used. Popular ones include:

Electroconvulsive Therapy (ECT)

This therapy impacts neurotransmitters’ function and effects by passing electrical currents through the brain.

Light Therapy

Although it is still under investigation, this therapy has been found to be beneficial in reducing bipolar disorder symptoms. It involves exposure to bright light, usually at home in the morning.

Alternative Medicine

Non-medical treatments like acupuncture, meditation, massage therapy, yoga, or tai chi can be combined with medication and psychotherapy to manage bipolar symptoms.


With consistent treatment, many individuals with bipolar 2 disorder can manage their symptoms effectively. Medication, therapy, and lifestyle changes can significantly reduce the frequency and severity of episodes.

However, when left untreated, bipolar-related depression can last up to a year. There’s also an increased risk of substance abuse, other health conditions, and suicidal ideation. Despite being milder than type 1, bipolar II is a serious condition necessitating professional care.

What is a person with bipolar II like?
A person with bipolar II disorder often experiences significant mood fluctuations. They can shift from periods of depression, sadness, hopelessness, and fatigue to hypomanic episodes, where they may feel unusually upbeat, energetic, and optimistic.
Can you live a normal life with bipolar II?
Absolutely. With the proper diagnosis, treatment, and support, individuals with bipolar II disorder can lead fulfilling, productive lives. Maintaining regular consultations with mental health professionals, adhering to prescribed medications, and possibly engaging in therapeutic practices is crucial.
Is bipolar type II serious?
Yes, bipolar type II is a serious mental health condition. While it might not involve the full-blown manic episodes seen in bipolar I, the depressive episodes in bipolar II can be profound and debilitating. Early diagnosis, consistent treatment, and a supportive environment are vital to managing the condition and preventing potential complications.
What is the difference between bipolar 1 and 2?
The primary distinction between bipolar I and bipolar II lies in the severity and nature of the mood episodes. Bipolar I involves at least one manic episode, which can be severe and sometimes requires hospitalization. On the other hand, bipolar II is characterized by hypomanic episodes, which are less intense than manic episodes, and major depressive episodes. Both conditions are serious and require professional medical attention.

Related Conditions

  • Bipolar Disorder
  • Bipolar I
  • Cyclothymia

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