Until April 2011, Academy Award-winning actor Catherine Zeta-Jones was best known for stellar performances in Traffic and Chicago, her high-profile marriage to actor Michael Douglas, and his recent struggle with throat cancer. In 2011, Jones stunned the public by announcing that she suffers from bipolar II disorder and is participating in inpatient treatment for the illness.
What is bipolar II disorder?
Bipolar II disorder is a mental illness that is characterized by mood swings, from depressed, anxious, and irritable to excessively elevated to a moderate degree (hypomania). While it is thought to occur a in a little over 1% of the United States population, slightly more than the 1% incidence of bipolar I disorder, that translates into millions of people who suffer from the condition. About two-thirds of individuals with manic depression (either bipolar disorder or bipolar II disorder) develop symptoms of the illness by the time they reach early adulthood. People with bipolar II disorder are at risk for engaging in substance abuse.
How common is bipolar II disorder?
Bipolar II disorder is thought to be more common in women than in men. As with depression, the hypomanic symptoms of bipolar II disorder can occur in the postpartum period. Children and adolescents with bipolar II disorder tend to experience episodes that are rapid cycling, having at least four mood problem episodes in a 12-month period.
In order to qualify for the diagnosis of bipolar II disorder, individuals must experience at least one episode of major depression and at least one hypomanic episode during their lifetime. Symptoms of major depression last at least two weeks and include depressed or irritable mood and a number of associated symptoms, like change in sleep or appetite, suicidal thoughts, plans, or actions, low energy, tendency to isolate from others, and loss of interest in formerly pleasurable activities. Diagnostic criteria for a hypomanic episode include symptoms like elevated or irritable mood, grandiosity, decreased need for sleep, excessive speech, racing thoughts, trouble focusing, excessive activity, suicidal thoughts, plans, or actions, and behaviors that indicate poor judgment that last for at least four days.
What causes bipolar II disorder?
As with most other mental disorders, there is no single cause for bipolar II disorder. For example, it is not directly passed from one generation to another genetically. Rather, it is the result of a complex group of genetic, psychological, and environmental factors. Genetically, bipolar disorders and schizophrenia have much in common, in that the two disorders share a number of the same risk genes. However, both illnesses also have some genetic factors that are unique. Stress has been found to be a significant contributor to the development of most mental illnesses, including bipolar disorder.
As is true with virtually any mental-health diagnosis, there is no one test that definitively indicates that someone has bipolar II disorder. Therefore, health-care practitioners diagnose this disorder by gathering comprehensive medical, family, and mental-health information. The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. Medical testing will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might have mental-health symptoms.
How is bipolar II disorder treated?
The treatment plan for bipolar II disorder usually includes psychotherapy, medication, and/or social support. Medications that stabilize mood have been used to treat this illness, including:
While some people with this illness benefit from treatment with an antidepressant medication (like fluoxetine [Prozac], venlafaxine [Effexor], or escitalopram [Lexapro]), practitioners use such medications with care because of the risk of antidepressant medication being associated with the development of hypomania or mania. For some people with severe symptoms of bipolar II disorder whom do not respond well to medications, electroconvulsive therapy (ECT) can be a viable treatment option.
Talk therapy (psychotherapy) is an important part of helping individuals with bipolar II disorder achieve the highest level of functioning possible. While medications can be quite helpful in alleviating and preventing overt symptoms, they do not address the many complex social and psychological issues that can play a major role in how the person with this disease functions at work, home, and in his or her relationships. Psychotherapies that have been found to be effective in treating bipolar disorders include family focused therapy, psycho-education, cognitive therapy, and interpersonal therapy. Family focused therapy involves education of family members about the disorder and how to help (psycho-education), communication-enhancement training, and teaching family members problem-solving skills training. Psycho-education involves teaching the person with bipolar II disorder and their family members about the symptoms of this illness, as well as warning signs (for example, a change in sleep pattern or appetite, increased irritability) that the person is beginning to experience a mood episode. In cognitive behavioral therapy, the mental-health professional works to help the person with bipolar II disorder identify, challenge, and decrease negative thinking and otherwise dysfunctional belief systems. The goal of interpersonal therapy tends to be identifying and managing problems the sufferers of bipolar disorder may have in their relationships with others.
In addition to whether the individual has medical or other mental illness, appropriate treatment or socioeconomic disadvantages, the prognosis of bipolar II disorder is largely connected to how often mood episodes occur. The lower the number of mood-disorder episodes, the better the prognosis for the individual.
Quick GuideBipolar Disorder: Symptoms, Testing for Bipolar Depression
Medically reviewed by Marina Katz, MD; American Board of Psychiatry & Neurology
Arnold, L.M. "Gender Differences in Bipolar Disorder." Psychiatric Clinics of North America 26.3 Sept. 2003: 595-620.
Birmaher, B., D. Axelson, B. Goldstein B, M. Strober, Et Al. "Four-Year Longitudinal Course of Children and Adolescents With Bipolar Spectrum Disorders: The Course and Outcome of Bipolar Youth (COBY) Study." American Journal of Psychiatry 166 (2009): 795-804.
Calabrese, J.R., P.E. Keck, W. Macfadden, M. Minkwitz, Et Al. "A Randomized, Double-Blind, Placebo-Controlled Trial of Quetiapine in the Treatment of Bipolar I or II Depression." American Journal of Psychiatry (162) July 2005: 1351-1360.
Goldberg, J.F. "Differential Diagnosis of Bipolar Disorder." Primary Psychiatry 17.2 (Supplement 3) (2010): 4-7.
Maj, M., R. Pirozzi, L. Magliano, and L. Bartoli. "The Prognostic Significance of 'Switching' in Patients With Bipolar Disorder: A 10-Year Prospective Follow-Up Study." American Journal of Psychiatry (159) Oct. 2002: 1711-1717.
Medda, P., G. Perugi, S. Zanello, M. Ciuffa, and G.B. Cassano. "Response to ECT in Bipolar I, Bipolar II and Unipolar Depression." Affective Disorders 118.1-3 Nov. 2009: 55-59.
Merikangas, K.R., R. Herrell, J. Swendsen, W. Rossler, Et Al. "Specificity of Bipolar Spectrum Conditions in the Comorbidity of Mood and Substance Use Disorders." Archives of General Psychiatry 65.1 (2008): 47-52.
President and Fellows of Harvard College. "Schizophrenia and Bipolar Disorder May Share Genetic Origins." Harvard Health Publications June 2009.
Sharma, V., V.K. Burt, and H.L. Ritchie. "Bipolar II Postpartum Depression: Detection, Diagnosis and Treatment." American Journal of Psychiatry 166.11 Nov. 2009: 1217-1221.
Steinkuller, A, and J.E. Rheineck. "A Review of Evidence-Based Therapeutic Interventions for Bipolar Disorder." Journal of Mental Health Counseling 31.4 Oct. 2009: 338-350.
Suppes, T. "Is There a Role for Antidepressants in the Treatment of Bipolar II Depression?" American Journal of Psychiatry 167 July 2010: 738-740.