Is Bipolar II a Serious Condition?

Bipolar disorder, also called manic-depressive disease, is a type of mental illness characterized by episodes of fluctuating moods (high and low). Bipolar II disorder is a subtype of bipolar disorder in which the manic episodes are mild (also called hypomania).

Most people suffering from bipolar II disorder spend almost three times of their lifespan in depressive episodes than manic episodes.

To be diagnosed with bipolar II disorder, a person must have at least one hypomanic episode in their entire life. They most often suffer from depression and are generally normal in between periods of depression and mania.

1. Bipolar I disorder: A person must have one or more manic episodes preceded by depression. Manic episodes may cause risky behaviors, require treatment, and even hospitalization.
2. Bipolar II disorder: Depressive episodes with hypomanic episodes but never a full-blown manic episode.
3. Cyclothymic disorder or cyclothymia: People may experience hypomania and mild depressive moods for at least two years.
4. Others: The criteria for these three types are not met, but a person still shows symptoms of bipolar disorder.

The exact cause of this disease is unknown, but a combination of certain factors is associated with the disease.

• Bipolar II disorder typically begins in young adults (aged 20 or 30 years), and, quite rarely, it affects people older than 50 years
• Children may develop this disease along with other mental health problems, such as attention deficit hyperactivity disorder
• Women are more prone to develop the disorder compared to men
• Family history or genetic tendency makes a person prone to develop this disease
• Stress and major life events (death or separation of a loved one, business failure, loss of job, chronic, and life-threatening diseases)
• Childhood trauma or sexual abuse
• Alcohol and drug dependency (substance abuse)
• Certain mental health issues, such as anxiety disorder and post-traumatic stress disorder (PTSD)

People with bipolar II disorder often suffer from depression called manic depression, while between an episode of hypomania and depression, they live a normal life.

• Hypomanic episode: Can last for a few days to months.
  • Manifested as either euphoria (top of the world feeling) or extreme irritability
  • Unable to make decisions
  • Overconfident
  • Talking loudly or rapidly
  • Hyperactive, cannot sleep
  • Positive mood (optimism)
  • Excessive happiness
  • Multitasking
  • Superiority complex
  • Increased sex drive
  • Impulsive
• Depressive episode: Can last for weeks or months and rarely for years.
  • Depressed mood
  • Lack of interest in previously enjoyable activities
  • Low energy
  • Guilty feeling
  • Worthlessness and hopelessness
  • Suicidal thoughts
  • Cannot concentrate
  • Insomnia (lack of sleep) or sleeping too much
  • Crying for no obvious reason
  • increased or reduced appetite
  • Decreased sex drive

A careful history taking that includes the duration, frequency, and severity of symptoms. These pieces of information are gathered from the patient or their family and close friends and play a key role to confirm the diagnosis.

Before making an appropriate diagnosis, a complete medical evaluation is done by a psychiatrist (mental health specialist) that may include questions regarding personal and family history and depression-screening questionnaires.

Imaging tests, such as electroencephalogram, computed tomography scan, or magnetic resonance imaging, of the brain may be recommended to rule out other medical conditions.

There is no cure for bipolar II disorder, but behavior therapy and drugs (such as mood stabilizers) can control the illness, helping most people to live normal and productive lives.

• Psychotherapy or talk therapy: Cognitive behavioral therapy.
• Mood stabilizers: These drugs help control hypomanic or manic episodes and include
  • Lithium controls
  • Carbamazepine
  • Lamotrigine
  • Valproate
• Antipsychotics: Aripiprazole, cariprazine, quetiapine, olanzapine, risperidone, and ziprasidone, may be prescribed.
• Benzodiazepines: Alprazolam, diazepam, and lorazepam are used to relieve acute episodes and control insomnia and agitation.
• Antidepressants: Seroquel and Seroquel XR are used to treat depressive episodes.
• Electroconvulsive therapy: An electric current is passed through the brain to treat the symptoms.
• Transcranial magnetic stimulation: It uses magnetic waves to stimulate the brain for controlling symptoms.
• Vagus nerve stimulation (VNS): A device is implanted under the skin that sends the pulses through the vagus nerve.

In addition to medications, certain lifestyle changes could help prevent a relapse.

• Eat a healthy and well-balanced diet
• Stay physically active and exercise for at least 30 minutes a day
• Get enough sleep
• Practice stress management
• Limit caffeine intake
• Quit smoking
• Avoid or limit alcohol consumption