Bipolar II

Don’t let the name confuse you. Bipolar II has a lot more in common with depression than it does with bipolar.

Bipolar-II is a common type of depression.  Exact rates are not clear, but it probably affects between 2-3 in 100 people.  Unfortunately there is little public awareness of this condition, which borrows its name from the more well-known bipolar-I disorder. This similarity in names is confusing, since the word bipolar brings to mind a more extreme state called mania or manic-depression.

People with bipolar-II never have mania; instead, they suffer from depressions that alternate with states of nervous excitation called hypomania.  Hypomania can make people feel anxious, impulsive, hyperactive, irritable and, sometimes, happy and confident. Hypomania may feel good or may feel uncomfortable, but unlike mania it never causes people to completely lose control.

Mood swings and depression

Bipolar-II affects everyone differently, but a common theme is that it causes mood to shift up and down throughout life. The first symptoms usually appear during adolescence, and these early mood swings often shift very rapidly as in the quote above. As people age, these shifts in mood usually slow down. Over time, depressions tend to occur more often and the ups (or hypomanias) may fade away.

Depression is so common in bipolar-II that it is often misdiagnosed as “major depression.” In fact, 1 in 3 people diagnosed with major depression actually have bipolar-II. Identifying the correct diagnosis is crucial since bipolar-II may worsen with antidepressant medication. The chart below details the differences between major depression, bipolar-I and bipolar-II:

“I was silly and giddy one minute, bursting with rage the next; running around excitedly in the afternoon but impossible to rouse out of bed in the morning.”
–Gogo Lidz, New York Magazine

Depression? Hypomania? Mania?
Unipolar Major Depression Yes No No
Bipolar II Yes Yes No
Bipolar I Usually Usually Yes

Because they may be rare or mild, it can be difficult to identify hypomanic times that distinguish bipolar-II from major depression. There are other clues which can alert people with depression to look carefully for bipolar-II. Most importantly, if anyone in your family has bipolar or manic-depression it is more likely that your depression is a bipolar-II type. Depressions that come on early in life, such as before age 20, are more likely to be bipolar-II, as are those which keep returning throughout life. Depressions that come on after pregnancy (called post-partum depression) are also a sign of bipolar-II.  Sometimes people with bipolar-II find that antidepressants work at first and then wear off, leading to frequent medication changes.

People with bipolar-II often have a highly reactive mood, and may experience mood swings even when depressed. This mood reactivity makes people feel easily hurt, rejected or irritated by others, and overwhelmed by or sensitive to stress. During depression, they may also have significant fatigue or over-eating.  Their mood may change with the seasons, with depressions in the Winter and hypomania in the Spring (read more about Light therapy for seasonal mood changes).

Other symptoms of bipolar-II

Mood impacts our thoughts as much as our emotions. People with bipolar-II are often misdiagnosed with Attention Deficit Hyperactivity disorder (ADHD) because of the difficulties it causes in concentration. During hypomania, people are easily distracted and their thoughts race quickly from topic to topic.  They may wander in daydreams while engaged in unrelated tasks, or their mind may be crowded with multiple streams of thought.

These shifting thoughts make it difficult to set priorities. They may neglect important responsibilities while they hyperfocus on a single task, or may shift from task to task in a disorganized way.  Thoughts can be experienced very powerfully, which can be a source of inspiration or frustration.  Hypomania can make people easily annoyed and quick to react.  It becomes very hard not to “sweat the small stuff,” and conflict with other people frequently erupts.

Energy is usually elevated in hypomania.  Sometimes this heightens creativity and productivity.  Other times the surge in energy makes people feel edgy and restless, and they may use alcohol or drugs to settle down.  People in this state tend to sleep less.  They may welcome this change or lie awake in an anxious state of insomnia.

Anxiety is one of the most common symptoms of hypomania. This may be felt physically as a restless nervousness or as an uncomfortable feeling of dread, as if something bad may happen at any moment.  Usually the person cannot identify what they are afraid of. Often the anxiety intensifies in social settings, and the intentions of other people may be seen as hostile or mean-spirited. At its most extreme, full panic attacks occur.

Sometimes the person with hypomania is not bothered by it at all and it is their relatives who are concerned.  Usually it is the impulsive and hyperactive symptoms that worry them.  These symptoms can cause people to spend too much money, jump into new relationships or start projects they can’t finish.

Hypomania also has a positive side, but I have emphasized the unpleasant aspects of it here because those are what lead people to seek help. In its sunny-side, hypomania can make people friendly, confident and outgoing. They can be very happy, or euphoric, in a way that lifts the spirits of those around them. Other people see them as inspiring, spontaneous, funny and generous. Indeed, hypomania can be a strength.

—Chris Aiken, MD, Updated 12/22/2016

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“Be brave; be strong; take your pills. Exercise because it’s good for you even if every step weighs a thousand pounds.”

Andrew Solomon • The Noonday Demon: An Atlas of Depression

“Denouncing these medicines makes as much sense as denouncing the immorality of motor oil. Without them, sooner or later the bipolar brain will go bang.”

David Lovelace • Scattershot: My Bipolar Family

“There is no harm in taking medication as it is utilizing the wisdom God gives to doctors. But it is also your responsibility to build faith for healing while using medication.”

Paul Silway • Pastor

“Being bipolar can be an all-consuming challenge, requiring a lot of stamina and even more courage, so if you’re living with this illness and functioning at all, it’s something to be proud of, not ashamed of. They should issue medals along with the steady stream of medication.”

Carrie Fisher • Actor and Author