Bipolar II Disorder

Bipolar II Disorder

When someone has Bipolar II disorder it means that they have periods of depressed moods (lasting at least two weeks) and one or more periods of elevated/agitated moods (lasting at least four days). According to the National Institute of Mental Health (NIMH), about 3 percent of the adult population in the United States experiences bipolar disorder. The prevalence of bipolar disorder is about the same among men and women.

What it looks like

It is important to understand the major components of Bipolar II disorder. Bipolar II disorder includes periods of major depression interspersed with times of hypomania. In addition, there are also regular periods of average/normal behavior. These periods of hypomania, depression, or normalcy vary within individuals in terms of how long they last and which symptoms are expressed.

Much of the focus associated with the treatment of bipolar disorder is on preventing further episodes and to return the individual to a normal mood. Bipolar disorder is highly treatable which means that most people who engage in treatment spend much of their life with few symptoms. This “maintenance phase” is most commonly obtained through the use of the medications discussed below and is often managed by primary care clinicians.

Hypomania

Hypomania means that the person is experiencing an excessively elevated mood. While this elevated mood may at times feel pleasurable it can lead to erratic and unhealthy behaviors that negatively impact many aspects of life. During hypomania someone may exhibit serious grandiosity (feeling like a superior human being compared to everyone else), impulsivity, high energy, or euphoria–but these symptoms do not rise to the level of needing hospitalization.

Some people with hypomania are not euphoric but instead they are agitated and irritable. People with hypomania may need only 3-5 hours of sleep yet still be able to function well at work, school, and home.

People with bipolar II disorder do not experience mania, which are symptoms similar to hypomania but magnified by many times and which may require hospitalization to protect the person.

Hypomania often feels good, and sometimes people with bipolar disorder worry that these euphoric (and sometimes productive times) may go away altogether with treatment/medication. Treatment does not mean that a person will have no mood variability or feel “blah”. Instead, it means that rather than their moods going up and down uncontrollably (like being on a roller coaster of extreme moods) their mood can be level (with the average ups and downs of day to day life), which vastly improves quality of life.

Symptoms of hypomania include

• Decreased need for sleep
• Rapid talking and talking significantly more than usual
• Racing thoughts
• Grandiosity–excessively high self-esteem or view of oneself
• Engaging in impulsive behavior that would not occur when in an average mood, such as spending excessively or engaging in sexual activities that they would normally not have done outside of the hypomanic episode.
• Being excessively goal-driven or engaging in multiple projects (many more projects than the person would normally undertake)
• Increase in desire to achieve goals
• Being highly distractible

Depression

A person experiencing depression will have a persistently sad or numb mood which lasts for at least two weeks. During a depressive episode someone may have trouble doing day-to-day activities or engaging with work/family/friends. Individuals with depression may have changes in their levels of sleep, such as sleeping for extended periods of time or not sleeping much at all. They may also have changes in their appetite, such as eating large quantities of food that they would not normally eat when not depressed or they may eat very little. As a result, there may be fluctuations in weight during depression where someone may either gain or lose weight. Individuals who are depressed may also have suicidal thoughts.

Some people describe depression as feeling like their “tank” is empty. Others report feeling extremely sad, or start to feel they are insignificant - that other people are looking right through them. Many people with depression stop getting pleasure from the things that used to make them happy, and can’t imagine being happy again. They sometimes wonder “if it’s all worthwhile,” and imagine how life would be if they weren’t around. The depressed mind can play horrible tricks on one’s thinking.

Symptoms of depression include the following

• Having a sad mood the majority of the day
• Having a significant weight gain or weight loss
• Apparent restlessness or irritability
• Sleeping much more or much less every day than in the past
• Eating much more or much less than in the past, causing an unintentional weight gain or loss
• Having difficulty meeting the daily requirements of life, such as dealing with work and family
• Extreme fatigue much of the time
• Difficulty with concentrating most of the time
• Feeling like a worthless or bad person, although individuals haven’t done anything wrong
• Taking no pleasure or happiness in activities that had previously been pleasurable
• Laughing less often or never
• Thoughts of death or suicide

It is possible to have both depression and hypomania at the same time, which is called a Mixed Episode, and can feel like high levels of distress plus extreme agitation. Both Depressive episodes and Mixed Episodes are particularly unpleasant and once a person experiences either they can become highly motivated to avoid a recurrence.

Depression vs Bipolar II Disorder

Someone with Bipolar II Disorder may have been previously diagnosed with Major Depressive Disorder and they may be confused on which diagnosis is accurate or what this new diagnosis means. This often happens because most people with Bipolar II Disorder initially seek treatment when they are in a depressive state, rather than a hypomanic state, since depression can feel very distressing whereas hypomania may be unreported due to it feeling good/productive or it is not considered to be an atypical/negative experience.

Having Bipolar is nobody’s fault

Many people with bipolar disorder may have blamed themselves for years for not being able to “shake” their mood swings. But this illness is no one’s fault. And, most of the time, it is highly treatable. Blaming oneself for bipolar disorder is like blaming oneself for having brown eyes or blonde hair. It’s nobody’s fault. However, what someone can do is learn to control the cycling moods with medication and therapy

The ongoing management of Bipolar II Disorder

When a person with bipolar II disorder feels better as a result of medication, therapy, or circumstances, they might assume they are cured, and stop taking their medication. The illusion of being “cured” is enticing. But, with bipolar II disorder, ongoing treatment is necessary, even when the illness is managed and mood is stable/steady.

This approach is different from taking an antibiotic for a week for an infection and achieving a complete recovery. In contrast, bipolar II disorder is a chronic illness, comparable to diabetes or hypertension. People with diabetes or hypertension may feel better when they take the appropriate medications - but if they stop taking their medicines their symptoms usually return. The goal of treatment is always maintenance of a stable mood.

In the case of bipolar II disorder, if taking a medication is helpful and is working, this is a positive indicator of its effectiveness rather than a sign that the underlying mania and depression are gone. For that reason, the process of determining if someone is ready to stop treatment should be made in partnership with their prescribing clinician to avoid stopping too abruptly or too soon.

In the case of bipolar II disorder, if the medication is working and helping, this is a positive indicator of its effectiveness rather than a sign that the disorder is gone. For that reason, the process of determining when an individual is ready to stop treatment should be made in partnership with a physician to avoid stopping too abruptly or too soon. It is also true that in the course of the illness, one may need a higher dosage of medications, a lower dosage, or a different medication altogether.

Outlook

While living with bipolar II disorder can present unique obstacles, and finding the best treatment for one's hypomania and depression can take at least several tries of different medications, the right treatment can dramatically improve one’s quality of life. The majority of people who are properly diagnosed and treated for bipolar disorder gain transformative results. In fact, people who have received medical treatment often say that accepting and launching treatment was one of their most important right decisions. With treatment, people with bipolar disorder can reclaim their lives. There will still be some difficult periods, even with medication and therapy, as when stress levels are very high. But bipolar II disorder is a psychiatric condition that is very manageable, as long as an individual continues to work with their medical provider.

In good company

Many prominent people reportedly struggle with bipolar disorders, such as academy award winning actress Catherine Zeta-Jones, singer Demi Lovato, General Hospital actor Maurice Benard, the late actress Carrie Fisher, and singer Mariah Carey. People living with Bipolar are definitely not alone in their experience.

The current thinking on what causes bipolar disorder

In the past, mental health clinicians have explained conditions such as bipolar disorder as a “chemical imbalance.” This may make it seem like this condition is similar to a vitamin or mineral deficiency, and that just taking the right drug will easily cure someone. Unfortunately, bipolar disorder is more complicated. And what’s more, there is disagreement over whether someone is born with the imbalance, or it gets triggered by their environment. Most likely, it’s a combination of both. In support of “chemical imbalance” being the cause, medications that stabilize the brain, such as lithium or other medications. often make people with bipolar disorder feel better. These drugs are called “mood stabilizers.”

Bipolar disorder may also be caused by genetics, and we often say that it “runs in families.” If somebody has a parent or sibling who has depression or bipolar disorder, it puts that person at an increased risk for having a bipolar disorder themselves. But, it is a complicated issue: For example, even in the case of identical twins, if one twin has bipolar disorder, the risk for the other twin to develop this disorder is about 50 percent. Since they are identical genetically, it would seem like both twins should develop the disorder–but they do not. This may mean that environmental impacts play a role in whether a person with a genetic risk develops bipolar disorder or not. Researchers are constantly studying possible causes and potential ways to mitigate the effects of this common condition.

People who suffered from severe childhood trauma have a higher risk for bipolar disorder than those who were not traumatized. Some people have both a genetic risk and an environmental risk, increasing the likelihood of developing bipolar disorder.

Other Diagnoses

Many people with bipolar disorder also have other diagnoses, especially anxiety disorders. If such disorders are present, they should also be treated as well as bipolar disorder. In addition, as mentioned earlier, sometimes people with bipolar disorder are suicidal, thus it is very important for the person with bipolar disorder to report suicidal thoughts to the physician so that medication can be adjusted as needed. For example, the lithium dosage may need to be changed.