What Is The Difference Between Bipolar 1 And 2?

As both professional and general understanding of bipolar disorder have evolved, many would find that the ways we describe the unique experiences of those living with bipolar disorder have evolved as well.

Bipolar I and II disorders are perhaps the most common and widely known types of bipolar spectrum disorders. However, there are some key differences between bipolar I and bipolar II disorder that affect how we treat them. 

What is bipolar disorder?

Bipolar disorder (BPD), previously called manic depression, is a mental illness defined by intense mood swings from extreme highs (manic episodes) to extreme lows (depressive episodes). Symptoms of manic and depressive episodes can affect your energy levels, ability to function and, in some cases, may even cause psychosis—hallucinations, delusions, and other symptoms that distort reality.

Currently, mental health professionals distinguish between a few subtypes of bipolar disorder based on the presence or absence, severity, and length of depressive episodes, hypomanic episodes, and manic episodes. 

The majority of bipolar disorder diagnoses are received by people in their 20s and 30s, but it’s possible for symptoms to have an earlier or later onset, such as during childhood. Overall, experts estimate that approximately 3% of adults in the United States have some form of bipolar disorder, most frequently bipolar I disorder or bipolar II disorder.

What is bipolar I and II disorder?

An individual may also experience other specified or unspecified bipolar disorder if symptoms of mood episodes are present but don’t fulfill the criteria for the primary types of the condition. 

Bipolar I and bipolar II are categorized as “Bipolar and Related Disorders” in the DSM-V. Both types are characterized by mood episodes that feature manic symptoms (or hypomanic symptoms) and depressive symptoms. Both forms of this mental health condition can significantly impact an individual’s well-being, relationships, and ability to function. 

Whether they have type I or II, people with bipolar disorder will all experience some form of mania. For many, symptoms of a manic or hypomanic episode—such as racing thoughts or a decreased need for sleep—will precede or follow those of a depressive episode. In severe cases, psychotic symptoms can occur in either mania or depression, though not during a hypomanic episode. 

The diagnostic criteria outline the symptoms required to make a diagnosis. However, even people with the same diagnosis may experience their conditions quite differently. One individual with type I might have more pronounced, longer lasting episodes of mania and few to no episodes of depression, while another individual may experience only one or two manic episodes in their life but struggle with several episodes of severe depression. And yet another may have a fairly even mix of manic and depressive episodes, or may experience what are called mixed episodes—periods of co-occurring manic and depressive symptoms.

Bipolar I disorder

To diagnose someone with bipolar I, a mental health professional needs to know whether the person in question has had at least one manic episode, a period of extremely elevated mood, lasting more than one week.  

Although many people with bipolar I disorder have episodes of both mania and depression, a major depressive episode is not required for diagnosis in the current diagnostic criteria. 

Symptoms of manic episodes

Because a main diagnostic criterion for bipolar I is a full manic episode, symptoms like those below are frequently experienced by those with the diagnosis:

• Increased risky behavior, such as irresponsible spending or excessive substance use

• A substantial increase in energy levels

• A lack of sleep or lack of need for sleep

• Racing thoughts

• Feeling much happier than usual, even euphoric

• Increased talkativeness

• Distractibility

• Feelings of grandiosity or superiority over others

• Hallucinations, false beliefs, or delusions (psychosis)

Bipolar II disorder

To receive a diagnosis of bipolar II, you generally have to have at least one hypomanic period lasting at least 4 days as well as one severe depressive period lasting at least 14 days. Hypomania is considered a milder form of mania, with less severe symptoms that typically do not require hospitalization or cause as significant of an impairment in everyday functioning. 

Those living with bipolar II might still be able to function fairly normally at work and in social situations. Additionally, they’re less likely to experience psychotic symptoms—and when they do experience psychosis, it’s only during depressive episodes. Psychosis that occurs during an episode of elevated mood typically indicates mania and a diagnosis of bipolar I disorder instead.

Symptoms of hypomanic episodes

Some symptoms of hypomania are:

• Poor, impulsive decision making

• Feeling upbeat, talkative, and much happier than usual

• An average or enhanced ability to perform at work and home life

• Feeling more creative and productive than usual

• Being in a very good mood for seemingly no reason

Symptoms of depressive episodes

Major depressive episodes are periods of low mood and decreased energy that can accompany both types, but are required only for a diagnosis of type II. The following are signs of acute bipolar depression:

• Intense feelings of sadness or disinterest in most activities

• Inability to concentrate

• Trouble making decisions

• Sleeping more than usual, yet still feeling fatigued

• Weight gain or loss, perhaps due to changes in appetite or eating patterns

• Social withdrawal and isolation

• Thoughts of harming oneself *

*If you or someone you know is experiencing suicidal thoughts, help is available. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255 and is available 24/7, or you can text the word “HOME” to 741741 to reach the Crisis Text Line.

Causes of bipolar I and II disorder

Although experts have not found one proven cause of these disorders, many studies have connected the disorder to factors like genetics. In fact, some researchers posit that genetics is a number one risk factor for developing bipolar disorder.

Other factors that are associated with a person’s likelihood of developing some type of bipolar disorder (though are not necessarily causative) include:

• Stressful, traumatic, or otherwise significant life events such as divorce or job loss

• Substance use, such use of as tobacco, alcohol, and illicit substances

• Abuse of any kind

• Experiencing the loss of a loved one

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Managing manic and depressive symptoms 

Treatment plans for bipolar I and II disorders usually consist of therapy, medication, and changes in lifestyle Bipolar disorder generally responds most to a combination of therapy and medication; lifestyle changes are not considered effective on their own.

Medications

Many people living with bipolar disorders find that prescription medications relieve or minimize the severity of their symptoms. Several classes of medication can be used to achieve this goal. Medications that a psychiatrist or other mental health professional may prescribe to a person with bipolar I or II include:

• Antidepressants: These may be prescribed to help reduce the impacts of depression 

• Mood stabilizers: These may help control or limit manic and hypomanic episodes, as well as depression.

• Antipsychotics: Medications in this class can be helpful when depression or mania persists despite the use of other treatment options

• Anti-anxiety medications: These may help a person sleep better and experience fewer anxious symptoms if they have a comorbid anxiety disorder.

Certain medications are used more frequently depending on the type of bipolar disorder present. For example, antidepressants may be more useful in bipolar II compared to bipolar I, given that antidepressants can cause or exacerbate symptoms of mania—the predominant polarity in type I. Other medications can help individuals manage symptoms of both types of bipolar disorder. For example, the results of five placebo-controlled trials show that the antipsychotic quetiapine can reduce symptoms in both bipolar I and bipolar II. Additionally, mood stabilizers can address mania and hypomania with a lower chance of triggering depression, and vice versa in both types.

Psychotherapy

Psychotherapy alone typically isn’t enough to fully treat bipolar disorder, but it can be highly beneficial, especially as an adjunct to medication. Talk and other forms of psychotherapy can help a person better understand their triggers, learn effective management strategies for their symptoms, and adopt other useful skills. One of the most commonly prescribed psychotherapies for this condition is cognitive behavioral therapy, or CBT.

Changes in lifestyle

Making certain changes in one’s day-to-day lifestyle can help stabilize mood—though these changes generally are not used on their own.

Below are a few potentially useful changes:

• Education: Learning all they can about bipolar disorder may help someone better understand and manage their own symptoms.

• Sleep health: Getting enough sleep and having a sleep routine may help limit stress, prevent the onset of some episodes, and aid in regulating mood symptoms.

• Exercise and nutrition: Taking care of one’s body through exercise and a balanced diet can help promote steady energy levels and avoid triggering mood symptoms.

• Substance use restriction: Substances like tobacco or recreational drugs can increase the severity of one’s symptoms and may interfere with prescription medications.

How can online therapy help those living with bipolar I and II?

Talk therapy is an important element of treatment for many mental health disorders, including bipolar disorder. No matter which form of bipolar disorder you may have, a professional can help you understand your symptoms, find strategies to manage them, and offer support as you learn how to navigate daily life with the condition.

Traditional in-person therapy is highly effective, but online therapy may be an easier option for you, especially if you have a tight budget, a busy schedule, or live far away from any therapy offices.

Is online therapy as effective as in-person therapy?

Research suggests that digital therapy options can be effective for managing bipolar disorder symptoms. One recent review of several studies on online and smartphone-based treatment for bipolar disorder found that both treatment options can help patients manage their symptoms more effectively.