Bipolar II Disorder

Written by BetterHelp Editorial Team
Medically reviewed by Dr. Jennie Stanford, MD, FAAFP, DipABOM, Julie Dodson, MA, LCSW, and Laura Angers Maddox, NCC, LPC

Overview

Bipolar disorder, previously known as manic depression, causes extreme mood swings and significant changes in activity levels, energy levels, and concentration. There are three types of bipolar disorder: bipolar I disorder, bipolar II disorder, and cyclothymic disorder. To understand bipolar disorder II (BP-II) in particular, it may be helpful to know more about the symptoms of bipolar disorder I.1

Bipolar I disorder versus bipolar II disorder

Bipolar I disorder is characterized by manic episodes that last most of the day, almost every day for at least seven days at a time. People with bipolar I disorder may also experience bouts of depression or episodes with mixed features of mania and depression, but depressive symptoms are not necessary in order for a diagnosis of bipolar I disorder to be considered. 

In contrast, depression is an integral part of the mental health diagnostic criteria for bipolar II disorder. A person must experience at least one major depressive episode and at least one hypomanic episode and must never have experienced a full manic episode for this diagnosis to be considered. These symptoms and/or the unpredictability caused by the alterations between depression and hypomania must also cause significant distress2 or impairment in critical areas of functioning—for example, at work or socially.

Symptoms

Bipolar II disorder symptoms include symptoms of hypomania and symptoms of depression, as outlined below. 

Hypomania symptoms of bipolar II disorder

For periods of time to be classified as hypomanic episodes, someone with bipolar II disorder must exhibit at least three of the following symptoms, which must represent significant changes from their usual behavior: 

  • Inflated self-esteem
  • Decreased need for sleep
  • Racing thoughts
  • Distractibility
  • Increased goal-directed activity
  • Excessive involvement in activities with unhealthy consequences 
  • Excessive talking or chattiness 

Unlike with mania, these episodes are typically not severe enough to cause marked impairment in occupational or social functioning or to require hospitalization. In addition, people with mania may experience psychotic episodes (psychosis),3 whereas those with bipolar II disorder are unlikely to unless they are also diagnosed with a psychotic disorder. 

Hypomania can look somewhat different depending on the person, but some examples of how someone in a hypomanic state may behave include things like: 

  • Staying up all night and not feeling tired the next day
  • Starting a project and working on it non-stop for 20 hours at a time
  • Getting into an intense cleaning frenzy and cleaning one’s house from top to bottom without a break
  • Calling and texting friends non-stop
  • Jumping from one subject to another when talking
  • Perceiving that they can do anything, even without experience or training

Depressive symptoms of bipolar II disorder

According to the diagnostic criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person with bipolar II disorder must have experienced at least one episode of major depression. Again, bipolar depression episodes are more closely associated with bipolar II disorder than bipolar I disorder, though they can occur in both.

According to the American Psychiatric Association, signs of a major depressive episode may include the following depressive symptoms: 

  • A depressed mood for most or all of the day 
  • A depressed mood that is observable by others
  • Struggling to experience pleasure 
  • Significant, unexpected weight loss or gain 
  • Significant changes in appetite
  • Sleeping too much or struggling to sleep; feeling tired all the time
  • Slower thoughts and movements
  • A lack of energy 
  • Thoughts of worthlessness or helplessness
  • Guilt or shame 
  • Difficulty concentrating 
  • Difficulty making decisions
  • Recurring thoughts of death or suicidal ideation, with or without a specific plan

It’s also possible for a person with bipolar disorder to experience rapid cycling, which refers to having four or more hypomanic, manic, or depressive episodes within a year.

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Causes

Researchers believe that, as with most mental illnesses, multiple factors are likely involved in causing bipolar I disorder. Some of these key factors include the following. 

Genetics impacting bipolar disorder

Although it’s not yet fully understood, there does seem to be a significant genetic component of bipolar disorder. Having first-degree biological relatives may be one of the key risk factors for developing bipolar disorder of any type, including bipolar II, and certain families may have stronger genetic markers of this condition than others. 

Stress

In addition to potentially triggering hypomania or depressive episodes in someone who already has bipolar disorder, stress may also contribute to a person developing bipolar disorder in the first place. Researchers suspect this may be because individuals with this illness may have elevated levels of stress hormones in general, meaning that additional stress can cause outside effects. It could also be that bipolar disorder causes or develops because of impaired brain function, which may be exacerbated by stress as well.

Brain structure 

Research suggests that people with bipolar disorder may have subtle differences in their brain structure, including smaller subcortical volumes, changes in white matter, and lower cortical thickness. Still, brain scans cannot be used to diagnose bipolar disorder at this time.

Treatments

There is no cure for bipolar II disorder, but there are treatment plans available that can help individuals effectively manage their symptoms. The goal of treatment is, first, to stabilize a person having an acute hypomanic episode or manic episode, if needed—though this is more common in those with bipolar I disorder. The other key goal of treatment is to bring the person to the level of functioning they had before developing their illness and to prevent relapse.

Therapy for bipolar I & bipolar II disorder

Clinicians are realizing the importance of psychotherapy and psychoeducation in treating bipolar disorder. Psychotherapy aims to help people identify and change behaviors, emotions, and thoughts. 

There are three types of therapy commonly used to treat this condition: cognitive behavioral therapy (CBT), family-focused therapy (FFT), and interpersonal and social rhythm therapy (IPSRT). Below are further descriptions of these modalities. 

CBT: Cognitive behavioral therapy

Cognitive behavioral therapy is one of the most common talk therapy modalities for treating a variety of psychiatric disorders, from anxiety to depression to bipolar disorder. A study from 2021 speaks to its use for individuals with bipolar II disorder in particular, with findings suggesting that CBT may help these individuals address symptoms, “increase medication conformity, prevent hypomanic or depressive episodes, or treat comorbidities like sleep disturbances or anxiety disorders.”

FFT: Functional family therapy

A key aim of FFT for bipolar II disorder is to decrease stress—high levels of which can trigger hypomanic or depressive episodes. FFT focuses on addressing common sources of stress within families, from high emotions and negative interactions to a lack of support. They do this through psychoeducation and teaching communication and problem-solving techniques. This type of clinician will typically try to help families understand the illness and how stress can contribute.

IPSRT: Interpersonal and social rhythm therapy

IPSRT focuses on improving stability and mood by regulating social rhythms. Social rhythms are daily habits, such as getting out of bed, showering, and eating regular meals. In this type of therapy, the clinician helps their client make connections between their mood and life events, identify and manage symptoms, and mourn the loss of who they may have been without a mental health condition so they can find peace and move forward.

Medication for bipolar II disorder

Medications are often a crucial part of helping people with bipolar II disorder manage their symptoms.

In particular, mood stabilizers like lithium and valproic acid are commonly used to treat bipolar II disorder. These medications can reduce the severity of episodes or prevent them entirely. That said, long-term use of lithium in particular can cause kidney or thyroid problems, so it should only be taken under close medical supervision. Consult a medical provider before starting, changing, or stopping any medication. 

If mood stabilizers are not effective in controlling symptoms of depression in an individual with bipolar II disorder, some antidepressant medications may be considered. Research from some clinical trials shows that selective serotonin reuptake inhibitors (SSRIs) or bupropion may sometimes be helpful in such cases.

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content is providing generalized information, not specific for one individual. You should not take any action without consulting with a qualified medical professional.

Other bipolar II disorder treatment options

Other treatment options for bipolar II disorder may include: 

  • Electroconvulsive therapy (ECT): ECT involves brief electrical stimulation to the brain. It may relieve symptoms of major depression or bipolar disorder in individuals who have not responded to other treatments or during a mental health emergency.
  • Repetitive transcranial magnetic stimulation (TMS): This procedure is similar to ECT but is not as powerful and has a lower risk of side effects. It stimulates the brain using magnetic waves.
  • Light therapy: Some people are affected by the seasons and may have more episodes in the winter months. Light therapy may be helpful for people who are affected in this way. 

Self-care for bipolar II disorder & bipolar disorder

Self-care can be an important component of treatment for a variety of mental illnesses, including bipolar II disorder. It may help individuals manage stress and contribute to overall physical and mental well-being, which can alleviate symptoms of the syndrome. Some examples of self-care can include drinking plenty of water, eating nutrient-rich foods, getting regular physical activity, maintaining strong social connections, and getting enough sleep.

Resources

Below are other resources to consider: 

  • The National Institute of Mental Health offers digital shareables to raise awareness about bipolar disorder along with many other resources. 
  • The Depression and Bipolar Support Alliance offers education and other resources. If you want to find an in-person support group for people with bipolar II disorder, check out their online directory to locate one in your area.
  • If you have bipolar disorder and are in crisis, or if you are a family member of someone with bipolar disorder who is in crisis, you can contact the National Alliance on Mental Illness Helpline by calling 1-800-950-6264 Monday through Friday, 10am to 10pm EST, or by text, email, or online chat. 

Professional help for bipolar II disorder & bipolar disorder

In general, it’s recommended that you seek professional mental health treatment right away if you’re showing signs of bipolar disorder.

Research

A recent study published in Nature Genetics examined genomic data from 57 groups across three continents—including 41,917 people with bipolar disorder and 371,549 people without. The results identified 64 genomic locations associated with bipolar disorder, including 33 that previous studies had never identified. These associations include links to immune function, schizophrenia, and attention-deficit/hyperactivity disorder (ADHD). Researchers also uncovered links to specific traits and behaviors like smoking, alcohol use, insomnia, and sleep duration.

Genes related to bipolar I disorder & bipolar II disorder

This research also distinguished between bipolar I disorder and bipolar II disorder, finding that bipolar II disorder was closely related to major depression while bipolar I disorder was linked to schizophrenia. The results of this study identified 15 genes as promising candidates for future research and the development of new treatments.

Bipolar I disorder & bipolar II disorder deaths

Another recent study looked at the mortality of people with bipolar disorder, suggesting that people with the condition may have double the risk of dying due to a physical illness and a sixfold increase in risk of early death from external causes. Of the deaths due to physical illness, 29% were caused by alcohol (namely, liver disease, accidental alcohol poisoning, and alcohol dependence), 27% by heart disease and stroke, and 22% by cancer. Of the deaths caused by external factors, 58% were due to suicide. Of those, nearly half were caused by overdosing on mental health medications. This study highlights the need to prevent deaths due to external causes and demonstrates the importance of effective long-term treatment.

Statistics

12 months of mindfulness-based therapy reduces depression in individuals with bipolar disorder

stat image
A study in the Behaviour Research and Therapy Journal found that after 12 months of a mindfulness-based cognitive-behavioral therapy intervention (CBT), individuals with bipolar disorder had significantly lower depression and anxiety scores.1
1Behaviour Research and Therapy Journal

Below are some more key statistics on bipolar disorder:

  • Estimates vary, but it’s suggested that around one in 40 US adults live with bipolar disorder.
  • Per one study, around 20–30% of those diagnosed with major depressive disorder (MDD) transitioned to a bipolar disorder diagnosis within three years. This statistic highlights the need for clinicians to remain aware of the possibility for misdiagnosis between these two conditions.
  • Online therapy can be a valuable component of treatment for those living with a mental illness like bipolar disorder. One study indicates that it can be an important part of “routine care” and may help reduce symptoms of anxiety and depression in those living with this type of condition.

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Associated terms

Updated on September 3, 2024.
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