Bipolar II is a psychiatric disorder that involves mood swings from depressed to hypomanic states. Unlike bipolar I, also called manic depression, bipolar II does not involve manic states. However, like bipolar I, the person afflicted suffers from varying degrees of mood. This disorder may create depression or anxiety so great that risk of suicide is increased over those who suffer from Bipolar I.
In order to properly diagnose Bipolar II, patients and their doctors must be able to recognize what constitutes hypomania. People in a hypomanic state may experience increased anxiety, sleeplessness, good mood, or irritability. The hypomanic state can last for four days or longer, and patients will note a significant difference in feelings from when they are in a depressed state.
Hypomania may also cause people to feel more talkative, result in inflated self-esteem, make people feel as though their thoughts are racing, and in some cases result in rash choices, such as indiscriminate sexual activity or inappropriate spending sprees. Often, the person who feels anxious or irritable and also has bouts of depression is diagnosed with anxiety disorder with depression, or merely anxiety disorder. As such, they do not receive the proper treatment, because if given an anti-depressant alone, the hypomanic state can progress to a manic state, or periods of rapid cycling of mood can occur and cause further emotional disturbance.
Manic states differ from hypomania because perception of self is generally so deluded as to cause a person to act unsafely and take actions potentially permanently destructive to one’s relationships. Additionally, the manic person may be either paranoid or delusional. Those with mania may feel they are invincible. High manic states often require hospitalization to protect the patient from hurting himself or others.
Conversely, hypomanic patients may find themselves extremely productive and happy during hypomanic periods. This can further complicate diagnosis. If a patient is taking anti-depressants, hypomania may be thought of as a sign that the anti-depressants are working.
Ultimately, though, those with bipolar II find that anti-depressants alone do not provide relief, particularly since anti-depressants can aggravate the condition. Another hallmark of the disorder is rapid cycling between depressed and hypomanic states. If this symptom is misdiagnosed, sedatives may be added to anti-depressants, further creating mood dysfunction.
The frequent misdiagnosis of this disorder likely creates more risk of suicidal tendencies during depressed states. Patients legitimately trying to seek treatment may feel initial benefits from improper medication, but then bottom out when treatments no longer work. The fact that multiple medications may be tried before the correct diagnosis is made can fuel despair and depression.
Depression associated with either bipolar I or II is severe. In many cases, depression creates an inability to function normally. Patients suffering from major depression describe feeling as though things will never feel right again.
Severely depressed patients may not leave their homes or their beds. Appetite can significantly increase or decrease. Sleeping patterns may be disrupted, and people may sleep much longer than usual.
This type of depression does not respond to reason or talking it out, because it is of chemical origin. Though therapy can improve the way a person deals with depression, it cannot remove chemically based depression. Because of what seems an inescapable mood and a feeling that things will never improve, patients frequently contemplate and often attempt suicide.
Once accurate diagnosis is made, treatment consists of many of the same medications used to treat bipolar I. These medications typically include mood stabilizers like lithium or anticonvulsants like carbamazepine (tegretol®), and many people also benefit from a low dose of an antidepressant.
Those with bipolar II rarely need antipsychotic medications since they are not prone to psychotic symptoms or behavior. Even with appropriate medication, it may take some time to stabilize a patient and find the right dosage. When patients have demonstrated suicidal tendencies, hospitalization may be necessary to provide a safe environment where medications can be adjusted accordingly.
When medication is combined with cognitive behavioral therapy, patients seem to respond more quickly and have the most success. Although this disorder is not thought to be caused by traumatic events, such factors as a history of abuse can affect recovery. By approaching the condition with both therapy and medication, the patient is likely to recover fully.
With treatment, those with bipolar I or II can live healthy normal lives and attain success in work and relationships. Many anticonvulsant medications are related to a high incidence of birth defects, however. Patients who are on medication and considering a pregnancy should seek the advice of both their psychiatrist and obstetrician before becoming pregnant.