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Bipolar II involves mood swings from depressive states to hypomanic states, but not manic states like bipolar I. Proper diagnosis is important, as antidepressants alone can aggravate the condition. Treatment includes mood stabilizers and cognitive behavioral therapy. Misdiagnosis can increase the risk of suicide.
Bipolar II is a psychiatric disorder that involves mood swings from depressive states to hypomanic states. Unlike bipolar I, also called manic depression, bipolar II does not involve manic states. However, like bipolar I, the afflicted person suffers from varying degrees of moodiness. This disorder can create such great depression or anxiety that the risk of suicide is increased compared to those with Bipolar I.
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, insomnia, low mood, or irritability. The hypomanic state can last for four days or more, and patients will notice a significant difference in feelings compared to when they are in a depressive state.
Hypomania can also cause people to feel more talkative, cause inflated self-esteem, make people feel like their thoughts are racing, and, in some cases, lead to rash choices, such as indiscriminate sexual activity or spending sprees. Often, the person who feels anxious or irritable and who also has bouts of depression is diagnosed with an anxiety disorder with depression or simply an anxiety disorder. As such, they do not receive the proper treatment, because when given an antidepressant alone, the hypomanic state can progress to a manic state, or periods of rapid mood cycling can occur and cause further emotional disturbances.
Manic states differ from hypomania because self-perception is usually so deluded that it causes a person to act unsafely and to take actions that are potentially permanently destructive to their relationships. Also, the manic person may be paranoid or delusional. Those with mania can feel invincible. High manic states often require hospitalization to protect the patient from harming himself or others.
Conversely, hypomanic patients may find themselves extremely productive and happy during hypomanic periods. This can further complicate the diagnosis. If a patient is taking antidepressants, hypomania can be considered a sign that the antidepressants are working.
Eventually, though, those with bipolar II find that antidepressants alone don’t provide relief, especially since antidepressants can aggravate the condition. Another hallmark of the disorder is the rapid cycling between depressive and hypomanic states. If this symptom is misdiagnosed, sedatives can be added to antidepressants, creating further mood dysfunction.
Frequent misdiagnosis of this disorder probably creates more risk of suicidal tendencies during depressive states. Patients legitimately seeking treatment may feel the initial benefits of an inappropriate drug, but then subside when the treatments no longer work. The fact that multiple drugs may be tried before the correct diagnosis is made can fuel despair and depression.
Depression associated with bipolar I or II is severe. In many cases, depression creates an inability to function normally. Patients suffering from major depression describe feeling that things will never be right again.
Severely depressed patients cannot leave their homes or their beds. Appetite can increase or decrease significantly. Sleep can be disrupted and people can sleep much longer than usual.
This type of depression does not respond to reason or talk about it, because it is chemical in origin. Although therapy can improve the way a person deals with depression, it cannot remove chemically based depression. Because of what seems like an inevitable state of mind and a feeling that things will never get better, patients often contemplate and often attempt suicide.
Once an accurate diagnosis is made, treatment consists of many of the same medications used to treat bipolar I. These medications typically include mood stabilizers such as lithium or anticonvulsants such as carbamazepine (tegretol®), and many people also benefit from a low dose of an antidepressant.
Those with bipolar II rarely need antipsychotic medication as they are not prone to psychotic symptoms or behaviors. Even with the proper medications, it may take some time to stabilize a patient and find the right dosage. When patients have demonstrated suicidal tendencies, hospitalization may be required to provide a safe environment in which medications can be adjusted accordingly.
When medications are combined with cognitive behavioral therapy, patients appear to respond the fastest and be the most successful. While this disorder is not thought to be caused by traumatic events, factors such as a history of abuse can affect recovery. By approaching the condition with both therapy and medication, the patient is likely to make a full recovery.
With treatment, those with bipolar I or II can live normal healthy lives and achieve success in work and relationships. However, many anticonvulsant drugs are related to a high incidence of birth defects. Patients who are taking medications and considering pregnancy should seek the advice of both their psychiatrist and obstetrician before becoming pregnant.
