Bipolar II Disorder: Signs, Symptoms and Treatment

What are the Signs, Symptoms, and Treatment Options for Bipolar II Disorder?

Bipolar disorder is a common mental health condition that affects up to six million people in the U.S. The disease is broken down into several categories, each with their own set of unique symptoms and treatment methods. A person can be diagnosed with bipolar I, bipolar II, cyclothymia, mixed features, or rapid-cycling bipolar.

Bipolar II disorder is a subset of bipolar disorder. Patients suffer from episodes of mania, usually followed by depression. Levels of mania in bipolar II patients do not reach the heights as the mania present in bipolar I. The less-intense levels of mania in bipolar II disorder are often referred to as hypomania in clinical terms. Almost four out of ten bipolar patients suffer from symptoms and do not get correct diagnosis and treatment for up to three years. Fortunately, once they do get the proper treatment, nine out of ten surveyed bipolar patients are happy with the outcomes.

Bipolar II Disorder: Signs, Symptoms and Treatment

Bipolar Disorder Statistics

If you or a loved one is living with signs or symptoms of bipolar II disorder, it can be helpful to know that you are not alone. According to the National Institute of Mental Health data, 2.8 percent of adults in the United States experience bipolar disorder in a given year, and 4.4 percent will experience the condition during their lifetimes. Prevalence is nearly equal in men and women. Consider these additional bipolar disorder statistics:

  • The prevalence of bipolar disorder is highest among young adults aged 18-29, of whom 4.7 percent experience bipolar disorder in a given year. 
  • Around 83 percent of people with bipolar disorder experience serious impairment in daily functioning. 
  • By the time they reach their teenage years, 2.9 percent of adolescents will have had bipolar disorder at some point during their lives.
  • The lifetime prevalence rate of bipolar disorder is higher in teen girls (3.3 percent) when compared to teen boys (2.6 percent).

What are the signs and symptoms of bipolar II disorder?

Significant changes in mood and behavior characterize bipolar disorder. The different subsets of the condition will manifest different symptoms and exhibit varying timeframes for mood changes. In bipolar II disorder, a patient will cycle between hypomania and depression.

Hypomania in bipolar patients can present as either euphoria or feeling “high,” or agitation and irritability. Hypomania symptoms can manifest as the following:

  • Going from one idea to the next in quick succession.
  • Exhibiting intense focus.
  • Displaying a grandiose sense of self and higher than usual confidence levels.
  • Exhibiting rapid, pressured, and loud talking.
  • Increased gregariousness, speaking, sociability, and charisma.
  • Becoming hyperactive and sleeping far less than usual.
  • Changes in eating habits.

If it is a person’s first hypomanic episode, family and friends typically don’t know what’s going on with their loved one. The bipolar II individual may be entertaining, lively, and charismatic. Their positive mood may be infectious. Unfortunately, untreated hypomanic episodes will lead to impulsive, erratic behavior that can be incredibly disruptive to a person’s life. In some cases, hypomania can be downright dangerous.

A person with hypomania may spend beyond their means and go into debt. They may engage in risky sexual behavior, or damage their relationships at work, school, or at home. In some cases, an untreated hypomania episode can turn into full-blown mania, complete with delusions, hallucinations, and paranoia.

A hypomanic episode can last for weeks or months. If left untreated, a person can then go on to develop a depressive episode. Depression in bipolar patients exhibits the same symptoms as major clinical depression. Patients can become withdrawn and suicidal. Sometimes, the erratic behavior that a bipolar patient showed during a hypomanic episode can worsen their depression. They may feel ashamed, guilty, and overwhelmed with the consequences of the hypomanic episode.

People with bipolar II disorder tend to have more depressive episodes than hypomanic episodes. In bipolar I disorder, patients are more likely to suffer from manic episodes than with depression.

Bipolar II Diagnostic Criteria

While the above signs can be indicative of bipolar II disorder, it is important to keep in mind that this is a clinical mental health condition. To be diagnosed, they must meet the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). 

In order to meet bipolar II diagnostic criteria, a person has to experience at least one depressive episode and one hypomanic episode, but no manic episodes, and symptoms must cause distress or difficulty with daily functioning. 

To meet diagnostic criteria for hypomania, a person must experience an elevated or irritable mood, as well as increased energy or activity, for at least four days, and the mood must never become severe enough to cause psychosis or require hospitalization, or it is a clinical case of mania, which is a different version of bipolar disorder. Beyond this, a person must show three or more of the following symptoms to be in a hypomanic episode:

  • High self-esteem or grandiose thoughts
  • Functioning well on reduced sleep
  • Constant talking 
  • Racing thoughts 
  • Distraction
  • Increased activity aimed at achieving goals, or constant movement due to restlessness (called psychomotor agitation)
  • Indulging in pleasurable but risky activities, such as unprotected sex or shopping sprees

On the contrary, a depressive episode during bipolar II disorder involves the following diagnostic criteria, and symptoms must be present most of the day for two weeks in a row:

  • Depressed mood
  • Loss of interest in usual activities, or experiencing no pleasure with enjoyable activities
  • Change in weight or appetite
  • Inability to sleep, or sleeping more than usual
  • Changes in psychomotor functioning, in the form of either constant movement or lack of movement
  • Fatigue and low energy levels
  • Guilt or feelings of worthlessness
  • Difficulty with thinking, concentrating, or making decisions
  • Thoughts of death or suicide attempts

Who is most likely to develop bipolar II disorder?

Anyone can develop a subset of bipolar disorder. But people with a close relative with either a bipolar disorder subset or unipolar depression are at higher risk for manifesting symptoms. Bipolar disorder episodes affect 3% of the U.S. adult population every year. Women who display signs of bipolar are more likely to end up with an erroneous depression diagnosis before getting an accurate diagnosis and treatment. On the other hand, men with bipolar disorder are more likely to receive a schizophrenia diagnosis initially.

People with bipolar II disorder are rarely hospitalized for hypomanic episodes. These episodes are often characterized by unrelenting optimism and increased happiness. If a person doesn’t display any unhealthy behaviors, the disease is often unnoticed by everyone in the patient’s life. Bipolar II patients are much more likely to end up in the hospital with severe depression. In contrast, bipolar I patients are more likely to end up hospitalized for erratic, dangerous behavior and delusions present in full-blown manic episodes.

 

What are the treatment options for bipolar II?

Bipolar disorder, no matter the subset, is a lifelong, chronic illness that requires patients to take medication and participant in therapy over their lifetime. When a patient presents with a severe hypomanic or depressive episode, they will need intense treatment regimens for an acute event of the disease. Patients are often given mood stabilizers, antipsychotics, benzodiazepines, or antidepressants when hospitalized.

Once the patient has stabilized, they will need continued therapy to gain insight into their specific triggers and how to prevent future episodes from starting.

Bipolar disorder episodes cannot entirely be prevented, but there are some things patients can do to lower the risk. Ongoing talk therapy and maintenance treatment plans are recommended and are effective for managing the symptoms of the disease. Transcranial magnetic stimulation (TMS) has also been found to help prevent future depressive episodes in bipolar II patients.

How can TMS treatment help bipolar II disorder patients?

Studies on TMS and bipolar II patients have found that patients significantly benefit from TMS treatment. Patients who undergo TMS as part of their maintenance plans for bipolar II had improvements in cognition and alleviation of depression symptoms. Research has also found that repetitive TMS treatment is highly effective for preventing the onset of a future bipolar episode, especially in regards to depression.

Research into the recurrence of bipolar incidents has found that half of all patients have a recurrence of symptoms within a year after initial treatment, despite participation in therapy and taking medication. Promising results with TMS treatment has found that patients can receive more extended remission between episodes and lessen the chances of recurrence.

More About Bipolar II

Bipolar disorder is a mental condition that affects millions of people. Also known as bipolar II, the disease includes both high and low periods. However, many patients find that they experience more high periods than low periods. Once you receive a diagnosis of bipolar II or find that someone you love suffers from the condition, you can begin looking at treatment options. Transcranial magnetic stimulation is a popular option that can help both your symptoms and your mood.

Rapid Cycling

One specific form of bipolar II disorder is bipolar II with rapid cycling. This means that a person will experience quicker shifts in mood, during which they may find they have no control over their emotions or cannot predict when their mood will change. A clinician will diagnose a person with rapid cycling bipolar II disorder if they have four episodes of either mania or depression within a single year. If you are living with bipolar disorder and experience rapid cycling with numerous depressive episodes, TMS is a viable treatment option, given its proven effectiveness for treating depression. Research has also found that TMS effectively alleviates symptoms among people with treatment-resistant bipolar disorder, who are not benefiting from medication alone.

Bipolar Disorder Symptoms

Looking at the symptoms of bipolar disorder is an excellent way to see if you or a loved one exhibits some of those signs before talking to a doctor. The common bipolar disorder symptoms can include:

  • sudden and unexpected changes in thought
  • unexplained improvements in your self-esteem
  • speaking loudly and trying to be the center of attention
  • feeling as though you do not need to sleep
  • having more energy than you did before

These are all signs of a hypomania episode. An episode can last for as little as a few days to several weeks or longer. In rare cases, these periods may persist for up to a month or more. Many patients will then suffer from periods of depression where they have no energy and do not want to be around others. Those with bipolar II may experience more prolonged periods of depression and shorter manic episodes.

Transcranial Magnetic Stimulation for Bipolar

 

As bipolar II shares some symptoms of depression, it’s not surprising that TMS is a popular treatment option. TMS requires that you meet with a psychiatrist to go over your symptoms before scheduling your first treatment. Each appointment takes only 18 minutes and asks that you return for six to eight weeks. You can schedule your appointments around your busy schedule, and you’ll often find that those appointments won’t get in your way.

Benefits of TMS for Bipolar II

Reading through our TMS FAQ section is an easy way to get a look at the benefits of this treatment:

  • your insurance often covers the cost of your treatment
  • many patients see improvements within the first week
  • there are minimal side effects
  • you do not need to do anything special before your appointment
  • it takes less time than other treatments

Call today to see how TMS can help with your bipolar II symptoms.

Updated 5/30/21