Part of this is attributable to the depth and duration of depressive episodes so often present in bipolar 2 diagnoses. [brightquest.com]

The two most common types, bipolar I and bipolar II, differ in the presentation of mood variations. The course of bipolar II is less well studied and less understood than bipolar I disorder. [medscape.com]

Bipolar disorder is categorized into two separate types of disorders that are differentiated by the type of manic-like behaviors presented by the person. Bipolar I occurs when the person presents with a formal manic episode. [americanaddictioncenters.org]

Types I and II present equally severe burdens. [1] [9] Bipolar II is notoriously difficult to diagnose. [en.wikipedia.org]

Like bipolar I, issues with school and careers are also present. Truancy or failure in school and occupational failure are common. Divorce is also very common in bipolar individuals. [courses.lumenlearning.com]

• Crying

  The symptoms of bipolar depression are the same as those of major depression and include: Sadness Loss of energy Feelings of hopelessness or worthlessness Loss of enjoyment from things that were once pleasurable Difficulty concentrating Uncontrollable crying [my.clevelandclinic.org]

  Common symptoms that occur in a major depressive episode include: Insomnia or hypersomnia Unexplained or uncontrollable crying Severe fatigue Loss of interest in things the patient enjoys during euthymia Recurring thoughts of death or suicide Both disorders [verywellmind.com]

  I had to listen to her violently cry into the phone again and again and again. I'm not sure how I did go on. I wanted so badly to kill myself. Maybe I lacked the strength even to do that. [thrillist.com]

  “I stood at my bedroom window, looking across the way at the store and crying. I felt helpless and stupid.” It is when we are in absolute despair that we most need the comfort of loved ones. [bphope.com]

  We were laughing and crying simultaneously. I felt the surge of something primal. [nytimes.com]

• Asymptomatic

  Weeks with no affective symptoms were classified as asymptomatic. [jamanetwork.com]

  A longitudinal study of cognition in asymptomatic and mildly symptomatic bipolar disorder patients. Psychiatry Res 210, 842–849, https://doi.org/10.1016/j.psychres.2013.01.003 (2013). 25. Mora, E., Portella, M. J., Forcada, I., Vieta, E. & Mur, M. [nature.com]

  When asymptomatic, patients with bipolar disorder have relatively good psychosocial functioning, although premorbid functional levels are seldom reached 1 Grande I, Berk M, Birmaher B, et al. Bipolar disorder. Lancet. 2016 ;387: 1561 – 1572. [tandfonline.com]

  Articles by Liu et al. (2010) and McCormack et al. (2015) did not characterize explicitly the sample mood despite presented scores of symptoms scales and the study by Gvirts et al. (2015) comprised two subgroups with regard to affective symptoms: asymptomatic [frontiersin.org]

• Nausea

  manic episodes (in bipolar patients), increased suicidality in children EPS: extrapyramidal symptoms; GI: gastrointestinal; N/V: nausea and vomiting. [medscape.com]

  Side Effects: The most common acute side effects include nausea, tremor, polyuria and thirst, weight gain, loose stools, and cognitive impairment. 12,18,19 Any exacerbation of these side effects may indicate lithium toxicity and should be addressed. [uspharmacist.com]

  Dry mouth, somnolence/sedation, and dizziness were the most common adverse events above placebo rates in the quetiapine group; nausea, diarrhea, and tremor were common adverse events associated with lithium; and nausea and insomnia were common events [annals-general-psychiatry.biomedcentral.com]

  A level > 2 mmol/L is a medical emergency. 17 Monitor for adverse effects : Fine tremor and nausea are common dose-dependent adverse effects of lithium treatment, but often pass after one to two days. [bpac.org.nz]

• Vomiting

  Antidepressants Fluoxetine 10–40 mg daily Nausea, headache, insomnia, sexual dysfunction, worsening of depression, manic episodes (in bipolar patients), increased suicidality in children EPS: extrapyramidal symptoms; GI: gastrointestinal; N/V: nausea and vomiting [medscape.com]

  This justifies the slow increase in dose as therapy continues. 2,26,27 Side Effects: Side effects include nausea, vomiting, diarrhea, hyponatremia, rash, pruritus, leukopenia, fluid retention, and neurotoxicity, which may manifest as drowsiness, dizziness [uspharmacist.com]

  Patients should seek medical advice if they develop fever, infection, rash, abdominal pain, vomiting, yellowing of the skin, bruising or bleeding. [bpac.org.nz]

• Diarrhea

  […] gain losse stools, cognitive impaiment, renal impairment, thyroid disorder, cardiac rhythm disturbances Anticonvulsants Carbamazepine 100–200 mg daily divided into once or twice daily doses Usual target dose : 800–1,000 mg daily in divided doses N/V, diarrhea [medscape.com]

  This justifies the slow increase in dose as therapy continues. 2,26,27 Side Effects: Side effects include nausea, vomiting, diarrhea, hyponatremia, rash, pruritus, leukopenia, fluid retention, and neurotoxicity, which may manifest as drowsiness, dizziness [uspharmacist.com]

  Dry mouth, somnolence/sedation, and dizziness were the most common adverse events above placebo rates in the quetiapine group; nausea, diarrhea, and tremor were common adverse events associated with lithium; and nausea and insomnia were common events [annals-general-psychiatry.biomedcentral.com]

• Suicidal Ideation

  Such medications seek to address bipolar depression while preventing ascension to hypomania, an imperative part of preventing future depressive episodes and suicidal ideation. [brightquest.com]

  The highest levels of suicide ideation were at the point when individuals had mixed phases of the illness and then peaking off into the more depressive stages (Valtonen, et al., 2008). [courses.lumenlearning.com]

  I told her I thought of committing suicide on the daily as if I were telling her what my favorite pizza toppings were. I had lived with suicidal thoughts ("suicidal ideation") for so many years that it had in fact become horrifyingly casual to me. [thrillist.com]

  Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan for completing suicide. [en.wikipedia.org]

  I psychiatric disorder, including depression. 34 Another study showed that patients with bipolar disorder had a higher lifetime history of suicide attempt than patients with any other psychiatric disorder. 35 Rates of suicidal ideation and attempts range [ajmc.com]

• Indecisiveness

  Patients often feel fatigued, restless, agitated, unfocused, indecisive, and in some cases, suicidal. Hypomanic episodes. [dualdiagnosis.org]

  […] as expected can be a sign of depression) Either insomnia or sleeping too much Either restlessness or slowed behavior Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Decreased ability to think or concentrate, or indecisiveness [mayoclinic.org]

  […] sleep-maintenance insomnia) or hypersomnia Psychomotor agitation or retardation observed by others (not self-reported) Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Diminished ability to think or concentrate or indecisiveness [msdmanuals.com]

  Diminished ability to think or concentrate, possible irritability or indecisiveness, nearly every day (either by subjective account or as observed by others). [en.wikipedia.org]

  […] every day Significant weight loss when not dieting, or weight gain of more than 5% in a month, or a decrease or increase in appetite nearly every day Psychomotor agitation or retardation nearly every day A decreased ability to think or concentrate, or indecisiveness [bpac.org.nz]

• Aggressive Behavior

  […] that is different from usual Increased sexual drive Abuse of drugs, particularly cocaine, alcohol, and sleeping medications Provocative, intrusive, or aggressive behavior Denial that anything is wrong A depressive episode is diagnosed if five or more [adaa.org]

  In uncomplicated cases, the appearance of prominent mood dysregulation, sleep irregularities and aggressive behaviors are more likely to predict a diagnosis of bipolar disorder than ADHD, especially if there is impulsive behavior associated with spending [tandfonline.com]

• Withdrawn

  16 Lithium should be avoided where possible during pregnancy and breast-feeding. 16 If lithium is withdrawn abruptly there is an increased risk of manic relapse. [bpac.org.nz]

• Persecutory Delusion

  Patients may have extreme grandiose or persecutory delusions (eg, of being Jesus or being pursued by the FBI), occasionally with hallucinations. Activity level increases markedly; patients may race about and scream, swear, or sing. [msdmanuals.com]

• Confusion

  Sometimes the ups and downs seem to happen at almost the same time; this confusing state is called a mixed episode. These cycles and emotional states are more than the moodiness of pregnancy or postpartum. [postpartum.net]

  These feelings can quickly turn to confusion, irritability, anger, and even rage. The word “depressive” describes the periods when the person feels very sad or depressed. [my.clevelandclinic.org]

  ‘After the confusion, relief, blaming and identity crisis, I knew I had to sort myself out with help from doctors, medication, therapy, and family understanding,’ she says. ‘I kept going and I’ve become a better human being. [sane.org]

  Confusing periods of irritability, impulsiveness and agitation are a few examples. 1 On the other hand, the milder “highs” can be enjoyable and energizing and are less likely to lead to the terrible repercussions of full-blown mania. [bipolar-lives.com]

  MD, Associate Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and Assistant Professor in psychiatry at Harvard Medical School, making a diagnosis of an anxiety disorder plus bipolar disorder can be confusing [adaa.org]

• Hyperactivity

  Symptoms of these episodes include: Decreased need for sleep Excessive spending Flying quickly from one idea to the next Hypersexuality Increased energy and hyperactivity Inflated self-image Making and pursuing grandiose, unrealistic plans Rapid, uninterruptable [baptisthealth.com]

  Children and adolescents, however, can develop this disease in more severe forms and often in combination with attention deficit hyperactivity disorder (ADHD). [my.clevelandclinic.org]

  Symptoms during hypomanic episodes include: Flying suddenly from one idea to the next Having exaggerated self confidence Rapid, "pressured" (uninterruptible) and loud speech Increased energy, with hyperactivity and a decreased need for sleep People experiencing [webmd.com]

  Bipolar II is often comorbid with Substance Abuse or Dependence, Anorexia Nervosa, Bulimia Nervosa, Attention Deficit/Hyperactivity Disorder, Panic Disorder, Social Phobia, and Borderline Personality Disorder. [courses.lumenlearning.com]

  Examples include: Anxiety disorders Eating disorders Attention-deficit/hyperactivity disorder (ADHD) Alcohol or drug problems Physical health problems, such as heart disease, thyroid problems, headaches or obesity Prevention There's no sure way to prevent [mayoclinic.org]

• Dizziness

  […] mouth, increased appetite, weight gain, orthostatic hypotension Quetiapine 100 to 200 mg once or twice daily Usual target dose: 400–800 mg (or up to 1,200 mg) at bedtime or in 2 divided doses Headache, dry mouth, constipation, weight gain, sedation, dizziness [medscape.com]

  This justifies the slow increase in dose as therapy continues. 2,26,27 Side Effects: Side effects include nausea, vomiting, diarrhea, hyponatremia, rash, pruritus, leukopenia, fluid retention, and neurotoxicity, which may manifest as drowsiness, dizziness [uspharmacist.com]

  Dry mouth, somnolence/sedation, and dizziness were the most common adverse events above placebo rates in the quetiapine group; nausea, diarrhea, and tremor were common adverse events associated with lithium; and nausea and insomnia were common events [annals-general-psychiatry.biomedcentral.com]

  CNS depression, anticholinergic effects, e.g. dry mouth and constipation, dizziness, extrapyramidal effects, e.g. dyskinesias, may also occur. [bpac.org.nz]

• Need for Sleep Decreased

  During the hypomanic period, mood brightens, the need for sleep decreases, and psychomotor activity accelerates. [msdmanuals.com]

• Akathisia

  Haloperidol 5–15 mg daily in 1 or 2 divided doses or 0.2 mg/kg per day EPS, akathisia, tardive dyskinesia Olanzapine 10–15 mg daily Usual target dose: 10–30 mg (or up to 50 mg) daily at bedtime or in 2 divided doses Sedation, constipation, dry mouth, [medscape.com]

Treatments for bipolar II disorder vary. There are only a few treatment guidelines aimed at this type of bipolar disorder. Most guidelines suggest using the same medications as for bipolar I disorder. [bbrfoundation.org]

The overall treatment response was 62.7%, and 14% of patients experienced a switch to hypomania (12%) or severe hypomania (2%), typically within the first 5 weeks after treatment initiation. [psychiatryadvisor.com]

Bipolar 2 Treatment at BrightQuest BrightQuest Treatment Centers provide world-class residential treatment for bipolar disorder and other complex mental illnesses. [brightquest.com]

Lithium treatment also showed an initial delay in symptom improvement for both bipolar subtypes, but by 8 weeks approached a similar symptom improvement to quetiapine treatment. [annals-general-psychiatry.biomedcentral.com]

Unfortunately, relatively little attention has been given to treatment of BP II. Concern that patients may switch from depressed to manic states during treatment of MDE has impeded the development of effective treatments for BP II MDE. [clinicaltrials.gov]

[…] are unique to each individual. [4] As with bipolar I disorder, the interval between episodes seems to decrease with age, though approximately 5% to 15% of patients experience rapid cycling. [4] The more episodes a patient experiences, the poorer the prognosis [medscape.com]

Prognosis Proper diagnosis and treatment help people with bipolar II disorder lead healthy and productive lives. [baptisthealth.com]

[…] with Bipolar II, much more so in women than in men (70% vs. 40%), and without treatment leads to added sources of disability and an increased risk of suicide. [19] To improve a patient’s prognosis, long-term therapy is most favorably recommended for [en.wikipedia.org]

This condition is often difficult to diagnose and may shade into a continuously cycling state; the prognosis is worse than that in a pure manic or hypomanic state. Risk of suicide during mixed episodes is particularly high. [msdmanuals.com]

[…] that are unique to each individual. 4 As with bipolar I disorder, the interval between episodes seems to decrease with age, though approximately 5% to 15% of patients experience rapid cycling. 4 The more episodes a patient experiences, the poorer the prognosis [uspharmacist.com]

Etiology Genetics play a big factor of people with bipolar 2 disorder. Individuals with family members that have bipolar 2 disorders have a big risk of bipolar 2. [courses.lumenlearning.com]

[…] particular focus on neurologic and endocrine systems, signs of substance abuse, symptoms of trauma to the CNS, and laboratory testing (including thyroid testing, CBC, blood chemistries, and urine toxicology testing), should be conducted to rule out other etiologies [uspharmacist.com]

This is the only academic and clinical management review focused entirely on bipolar II, scrutinizing history, epidemiology, burden and neurobiology and including an extensive clinical debate by international experts about effective management strategies [cambridge.org]

The National Comorbidity Survey suggested a lifetime prevalence of 1.6%. 1 The Epidemiologic Catchment Area (ECA) surveys have suggested a lifetime prevalence of 1.3%. 2 An epidemiologic study of 38 000 community-dwelling individuals in 10 countries found [ajmc.com]

Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord. 2003;73:133-146. 5. Judd LJ, Akiskal HS. [mdedge.com]

Epidemiology The average lifetime prevalence rate for Bipolar II Disorder is approximately 0.5 percent. The average age for children with bipolar 2 disorder is 10 which is found in 0.3%-0.5% of patients. [courses.lumenlearning.com]

Epidemiology of bipolar disorder. In: Kasper S, Hirschfeld RMA, editors. Handbook of Bipolar Disorder. New York: Taylor and Francis; 2005. p. 21-35. 5 Coryell W. Bipolar II disorder: a progress report. [bmj.com]

[…] disorder is more common in women, whereas bipolar I affects men and women equally. 3 The age of onset of bipolar II is generally between 15 and 30 years of age, with less common new diagnoses made in childhood and in adults over the age of 65 years. 3 Pathophysiology [uspharmacist.com]

Increased chronicity and recurrent depressive phases 7, reverse vegetative symptoms, mood reactivity, as well as antidepressant non-response in bipolar II depression, on the other hand, suggest a different pathophysiological substrate than UD 11. [nature.com]

Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT) axis dysfunction may be relevant to the pathophysiology and clinical course of bipolar affective disorder 62 Chakrabarti S. Thyroid functions and bipolar affective disorder. [tandfonline.com]

Pathological amygdala activation during working memory performance: evidence for a pathophysiological trait marker in bipolar affective disorder. Hum. [frontiersin.org]

People with bipolar II disorder can benefit from preventive drugs that level out moods over the long term. These prevent the negative consequences of hypomania, and also help to prevent episodes of depression. [webmd.com]

Examples include: Anxiety disorders Eating disorders Attention-deficit/hyperactivity disorder (ADHD) Alcohol or drug problems Physical health problems, such as heart disease, thyroid problems, headaches or obesity Prevention There's no sure way to prevent [mayoclinic.org]

Patients who recover from MDE are then randomized to receive a relapse-prevention treatment of fluoxetine, lithium, a combination of fluoxetine and lithium, or placebo for 1 year. [clinicaltrials.gov]

Prevention Bipolar II disorder cannot be prevented. Seeking treatment at the earliest sign can help prevent the condition from getting worse or interfering with your life. [baptisthealth.com]

Although preventive treatment hasn’t been identified yet, there is some hope among researchers that early treatment for cyclothymia may prevent full-blown bipolar disorder from developing. [everydayhealth.com]