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The Wizard has Bipolar Disorder...
Bipolar II disorder is a serious but very treatable mood disorder, and it is often misunderstood because it does not involve the full manic episodes seen in bipolar I disorder.
What is bipolar II disorder?
Bipolar II is characterized by recurring episodes of:
- Major depression — periods of significant depression that can last weeks or longer.
- Hypomania — periods of unusually elevated, energetic, irritable, or activated mood that are noticeable and represent a clear change from the person's usual behaviour, but are not severe enough to qualify as full mania.
A person with bipolar II has experienced at least one hypomanic episode and at least one major depressive episode, with no history of a manic episode.
The distinction is important:
Bipolar I: depression may occur, but the defining feature is mania.
Bipolar II: hypomania + major depression, but no full mania.
What does hypomania feel like?
Hypomania can actually feel pretty good at first. Someone might feel unusually confident, energetic, productive, sociable or creative.
Common signs include:
- Needing considerably less sleep without immediately feeling tired
- Talking more rapidly or much more than usual
- Racing thoughts
- Feeling unusually confident or optimistic
- Increased productivity or activity
- Becoming easily distracted
- Increased sexual interest
- Spending more money or taking unusual risks
- Starting numerous projects
- Becoming unusually outgoing or impulsive
- Irritability or impatience
The key is that this represents a distinct change from the person's normal functioning.
Hypomania generally lasts at least four consecutive days according to DSM-5-TR diagnostic criteria.
Unlike mania, hypomania doesn't normally cause the extreme loss of functioning that can occur during mania. A person may continue working, socializing and carrying out everyday responsibilities.
Then why can bipolar II be so difficult?
The depression can be extremely debilitating.
Someone with bipolar II might spend weeks or months experiencing:
- Persistent sadness or emptiness
- Loss of interest or pleasure
- Fatigue
- Sleeping too much or too little
- Changes in appetite
- Difficulty concentrating
- Feelings of worthlessness or guilt
- Slowed thinking or movement
- Withdrawal from other people
- Difficulty functioning at work or home
- Thoughts about death or suicide
In fact, depression tends to account for substantially more of the illness burden in bipolar II than hypomania does.
That's one reason bipolar II can sometimes initially be mistaken for recurrent major depressive disorder.
Bipolar II isn't simply "milder bipolar disorder"
This is a very common misconception.
Although hypomania is less severe than mania, bipolar II can still cause considerable disruption because of the depressive episodes, mood instability, relationship difficulties, occupational problems and increased risk of suicidal behaviour.
The absence of full mania does not mean the disorder is trivial.
What causes it?
There isn't one single cause.
Research suggests that bipolar disorders result from a combination of:
Genetics: Bipolar disorders tend to run in families.
Brain biology: Differences involving neurotransmitter systems, neural circuits and regulation of mood and reward appear to contribute.
Environment: Stress, trauma, major life changes and disrupted routines can contribute to episodes in susceptible individuals.
Sleep and circadian rhythms: Irregular or insufficient sleep can be particularly important.
Substance use can also trigger or worsen mood episodes in some people.
Importantly, having bipolar II isn't a character flaw or a failure of willpower.
How is bipolar II diagnosed?
There isn't a blood test or brain scan that can diagnose it.
Diagnosis is based on a detailed psychiatric assessment that looks at the person's entire history of mood episodes.
This is particularly important because people experiencing hypomania don't necessarily realize that anything unusual is happening. Sometimes family members or friends notice the change before the person does.
A clinician may ask about:
- Sleep patterns
- Energy levels
- Changes in behaviour
- Spending
- Relationships
- Work performance
- Depression
- Irritability
- Substance use
- Family history
- Previous medications and their effects
A particularly useful approach is keeping a mood and sleep diary, because patterns can become much easier to recognize over time.
How is bipolar II treated?
Treatment usually involves a combination of medication, psychotherapy and lifestyle/routine management.
Medications can include mood stabilizers and certain atypical antipsychotics. The appropriate medication depends heavily on the individual and whether depression, hypomania or prevention of future episodes is the main concern.
Antidepressants require particular care in bipolar disorder. For some people they can worsen mood instability or contribute to hypomanic symptoms, so they shouldn't be started, stopped or changed without discussing it with the prescribing clinician.
Psychotherapy can be very useful. Approaches such as:
- Cognitive behavioural therapy (CBT)
- Psychoeducation
- Interpersonal and social rhythm therapy
- Family-focused therapy
can help people recognize early warning signs, maintain routines and manage stress.
Sleep is especially important
One of the most useful practical things someone with bipolar II can do is maintain a consistent sleep/wake schedule.
Major changes in sleep can sometimes precede mood episodes.
For example, a person who normally sleeps seven or eight hours might suddenly start sleeping only three or four hours and feel fantastic rather than tired.
That can be an important warning sign of emerging hypomania.
Can people recover?
Yes. ❤️
Bipolar II is generally considered a long-term condition, but that doesn't mean someone will constantly be ill.
With appropriate treatment, many people have long periods of stability and are able to work, maintain relationships, pursue hobbies and live fulfilling lives.
Treatment is generally about preventing episodes and recognizing them early, rather than simply treating symptoms once they become severe.
A particularly important warning sign
If someone with bipolar II begins experiencing a dramatic decrease in the need for sleep, rapidly increasing energy, escalating impulsivity, unusually grandiose ideas, severe agitation or rapidly worsening depression, it's worth contacting their healthcare provider promptly.
And if depression progresses to thoughts of suicide or self-harm, or someone feels they may act on those thoughts, that's an emergency. In Canada, calling or texting 988 connects you with the Suicide Crisis Helpline; if there is immediate danger, call 911 or go to an emergency department.
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