Bipolar II

Also Known As: Bipolar II, Bipolar 2

Bipolar II disorder (BP-II; pronounced "type two bipolar disorder") is a bipolar spectrum disordercharacterized by at least one episode of hypomania and at least one episode of major depression.[1][2]Diagnosis for bipolar II disorder requires that the individual must never have experienced a full manic episode (one manic episode meets the criteria for bipolar I disorder).[2] Symptoms of mania and hypomania are similar, though mania is more severe and may precipitate psychosis.[1] The hypomanic episodes associated with bipolar II disorder must last for at least four days.[2][3] Commonly, depressive episodes are more frequent and more intense than hypomanic episodes.[2][4] Additionally, when compared to bipolar I disorder, type II presents more frequent depressive episodes and shorter intervals of well-being.[1][2] The course of bipolar II disorder is more chronic and consists of more frequent cycling than the course of bipolar I disorder.[1][5] Finally, bipolar II is associated with a greater risk of suicidal thoughts and behaviors than bipolar I or unipolar depression.[1][5] Although bipolar II is commonly perceived to be a milder form of Type I, this is not the case. Types I and II present equally severe burdens.[1][6]

Bipolar II is difficult to diagnose. Patients usually seek help when they are in a depressed state. Because the symptoms of hypomania are often mistaken for high functioning behavior or simply attributed to personality, patients are typically not aware of their hypomanic symptoms. As a result, they are unable to provide their doctor with all the information needed for an accurate assessment; these individuals are often misdiagnosed with unipolar depression.[1][2][5] Of all individuals initially diagnosed with major depressive disorder, between 40% and 50% will later be diagnosed with either BP-I or BP-II.[1] Substance abuse disorders (which have high comorbidity with BP-II) and periods of mixed depression may also make it more difficult to accurately identify BP-II.[2] Despite the difficulties, it is important that BP-II individuals are correctly assessed so that they can receive the proper treatment.[2] Antidepressant use, in the absence of mood stabilizers, is correlated with worsening BP-II symptoms.[1]

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