Bipolar I vs. bipolar II: Symptoms, tests, and treatment

There are several types of bipolar disorder, the most widespread being bipolar I and bipolar II.

In this article, learn about the similarities and differences between bipolar I and bipolar II. We also consider their causes, symptoms, and the available treatment options.

Types of bipolar disorder

People with bipolar disorder experience abnormal highs or lows in mood. During a “high,” also known as a manic episode, people feel intense energy or excitement.

During a “low,” or depressive episode, they experience symptoms of depression, such as sadness and hopelessness.

There are four distinct types of bipolar disorder:

• bipolar I disorder
• bipolar II disorder
• cyclothymic disorder, or cyclothymia
• other specified and unspecified bipolar disorder

A doctor can diagnose a person with one of the above types based on the duration and intensity of their symptoms.

Bipolar I and bipolar II are the most widespread forms of bipolar disorder. They are also the more severe of the bipolar disorders.

Bipolar I vs. bipolar II

Bipolar I and II have similar symptoms and patterns in which symptoms occur. However, people who have bipolar II will experience less severe manic episodes than people with bipolar I. This type of mania is known as hypomania.

To receive a diagnosis of bipolar II, a person must also experience a major depressive episode , which does not apply in a diagnosis of bipolar I.

A doctor can diagnose bipolar I based on the presence of a manic episode alone. People with bipolar I disorder have at least one manic episode that persists for a week or longer or severe mania that requires hospitalization.

Those with bipolar II disorder do not generally require hospitalization during hypomanic periods. Doctors sometimes misdiagnose bipolar II as depression because the hypomanic symptoms can be very subtle.

In between these episodes of mania and depression, people who have either of these types of bipolar may experience periods of stable mood. It is also possible to have symptoms of depression and mania at the same time. This is known as bipolar with “mixed features.”

During a manic episode, people can experience:

• intense enthusiasm, happiness, or excitement
• anger, restlessness, or irritability
• increased energy, characterized by being over-talkative or overactive
• less need for sleep and difficulty sleeping
• racing thoughts
• difficulty concentrating and making decisions
• reckless behavior
• pleasure-seeking behaviors, such as increased interest in sex, alcohol, and drugs
• high self-esteem

Periods of mania can interfere with a person’s daily activities and their relationships with others.

Some people may be unable to achieve a calm state or to have rational thoughts during a manic episode.

Hypomania

In a state of hypomania, people experience symptoms similar to those in mania, except less severe.

Hypomania can still interfere with a person’s quality of life, and family and friends may notice that the person is experiencing mood changes.

Depression

People with bipolar disorder may experience depressive symptoms that are the same as those experienced in cases of clinical depression. These include:

• sadness
• hopelessness
• low energy and fatigue
• changes in sleeping patterns
• changes in appetite
• poor concentration
• loss of interest in formerly enjoyable activities
• low self-esteem
• aches and pains that have no apparent physical cause
• thoughts of suicide or death
• suicidal behavior

Doctors consider these symptoms to be a depressive episode if they persist for 2 weeks or more.

Prevalence

According to the National Institute of Mental Health (NIMH), approximately 2.8 percent of adults in the United States experience bipolar disorder in a given year. An estimated 4.4 percent of people experience bipolar at some point in their lives.

The condition affects men and women almost equally. Onset occurs at an average age of 25, but it can happen to people of any age.

To receive a diagnosis of bipolar disorder, individuals will need to see a psychiatrist or psychologist. They will review the person’s medical history and symptoms.

This psychiatric assessment will focus on a person’s thoughts, feelings, and behaviors.

Some people might find it helpful to have a loved one present to provide the doctor with information about other symptoms, especially during manic periods.

The psychiatrist or psychologist may also ask a person to keep a mood diary to track their moods, sleep patterns, and other symptoms. This diary can help with a diagnosis.

The psychiatrist or psychologist will compare the person’s symptoms to the criteria for bipolar disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The psychiatrist or psychologist may carry out blood tests, a physical examination, or brain imaging tests to rule out other causes of the symptoms.

Treatment

Treatment for bipolar I disorder and bipolar II disorder typically consists of medications, psychotherapy, and lifestyle changes.

As bipolar disorder is a long-term condition, treatment will be long-lasting. Some people may have a treatment team that includes a psychologist, therapist, and psychiatric nurse practitioner.

Medications

Doctors usually prescribe mood stabilizers, such as lithium, for bipolar disorder. They may also prescribe antipsychotic drugs for manic episodes and antidepressants for depression.

As antidepressant medications may “trigger” manic episodes in some people, doctors might recommend a combination of antidepressant and antipsychotic drugs to reduce depression while stabilizing mood.

For people who have anxiety or sleep problems, anti-anxiety medications, such as benzodiazepines, may help. However, this strategy may come with a risk of dependence to benzodiazepines.

People can begin taking medications right away, even if they are not currently experiencing a manic or depressive episode.

It is vital to continue taking medications even during periods of stable mood to avoid relapse.

Psychotherapy

Psychotherapy is an essential part of treatment for bipolar I and II disorders. Therapy may take place on a one-to-one basis, as part of a group, or in a family setting.

Several different types of therapy can help, including:

• Interpersonal and social rhythm therapy (IPSRT), which focuses on establishing a structured routine to help people cope with symptoms.
• Cognitive behavioral therapy (CBT), to challenge negative thoughts and replace them with positive ones.
• Family-focused therapy, to enhance communication with family members and to foster family support.

Lifestyle changes

Many people can make lifestyle changes to manage their symptoms and help stabilize their moods. Examples of helpful changes include:

• avoiding alcohol and drugs
• exercising regularly
• eating a balanced diet
• establishing a sleep routine
• attending a support group for people with mood-related disorders
• practicing mindfulness and meditation
• reducing stress where possible
• learning more about their condition

Some people also find it helpful to keep a daily mood diary. Keeping a journal can allow people to see patterns in their thoughts, moods, and behaviors.

A mood diary also helps identify triggers for manic or depressive episodes. This may help a person take appropriate action before a slight mood change worsens.

Outlook

Although bipolar I and II are long-term conditions, most people can manage their symptoms with medications, therapy, and lifestyle changes.

Maintaining regular contact with mental health professionals and seeking support from friends and family can make it easier to cope with challenging symptoms.

Anyone who thinks they may be experiencing symptoms of bipolar I or II should speak to a doctor for a proper diagnosis.

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