"Diagnosis Of Last Resort:" Understanding Bipolar II

Sep 9, 2020

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As part of KVCR’s series on Suicide Prevention Month called “Wellness For Times of Uncertainty,” we’re talking about bipolar disorder.

If you hear the term “bipolar,” you probably think of what’s known as bipolar I: a disorder characterized by deep lows of depression and sharp highs of mania that may result in hospitalization. But what you might not know is there’s another type of the disease, called bipolar II, which has longer lows and slightly lower highs, called hypomanic episodes.

David Puder is a psychiatrist with Loma Linda University Health. As a warning, his explanation of the difference between the two types of bipolar does talk about suicide.

“So bipolar II is, you're having episodes of depression similar to bipolar I or similar to major depressive disorders, so the episodes of depression are characterized by depressed mood, poor sleep or increased sleep, decreased interest, higher guilt, poor concentration, sometimes with passive suicidal thoughts or thoughts like ‘I wish I was dead’ or ‘I wish I wasn't alive,’ or suicidal thoughts like thinking about actually, ‘How to end my life,’” Puder says. 

“So there's depressive episodes and then in bipolar II there's hypomanic episodes, so these are episodes where there's an elevated mood or irritable mood and there may be a flight of ideas, so you're jumping from one idea to another, or you may have an exaggerated self-confidence, so maybe you have a baseline level but during these episodes you have increased confidence, you may have rapid or pressured speech, increased energy, decreased need for sleep so maybe you're only sleeping through three hours or more.  And for a hypomanic episode it has to be four days in duration at least, or it could be longer than that,” Puder says.

Unlike true mania, which occurs in bipolar I and often is accompanied by some sort of psychosis, hypomania doesn’t disrupt your life too much.

“The difference is, one, you can continue to work and be productive and two, there's not as much psychosis in it so you're not seeing things, hearing things, you're not having internal stimuli that you're responding to like, you're not getting psychotic or paranoid, thinking that people are after you, chasing you, which is common as the mania progresses in bipolar type 1,” Puder says.

Most people are in their teens or early 20’s when symptoms of either type of bipolar disorder start to appear. And the treatment, according to Dr. Puder, includes medication and psychotherapy.

“I think it's a combination of lifestyle, psychotherapy, and consideration of what medications might be appropriate. Medications can reduce the risk of having future episodes, and we know with each episode of severe depression there is damage to the brain, like a bipolar manic episode there is some damage to the brain. So it's better, long-term, to have effective treatment,” Puder says.

So what does it feel like to have bipolar II? Karla Dougherty is the author of “Less Than Crazy: Living Fully with Bipolar II.”

“I was getting off the school bus with some of my friends and I remember just feeling - there was no incident that occurred that would make me feel exhilarated or excited or happy, but I just remember saying 'Wow, I can feel all my veins and my arteries and the blood streaming and my brain working and I feel so alive,'” Dougherty says.

That description of hypomania is common to those with bipolar II: they feel alive.

“I love my hypomanic episodes, I wish they lasted longer,” Dougherty says. “Unfortunately they don't, and they become quite problematic. So that's a problem.”

Dougherty says that feeling of being alive is part of what makes it hard to diagnose bipolar II: people generally don’t seek help when they’re feeling great.

“It's really hard to differentiate and to diagnose, and that's why it took 40 years for me to get diagnosed. Because for the longest time I was considered depressed, because of all my symptoms or generalized anxiety disorder, separation disorder, you know, you name it, they thought I had it,” Dougherty says.

“And it turned out to be bipolar II, and it was really, I think, because nothing seemed to work and it wasn't getting better and that's when they said, maybe you have bipolar II. And that's why I consider it a diagnosis of last resort.”

Hypomania can also lead to irritability and anxiety. And then, of course, there’s the depression, which generally lasts longer for people with bipolar II than people with bipolar I.

Dr. Matthew Rudorfer is a psychiatrist with the National Institute of Mental Health who has studied mood disorders like bipolar extensively.

He says when it comes to the difference between bipolar I and bipolar II, it’s not an issue of one being more severe or mild than the other – they’re just different.

“While it's true that the highs of bipolar II are much less severe by definition than full-blown manic episodes in true bipolar, or bipolar I, it turns out that the depressions often are more long-lasting, more destructive, and people with bipolar II disorder often spend more than half their life, half their adult life being depressed. Which can even take the greater toll on one's quality of life than some people with bipolar I who often have longer periods of wellness in between mood episodes,” Rudorfer says.

Rudorfer says there is research going on to determine what causes bipolar disorder, but so far, there’s no definitive test for it.

“The field has been looking for many years and we continue to look for bio-markers and blood tests and brain imaging studies. All of which have hints, but cannot add up yet to something that can be applied in the clinic,” Rudorfer says.

If you think you might have bipolar II, consult a psychiatrist or psychologist.

To learn more about resources available regarding mental health, visit our website at kvcrnews.org/wellness.

Support for the "Wellness For Times Of Uncertainty" serie son KVCR is provided by the San Bernardino County Superintendent of Schools' Innovation and Engagement Branch. Information at sbcss.net