There are 3 types of bipolar disorder (BD) to be aware of. Bipolar 1 disorder (bipolar i disorder), bipolar 2 disorder (bipolar ii disorder), and a third type called cyclothymic disorder. 

Bipolar 2 disorder is a mental health condition marked by mood swings that vary between episodes of hypomania (intense periods of being “up” — like bipolar 1’s manic episodes, but less extreme) and depression. Although type 2 bipolar is similar to type 1, it’s less severe.

Here we’re discussing what are the causes of bipolar, risk factors, diagnosis, symptoms, and treatment options for bipolar 2. It’s a common but treatable mental health condition that affects roughly 0.5% of people at some point in their life.

Bipolar Disorder II Symptoms

What is bipolar 2 disorder? If you’re familiar with bipolar 1, then you already have a pretty good idea of what this version of the disorder might look like. The main difference between the two conditions is the severity of the manic episode — as noted previously, people who have bipolar 2 can experience less extreme mania.

Common bipolar ii disorder symptoms can include:

  • Fatigue, typically daily
  • Repetitive thoughts of suicide or death
  • Noticeably slower physical movements and thoughts
  • Significant changes in weight or appetite
  • Feelings of guilt, worthlessness, shame, or hopelessness
  • Decreased ability to concentrate 
  • Intense feelings of indecisiveness 

According to Comorbidity Guidelines, bipolar 1 disorder is marked “by one or more manic episodes, which can be preceded or followed by hypomanic episode or major depressive episode.” Bipolar 2 disorder involves “recurring mood episodes, consisting of at least one or more major depressive episodes and at least one hypomanic episode.”

It’s easy to see that bipolar 1 and bipolar 2 disorder are quite similar.

Hypomania symptoms

Bipolar ii disorder hypomania is less intense in general. It can be marked by several bipolar disorder symptoms, including:

  • High energy and boosted self-confidence
  • Feeling elated and excited
  • Less need for sleep
  • Racing thoughts
  • Distractibility
  • Talking fast

To be considered legitimate hypomania (seen in bipolar 2), the condition must last for a minimum of 4 consecutive days, nearly all day long each day.

Mania (seen in bipolar 1) is marked by a heightened mood that’s present nearly all day for at least 7 consecutive days. Full-blown mania can impair your ability to perform in life. It can include psychotic features or even result in the need for hospitalization.

Hypomania, though it shares some of bipolar I disorder’s manic symptoms, typically doesn’t cause the need for hospitalization or include psychotic episodes. Hypomania symptoms may or may not affect your ability to perform at work or in other areas of life, but it certainly won’t affect you to the degree that full-blown mania does.

Depression symptoms

Those with bipolar 2 disorder generally do experience depression throughout life. Like many other mental health conditions, this can make an accurate bipolar disorder diagnosis challenging. Bipolar depression (in both 1 and 2) includes depressive episodes that come and go, potentially bouncing between periods of excitability or an elevated mood, and then back to a depressed mood.

Bipolar I disorder, bipolar II disorder, and cyclothymic disorder don’t resolve on their own — bipolar disorder lasts for life. This is why it’s so imperative to get a proper diagnosis and then to work with your doctor and therapist to develop an effective and comprehensive treatment protocol.

Causes & Risk Factors for Bipolar II

According to the National Institute for Mental Health (NIMH), though we’re not totally sure what causes bipolar disorder, there are many different factors that are likely to contribute to someone’s chance of developing bipolar disorder type 2.

Brain function and structure in people with bipolar disorder might differ from the brains in people who don’t have it. There’s also thought to be a genetic and hereditary component as well. 

Some studies suggest that people with familial risk and certain genetic anomalies are more likely to develop bipolar disorder. It’s also believed that people who have a sibling or parent with this condition are more likely to develop it. Finally, research shows a high correlation between bipolar disorder and twins. There are many different genes and chromosomes that could be involved with bipolar disorder. Researchers are not yet sure about any specific cause.

“There certainly can be a genetic component to Bipolar 2, but elevated and persistent stress, substance use, trauma and other negative life experiences have been shown to exacerbate risk. Often distinguishable to Bipolar 2, hypomania, for at least 4 days, followed by a depressed episode can earmark the need for intervention. The right professional help and a dedicated routine can instill a bit of hope and the support needed to increase management.”

Talkspace therapist Elizabeth Keohan, LCSW-C, MSW

Diagnosis

Diagnosing bipolar disorder type 2 can be challenging because it shares symptoms with various other mental health conditions. Doctors and psychiatrists consider other variables, besides symptoms, to make a diagnosis. This can include lifetime experiences, family history, and the presence of any other mental health conditions.

Currently, diagnosis and treatment of bipolar disorder is based on both history and symptoms, instead of brain imaging or other brain diagnostics.

Treatment for Bipolar II

Treatment for bipolar 2 disorder is a lifelong process that involves medication and psychotherapy (talk therapy) to help stabilize moods, teach new coping skills, and allow you the best chance at living a healthy, productive life.

Medication

Medication won’t be able to cure bipolar II disorder, but it is a crucial part of your treatment plan. The right bipolar disorder medication, combined with consistent therapy for bipolar disorder, is your best chance at managing bipolar 2 disorder and living a stable life. 

There’s no “best” bipolar 2 medicine, but some meds are known to work better than others. The best medication is the one that’s most effective for you. Common prescription drugs used to treat bipolar disorder type 2 include: 

  • Lithium 
  • Valproate (Depakote)
  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)

Numerous others are used as well, including additional mood stabilizers, antipsychotics, antidepressants, and beta channel blockers.

Medication for bipolar 2 typically causes noticeable effects in the initial stages. That said, sometimes those effects begin to plateau over time as you develop tolerance.

This might mean trying another medication may be more beneficial. There’s never a guarantee that any type of medication will work. Unfortunately, this might mean needing to experiment with different medicines, or different combinations of medicines, as recommended by your doctor or psychiatrist, to better manage your bipolar symptoms.

Success rates for medications can vary, although many do work well for some people.

Finally, it’s important to keep in mind that all laboratory-made medications come with the risk of possible adverse side effects.

Psychotherapy

While medication is used as a frontline treatment for bipolar 2 disorder, sometimes, it’s just not enough on its own. That’s why psychotherapy is such an essential element of bipolar disorder treatment.

Talk therapy for bipolar disorder can be used in addition to meds or alone. Therapy teaches you useful skills you can use throughout your life. It also can potentially decrease the need for prescription drugs.   

Therapists use various techniques to treat people who’ve been diagnosed with bipolar ii disorder. Types of therapy for bipolar disorder known to be effective include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), family-focused therapy (FFT), and interpersonal and social rhythm therapy (IPSRT). 

Therapy teaches you to:

  • Learn about the nuances of bipolar disorder
  • Learn and practice new stress management techniques
  • Identify and explore triggers of depression or hypomania episodes
  • Learn and practice new coping strategies to decrease symptom severity and frequency

Some people with bipolar 2 also live with other challenging conditions, including alcohol or substance abuse and overeating. Online therapy can also be helpful in addressing these conditions as well.

New research on psychedelics

A new study suggests that psilocybin in magic mushrooms can create a hyperconnectivity inside the brain that’s beneficial in treating depression. According to researchers, “By boosting connectivity between different areas of the brain, psychedelics may help people with depression break out of rigid, negative patterns of thinking.” Research has begun on the efficacy of psilocybin in treating bipolar 2. 

Lifestyle Changes

Regardless of the medications you might take if you have bipolar, or how much time you spend with a therapist in session, most of your time will not be with your doctor or therapist. It will be alone or with family, friends, coworkers, or loved ones.

That’s why it’s so integral for anybody with bipolar ii disorder symptoms to modify their lifestyle habits to encourage a healthier, happier future.

Whether you have bipolar two disorder, bipolar one disorder, another mental health condition, or even if you’ve never been diagnosed with any physical or mental health condition, the following lifestyle habits can improve your life.

  • Spending time in nature, appreciating the simplicity there
  • Getting enough exercise, every day, to cause a mild perspiration
  • Eating a diet based on multicolored fruits and vegetables and lean cuts of meat
  • Paying attention to and avoiding triggers
  • Expressing your creative side by drawing, journaling, singing, or even dancing
  • Learning and practicing mindfulness meditation to stay in touch with your thoughts and feelings
  • Yoga 

“A proactive approach to Bipolar management can truly help one to create and establish stability. Self-education, connection to meaningful support and creating your own self-care, can help you feel less isolated and less defined by Bipolar.  Maintaining a routine with adequate sleep, nutrition and exercise have obvious benefits to allow space for healthy relating and improved mood.”

Talkspace therapist Elizabeth Keohan, LCSW-C, MSW

Bipolar 2 disorder is a condition that lasts for life. There’s no cure, so it makes sense that beginning to learn and practice new coping skills can help you live a more rewarding life outside of just taking your medication.

Work with your therapist to learn about more positive lifestyle changes you can make to enhance your ability to manage bipolar symptoms. You can find a treatment plan that works for you, that allows you to get control over bipolar 2, so you can get the most out of your life.