Bipolar II disorder

{{short description|Bipolar spectrum disorder}} {{Redirect|BP-II||BP2 (disambiguation){{!}}BP2}} {{Infobox medical condition | name = Bipolar II disorder | synonyms = BP-II, type two bipolar, bipolar type two, manic-depressive illness | image = | caption = Graphical representation of Bipolar I, bipolar II and cyclothymia | pronounce = | field = Psychiatry, clinical psychology | symptoms = | complications = Suicide, self-harm | onset = | duration = | types = | causes = Environmental and genetic | risks = Family history, child abuse, long term stress | diagnosis = | differential = Bipolar I disorder, bipolar disorder not otherwise specified | prevention = | treatment = {{cslist|Medication|psychotherapy}} | medication = {{cslist|Mood stabilizers|antipsychotics}} | prognosis = | frequency = 1% | deaths = 15-20% die by suicide }} '''Bipolar II disorder''' ('''BP-II''') is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression.<ref name="Benazzi22">{{cite journal|vauthors=Benazzi F|date=2007|title=Bipolar II disorder: Epidemiology, Diagnosis and Management|url=https://link.springer.com/article/10.2165/00023210-200721090-00003|journal=CNS Drugs|type=Therapy in Practice|volume=21|issue=9|pages=727–40|doi=10.2165/00023210-200721090-00003|pmid=17696573|url-access=subscription|via=|s2cid=28078494}}</ref><ref name="Dodd2">{{cite journal|vauthors=Berk M, Dodd S|date=February 2005|title=Bipolar II disorder: a review|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1399-5618.2004.00152.x|journal=Bipolar Disorders|volume=7|issue=1|pages=11–21|doi=10.1111/j.1399-5618.2004.00152.x|pmid=15654928|url-access=subscription|via=}}</ref><ref>{{cite web|date=24 November 2020|title=Bipolar Disorder and Depression: Understanding the Difference|url=https://www.psycom.net/depression.central.bipolar.depression.html|url-status=live|archive-url=https://web.archive.org/web/20180907060344/https://www.psycom.net/depression.central.bipolar.depression.html |archive-date=2018-09-07 |access-date=29 January 2021|website=Psycom|vauthors=Hurley K}}</ref><ref>{{Cite web|last=|first=|date=29 January 2021|title=Bipolar Diagnosis|url=https://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-diagnosis#1|url-status=live|archive-url=https://web.archive.org/web/20070303112536/http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-diagnosis#1|archive-date=3 March 2007|access-date=30 January 2021|website=WebMD|location=Atlanta, Georgia|page=1|language=en-US}}</ref> Diagnosis for BP-II requires that the individual must never have experienced a full manic episode.<ref name=":0">{{Cite book|last=American Psychiatric Association. American Psychiatric Association. DSM-5 Task Force.|url=https://archive.org/details/diagnosticstatis0005unse|title=Diagnostic and statistical manual of mental disorders: DSM-5.|publisher=American Psychiatric Association|year=2017|isbn=978-0-89042-554-1|edition=5th|location=Washington, D.C.|pages=139|oclc=1042815534|orig-date=2013|url-access=registration|via=Internet Archive}}</ref> Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).<ref name="Dodd2"/>

Bipolar II Disorder is a mood disorder characterized by alternating periods of depression and hypomania, a less severe form of mania. Individuals with Bipolar II experience episodes of major depression, marked by symptoms like persistent sadness, fatigue, and loss of interest in activities, as well as episodes of hypomania, which involve elevated mood, increased energy, and impulsivity, but without the full-blown manic episodes seen in Bipolar I Disorder.

The disorder is often underdiagnosed because the hypomanic episodes may not be as disruptive as full mania. Bipolar II tends to be chronic and can significantly impact a person's social, professional, and emotional life. Though the causes are not fully understood, a combination of genetic, environmental, and neurobiological factors is believed to play a role.

Bipolar II is typically managed through a combination of medication, such as mood stabilizers, atypical antipsychotics, as well as psychotherapy.<ref name=":6">{{Cite journal |last1=Berk |first1=Michael |last2=Corrales |first2=Asier |last3=Trisno |first3=Roth |last4=Dodd |first4=Seetal |last5=Yatham |first5=Lakshmi N. |last6=Vieta |first6=Eduard |last7=McIntyre |first7=Roger S. |last8=Suppes |first8=Trisha |last9=Agustini |first9=Bruno |date=June 2025 |title=Bipolar II disorder: a state-of-the-art review |journal=World Psychiatry|volume=24 |issue=2 |pages=175–189 |doi=10.1002/wps.21300 |issn=1723-8617 |pmc=12079553 |pmid=40371769}}</ref> Antidepressant use in bipolar disorder is controversial, with some studies finding benefit, while others find risks of switching to hypomania or worsening of rapid cycling.<ref name=":6" /><ref name=":7" /><ref name=":8" />

Early diagnosis and treatment can help mitigate the intensity and frequency of mood episodes. Hypomania is a sustained state of elevated or irritable mood that is less severe than mania yet may still significantly affect the quality of life and result in permanent consequences including reckless spending, damaged relationships and poor judgment.<ref name="Sadock 2017">{{cite book | last1=Sadock | first1=Benjamin J. | last2=Sadock | first2=Virginia A. | last3=Ruiz | first3=Pedro | title=Kaplan & Sadock's comprehensive textbook of psychiatry | edition=10th | publisher=Wolters Kluwer | publication-place=Philadelphia | year=2017 | isbn=978-1-4963-8915-2 | oclc=988106757 | url=https://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=5472153}}</ref>{{rp|1651}} Unlike mania, hypomania cannot include psychosis.<ref name="Benazzi22" /><ref>{{Cite journal |last=Goodwin |first=Guy |date=August 2002 |title=Hypomania: What's in a name? |journal=The British Journal of Psychiatry |language=en |volume=181 |issue=2 |pages=94–95 |doi=10.1192/bjp.181.2.94 |s2cid=41536783 |issn=0007-1250|doi-access=free }}</ref> The hypomanic episodes associated with BP-II must last for at least four days.<ref name="Dodd2" /><ref>{{cite book|last=|first=|url=https://archive.org/details/stcenturypsychol00davi|title=21st Century Psychology: A Reference Handbook|publisher=Sage Publications|year=2008|isbn=978-1-4129-4968-2|veditors=Buskist W, Davis SF|location=Thousand Oaks, California|pages=[https://archive.org/details/stcenturypsychol00davi/page/n320 290]|url-access=limited|via=Internet Archive}}</ref>

Commonly, depressive episodes are more frequent and more intense than hypomanic episodes.<ref name="Dodd2"/> Additionally, when compared to BP-I, type II presents more frequent depressive episodes and shorter intervals of well-being.<ref name="Benazzi22"/><ref name="Dodd2"/> The course of BP-II is more chronic and consists of more frequent cycling than the course of BP-I.<ref name="Benazzi22"/><ref name="Mak2">{{cite journal|vauthors=Mak AD|year=2007|title=A short review on the diagnostic issues of bipolar spectrum disorders in clinically depressed patients – Bipolar II disorder|url=https://www.questia.com/library/journal/1G1-173513825/a-short-review-on-the-diagnostic-issues-of-bipolar|journal=Hong Kong Journal of Psychiatry|volume=17|pages=139–144|url-access=subscription|via=Gale|access-date=2018-09-21|archive-date=2020-08-13|archive-url=https://web.archive.org/web/20200813152226/https://www.questia.com/library/journal/1G1-173513825/a-short-review-on-the-diagnostic-issues-of-bipolar}}</ref> Finally, BP-II is associated with a greater risk of suicidal thoughts and behaviors than BP-I or unipolar depression.<ref name="Benazzi22"/><ref name="Mak2"/> BP-II is no less severe than BP-I, and types I and II present equally severe burdens.<ref name="Benazzi22"/><ref name="Merikangas">{{cite journal|vauthors=Merikangas KR, Lamers F|date=January 2012|title=The 'true' prevalence of bipolar II disorder|journal=Current Opinion in Psychiatry|volume=25|issue=1|pages=19–23|doi=10.1097/YCO.0b013e32834de3de|pmid=22156934|s2cid=10768397}}</ref>

BP-II is notoriously difficult to diagnose. Patients usually seek help when they are in a depressed state, or when their hypomanic symptoms manifest themselves in unwanted effects, such as high levels of anxiety, or the seeming inability to focus on tasks. Because many of 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. In addition, many people with BP-II have periods of normal affect. As a result, when patients seek help, they are very often unable to provide their doctor with all the information needed for an accurate assessment; these individuals are often misdiagnosed with unipolar depression.<ref name="Benazzi22"/><ref name="Dodd2"/><ref name="Mak2"/>

BP-II is more common than BP-I, while BP-II and major depressive disorder have about the same rate of diagnosis.<ref>{{Cite journal|last=Benazzi|first=Franco|date=March 2004|title=How to treat bipolar II depression and bipolar II mixed depression?|journal=The International Journal of Neuropsychopharmacology|language=en|volume=7|issue=1|pages=105–106|doi=10.1017/S146114570300395X|pmid=14731315|s2cid=43388979 |issn=1461-1457|doi-access=}}</ref> Substance use disorders (which have high co-morbidity with BP-II) and periods of mixed depression may also make it more difficult to accurately identify BP-II.<ref name="Dodd2" /> Despite the difficulties, it is important that BP-II individuals be correctly assessed so that they can receive the proper treatment.<ref name="Dodd2" /> Antidepressant use, in the absence of mood stabilizers, is correlated with worsening BP-II symptoms.<ref name="Benazzi22" />

==Signs and symptoms== Bipolar disorder is characterized by marked swings in mood, activity, and behavior.<ref name=":02">{{Cite book|last1=Black|first1=Donald W. |author-link=Donald W. Black|last2=Andreasen|first2=Nancy C.|author-link2=Nancy C. Andreasen|name-list-style=vanc|title=Introductory textbook of psychiatry|date=2014|isbn=978-1-58562-469-0|edition=Sixth |location=Washington, DC |publisher=American Psychiatric Publishing |pages=156–157|oclc=865641999}}</ref> BP-II is characterized by periods of hypomania, which may occur before, after, or independently of a depressive episode.<ref name=":1">{{Cite book|last1=Black|first1=Donald W.|author-link=Donald W. Black|last2=Andreasen|first2=Nancy C.|author-link2=Nancy C. Andreasen|name-list-style=vanc|title=Introductory textbook of psychiatry|date=2014|isbn=978-1-58562-469-0|edition=Sixth |location=Washington, DC |publisher=American Psychiatric Publishing |pages=157–161|oclc=865641999}}</ref>

=== Hypomania === {{further|Hypomania}}

Hypomania is the signature characteristic of BP-II, defined by an experience of elevated mood. A patient's mood is typically cheerful, enthusiastic, euphoric, or irritable.<ref name=":1" /> In addition, they can present with symptoms of inflated self-esteem or grandiosity, decreased need for sleep, talkativeness or pressured speech, flight of ideas or rapid cycling of thoughts, distractibility, increased goal-directed activity, psychomotor agitation, and/or excessive involvement in activities that have a high potential for painful consequences (engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments.)<ref name="Springer-Verlag">{{Citation|title=American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)|year=2011 }}</ref>

Hypomania is distinct from mania.<ref>{{Cite web |last=Forbes |first=Elizabeth |date=2020-03-27 |title=What Is Bipolar Disorder? |url=https://www.bphope.com/what-is-bipolar-disorder/ |access-date=2023-09-27 |website=bpHope.com |language=en-US}}</ref><ref>{{Cite web |last1=Hoffman |first1=Matthew |last2=MD |title=An Overview of Bipolar II Disorder |url=https://www.webmd.com/bipolar-disorder/bipolar-2-disorder |access-date=2023-09-27 |website=WebMD |language=en}}</ref> During a typical hypomanic episode, patients may present as upbeat, may show signs of poor judgment or display signs of increased energy despite lack of sleep, but do not meet the full criteria for an acute manic episode.<ref name=":1" /> Patients may display elevated confidence, but do not express delusional thoughts as in mania. They can experience increase in goal-directed activity and creativity, but do not reach the severity of aimlessness and disorganization. Speech may be rapid, but interruptible. Patients with hypomania never present with psychotic symptoms and do not reach the severity to require psychiatric hospitalization.<ref>{{Cite journal|last=Benazzi|first=Franco|date=March 2007|title=Bipolar disorder—focus on bipolar II disorder and mixed depression|journal=The Lancet|volume=369|issue=9565|pages=935–945|doi=10.1016/s0140-6736(07)60453-x|pmid=17368155|s2cid=10704613|issn=0140-6736}}</ref>

For these reasons, hypomania commonly goes unnoticed. Individuals often will only seek treatment during a depressive episode, and their history of hypomania may go undiagnosed.<ref>{{Cite journal |date=October 2006 |title=Misdiagnosis of Bipolar Disorder |pmc=2945875 |last1=Singh |first1=T. |last2=Rajput |first2=M. |journal=Psychiatry (Edgmont) |volume=3 |issue=10 |pages=57–63 |pmid=20877548 }}</ref> Although hypomania may increase functioning, episodes require treatment as they may indicate increasing instability and can precipitate a depressive episode.<ref name="Benazzi22" /><ref name="Dodd2" />

===Depressive episodes=== {{further|Depression (mood)}}

It is during depressive episodes that BP-II patients often seek help. Symptoms may be syndromal or subsyndromal.<ref name="Benazzi22" />

Depressive episodes in BP-II can present similarly to those experienced in unipolar depressive disorders.<ref name=":03">{{Cite book|title=Kaplan & Sadock's synopsis of psychiatry|date=2022|last1=Boland|first1=Robert|last2=Verduin|first2=Marcia|last3=Ruiz|first3=Pedro|last4=Sadock|first4=Benjamin|isbn=978-1-9751-4556-9|edition=12|location=Philadelphia|publisher=Wolters Kluwer|page=366|oclc=1227837243}}</ref> Patients characteristically experience a depressed mood and may describe themselves as feeling sad, gloomy, down in the dumps, or hopeless, for most of the day, nearly every day. In children, this can present with an irritable mood. Most patients report significant fatigue, loss of energy, or tiredness. Patients or their family members may note diminished interest in usual activities such as sex, hobbies, or daily routines. Many patients report a change in appetite along with associated weight change. Sleep disturbances may be present, and can manifest as problems falling or staying asleep, frequent awakenings, excessive sleep, or difficulties getting up in the morning.

Around half of depressed patients develop changes in psychomotor activity, described as slowness in thinking, speaking, or movement. Conversely, they may also present with agitation, with inability to sit still or wringing their hands. Other signs and symptoms include changes in posture and facial expression, slowed speech, poor hygiene, unkempt appearance, feelings of guilt, shame, or helplessness, diminished ability to concentrate, nihilistic thoughts, and suicidal ideation.<ref>{{Cite book|title=Current diagnosis & treatment. Psychiatry|date=2019|last1=Ebert|first1=Michael|last2=Leckman|first2=James|last3=Petrakis|first3=Ismene|isbn=978-0-07-177194-8|edition=3|location=New York|publisher=McGraw-Hill Education|oclc=1057895724}}</ref><ref name=":02" />

Many experts in the field have attempted to find reliable differences between BP-II depressive episodes and episodes of major depressive disorder (MDD), but the data is inconsistent. However, some clinicians report that patients who came in with a depressive episode, but were later diagnosed as having bipolar disorder often presented with hypersomnia, increased appetite, psychomotor retardation, and a history of antidepressant-induced hypomania.<ref name=":03" /><ref name="Mak2" /> Evidence also suggests that unlike MDD depressive episodes, BP-II depressive episodes tend to include symptoms more commonly associated with atypical depression, such as overeating or oversleeping. Other factors that can distinguish BP-II from MDD are age of onset, which is lower for BP, the frequency of recurrence, which is greater for BP-II, and bipolar disorder family history (both type 1 and 2).<ref name="Benazzi22" />

===Mood episodes with mixed features=== {{further|Mixed affective state}}

A mixed episode is defined by the presence of a hypomanic or depressive episode that is accompanied by symptoms of the opposite polarity. This is commonly referred to as a mood episode with mixed features (e.g. depression with mixed features or hypomania with mixed features), but can also be referred to as mixed episodes or mixed states.<ref name=":2">{{Cite journal|last1=Betzler|first1=Felix|last2=Stöver|first2=Laura Apollonia|last3=Sterzer|first3=Philipp|last4=Köhler|first4=Stephan|date=2017-04-18|title=Mixed states in bipolar disorder – changes in DSM-5 and current treatment recommendations|journal=International Journal of Psychiatry in Clinical Practice|volume=21|issue=4|pages=244–258|doi=10.1080/13651501.2017.1311921|pmid=28417647|s2cid=19068715|issn=1365-1501}}</ref> For example, a patient with depression with mixed features may have a depressed mood, but has simultaneous symptoms of rapid speech, increased energy, and flight of ideas. Conversely, a patient with hypomania with mixed features will present with the full criteria for a hypomanic episode, but with concurrent symptoms of decreased appetite, loss of interest, and low energy.<ref>{{Cite book|last1=Wright|first1= Padraig|last2=Stern|first2=Julia|last3=Phelan|first3=Michael|url=https://www.sciencedirect.com/book/9780702033971/core-psychiatry|title=Core psychiatry|date=2012|pages=501–510|publisher=Elsevier|isbn=978-0-7020-3397-1|oclc=712765641}}</ref>

Episodes with mixed features can last up to several months. They occur more frequently in patients with an earlier onset of bipolar disorder, are associated with higher frequency of episodes, and are associated with a greater risk of substance use, anxiety disorders, and suicidality. In addition, they are associated with increased treatment resistance compared to non-mixed episodes.<ref name=":2" />

=== Psychosis === {{Further|Psychosis}} An estimated 20% of people with bipolar II disorder have experienced psychosis.<ref name=":9">{{Cite journal |last1=Chakrabarti |first1=Subho |last2=Singh |first2=Navdeep |date=2022-09-19 |title=Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review |journal=World Journal of Psychiatry |volume=12 |issue=9 |pages=1204–1232 |doi=10.5498/wjp.v12.i9.1204 |doi-access=free |issn=2220-3206 |pmc=9521535 |pmid=36186500}}</ref><ref name=":10">{{Cite journal |last1=Mazzarini |first1=Lorenzo |last2=Colom |first2=Francesc |last3=Pacchiarotti |first3=Isabella |last4=Nivoli |first4=Alessandra M. A. |last5=Murru |first5=Andrea |last6=Bonnin |first6=C. Mar |last7=Cruz |first7=Nuria |last8=Sanchez-Moreno |first8=Jose |last9=Kotzalidis |first9=Giorgio D. |last10=Girardi |first10=Paolo |last11=Tatarelli |first11=Roberto |last12=Vieta |first12=Eduard |date=2010-10-01 |title=Psychotic versus non-psychotic bipolar II disorder |url=https://www.sciencedirect.com/science/article/pii/S0165032710003216 |journal=Journal of Affective Disorders |volume=126 |issue=1 |pages=55–60 |doi=10.1016/j.jad.2010.03.028 |pmid=20457470 |issn=0165-0327|url-access=subscription }}</ref> Symptoms of psychosis include delusions, hallucinations, or both. Delusions are more common than hallucinations in bipolar disorder. In general, having psychotic episodes means the illness is more severe. People with psychosis have poor insight and more agitation, anxiety, and hostility.<ref name=":9" /><ref name=":10" />

In contrast to bipolar II, in bipolar I, more than 50% of people have experienced psychosis. Psychosis is more common during manic episodes than depressive episodes, so psychotic symptoms are more common in bipolar type I compared to bipolar type II.<ref name=":9" /><ref name=":10" />

== Causes == {{Main|Biology of bipolar disorder}}

Multiple factors contribute to the development of bipolar spectrum disorders,<ref>{{Cite web|last=The National Institute of Mental Health|date=January 2020|title=Bipolar Disorder|url=https://www.nimh.nih.gov/health/topics/bipolar-disorder|url-status=live|archive-url=https://web.archive.org/web/20070920162653/http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml|archive-date=2007-09-20|access-date=31 January 2021|website=|publisher=National Institute of Mental Health|at=Risk Factors|language=en}}</ref> although there have been very few studies conducted to examine the possible causes of BP-II specifically.<ref>{{Cite journal |vauthors=Leahy RL |date=2007 |title=Bipolar disorder: Causes, contexts, and treatments |url=https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.20360 |journal=Journal of Clinical Psychology |volume=63 |issue=5 |pages=417–424 |doi=10.1002/jclp.20360 |issn=0021-9762 |pmid=17417809 |url-access=subscription |via=}}</ref> While no identifiable single dysfunctions in specific neurotransmitters have been found, preliminary data has shown that calcium signal transmission, the glutamatergic system, and hormonal regulation play a role in the pathophysiology of the disease.<ref>{{Cite journal |last1=Almeida |first1=Hugo Sérgio |last2=Mitjans |first2=Marina |last3=Arias |first3=Barbara |last4=Vieta |first4=Eduard |last5=Ríos |first5=José |last6=Benabarre |first6=Antonio |date=November 2020 |title=Genetic differences between bipolar disorder subtypes: A systematic review focused in bipolar disorder type II |journal=Neuroscience and Biobehavioral Reviews |volume=118 |pages=623–630 |doi=10.1016/j.neubiorev.2020.07.033 |issn=1873-7528 |pmid=32755611 |s2cid=220923413}}</ref> The cause of Bipolar disorder can be attributed to misfiring neurotransmitters that overstimulate the amygdala, which in turn causes the prefrontal cortex to stop working properly. The bipolar patient becomes overwhelmed with emotional stimulation with no way of understanding it, which can trigger mania and exacerbate the effects of depression.<ref>{{Cite book |url=https://books.google.com/books?id=1qoc89jy0LsC&pg=PA63 |title=The complete idiot's guide to bipolar disorder |vauthors=Carter J |publisher=Alpha |others=Bobbi Dempsey |year=2009 |isbn=978-1-59257-817-7 |location=New York |pages=63–65 |oclc=213308949 |url-access=limited |via=Google Books}}</ref>

==Diagnosis== BP-II is diagnosed according to the criteria established in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).<ref name="Springer-Verlag" /> In addition, alternative diagnostic criteria is established in the World Health Organization's [[ICD-11|International Classification of Diseases-11th Revision (ICD-11)].]]<ref>{{Cite book |title=The ICD-11 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines |date=2022 |publisher=World Health Organization |isbn= |location= |oclc=}}</ref> The diagnostic criteria are established from self-reported experiences from patients or their family members, the psychiatric assessment, and the mental status examination. In addition, Screening instruments like the Mood Disorders Questionnaire are helpful tools in determining a patient's status on the bipolar spectrum. In addition, certain features have been shown to increase the chances that depressed patients have a bipolar disorder, including atypical symptoms of depression like hypersomnia and hyperphagia, a family history of bipolar disorder, medication-induced hypomania, recurrent or psychotic depression, antidepressant refractory depression, and early or postpartum depression.<ref name="George" />

=== DSM-5 criteria === According to the DSM-5, a patient diagnosed with BP-II will have experienced at least one hypomanic episode, at least one major depressive episode, and no manic episode. Furthermore, the occurrence of the mood episodes are not better explained by schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. The final criteria that must be met is that the mood episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (from the depressive symptoms or the unpredictability of cycling between periods of depression and hypomania).<ref name=":0" />

A hypomanic episode is established if a patient's symptoms last for most of the day each day for at least four days. Furthermore, three or more of the following symptoms must be present: Inflated sense of self-esteem or grandiose thoughts, feeling well rested despite getting low amounts of sleep (3 hours), talkativeness, racing thoughts, distractibility, and increase in goal-directed activity or psychomotor agitation, or excessive involvement in activities with high risk of painful consequences. Per DSM-5 criteria, a major depressive episode consists of the presence of a depressed mood or loss of interest/pleasure in activities (anhedonia). In addition to the former symptoms, five out of the nine following symptoms must occur for more than two weeks (to the extent in which it impairs functioning): weight loss/gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness/inappropriate guilt, decreased concentration, or thoughts of death/suicide.<ref name=":0" />

Specifiers: * With current or most recent episode hypomanic or depressed * With partial remission or full remission * With mild, moderate, or severe severity * With anxious distress * With catatonic features * With mood congruent psychotic features * With peripartum onset * With seasonal pattern (applies only to the pattern of major depressive episodes) * With rapid cycling.

=== ICD-11 === According to the ICD-11, a BP-II patient will have experienced episodic experiences of one or more hypomanic episode and one or more major depressive episode, and no history of a manic episode or mixed episode.<ref name=":5">{{Cite web |title=ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/199053300 |access-date=2022-05-03 |website=icd.who.int |page=Section 6A61. Subtypes listed}}</ref> These symptoms cannot be explained by other diagnoses such as:

* Cyclothymia<ref name=":5" /> * ADHD<ref name=":5" /> * Oppositional Defiant Disorder<ref name=":5" /> * Schizophrenia and other primary psychotic disorders<ref name=":5" /> * Substance-Use Disorder<ref name=":5" /> * Personality Disorders<ref name=":5" /> * Other Mental illness<ref name=":5" /> * Physical issues such as a brain tumor<ref name=":5" />

The specifiers are the same as the DSM-5 with the exception of catatonic features and if symptoms have occurred with or without psychosis about 6 weeks after childbirth.<ref name=":5" />

=== Differential diagnoses === The signs and symptoms of BP-II may overlap significantly with those of other conditions. Thus, a comprehensive history, medication review, and laboratory work are key to diagnosing BP-II and differentiating it from other conditions. The differential diagnosis of BP-II is as follows: unipolar major depression, borderline personality disorder, post traumatic stress disorder, substance use disorders, and attention deficit hyperactivity disorder.<ref name="Sadock 2017" />{{rp|1653–7}}

Major differences between BP-I and BP-II have been identified in their clinical features, comorbidity rates and family histories. During depressive episodes, BP-II patients tend to show higher rates of psychomotor agitation, guilt, shame, suicidal ideation, and suicide attempts. BP-II patients have shown higher lifetime comorbidity rates of phobias, anxiety disorders, substance use, and eating disorders. In addition, there is a higher correlation between BP-II patients and family history of psychiatric illness, including major depression and substance-related disorders compared to BP-I.<ref name="Baek">{{cite journal|vauthors=Baek JH, Park DY, Choi J, Kim JS, Choi JS, Ha K, Kwon JS, Lee D, Hong KS|date=June 2011|title=Differences between bipolar I and bipolar II disorders in clinical features, comorbidity, and family history|journal=Journal of Affective Disorders |volume=131|issue=1–3|pages=59–67|doi=10.1016/j.jad.2010.11.020|issn=1573-2517|pmid=21195482}}</ref> The occurrence rate of psychiatric illness in first degree relatives of BP-II patients was 26.5%, versus 15.4% in BP-I patients.<ref name="Baek" /><ref name="George" />

==Management== {{Main|Treatment of bipolar disorder}}

Although BP-II is a prevalent condition associated with morbidity and mortality, there has been an absence of robust clinical trials and systematic reviews that investigate the efficacy of pharmacologic treatments for the hypomanic and depressive phases of BP-II.<ref name=":6" /> Thus, the current treatment guidelines for the symptoms of BP-II are derived and extrapolated from the treatment guidelines in BP-I, along with limited randomized controlled trials published in the literature.<ref name="pmid17162626">{{cite journal|vauthors=El-Mallakh R, Weisler RH, Townsend MH, Ginsberg LD|year=2006|title=Bipolar II disorder: current and future treatment options|journal=Annals of Clinical Psychiatry|volume=18|issue=4|pages=259–66|doi=10.1080/10401230600948480|pmid=17162626}}</ref><ref name="Sadock 2017" />{{rp|1697}}

The treatment of BP-II consists of the following: treatment of hypomania, treatment of major depression, and maintenance therapy for the prevention of relapse of hypomania or depression. As BP-II is a chronic condition, the goal of treatment is to achieve remission of symptoms and prevention of self-harm in patients.<ref name="Benazzi22" /> Treatment modalities of BP-II include medication-based pharmacotherapy, along with various forms of psychotherapy.<ref>{{Cite journal|last1=Novick|first1=Danielle M.|last2=Swartz|first2=Holly A.|date=June 2019|title=Psychosocial Interventions for Bipolar II Disorder|journal=American Journal of Psychotherapy|language=en|volume=72|issue=2|pages=47–57|doi=10.1176/appi.psychotherapy.20190008|pmid=31070452|s2cid=148569714|issn=0002-9564|doi-access=free}}</ref>

===Medications=== [[File:Lamictal 25mg.JPG|thumb|Lamotrigine (Lamictal) is an anticonvulsant that can be used as a mood stabilizer to treat BP-II.]] The most common pharmacologic agents utilized in the treatment of BP-II includes mood stabilizers, atypical antipsychotics, and antidepressants, though antidepressant use in bipolar disorder is controversial.<ref name="Benazzi22" /><ref name=":6" />

====Mood stabilizers==== {{Further|Mood stabilizer}}

Mood stabilizers used in the treatment of hypomanic and depressive episodes of BP-II include lithium, and the anticonvulsant medications valproate, carbamazepine, lamotrigine, and topiramate.<ref name=":4">{{Cite book|last1=Black|first1=Donald W.|author-link=Donald W. Black|last2=Andreasen|first2=Nancy C.|author-link2=Nancy C. Andreasen|name-list-style=vanc|title=Introductory textbook of psychiatry|date=2014|isbn=978-1-58562-469-0|edition=6|location=Washington, DC |publisher=American Psychiatric Publishing |pages=184–186|oclc=865641999}}</ref>

There is strong evidence that lithium is effective in treating both the depressive and hypomanic symptoms in BP-II, along with the reduction of hypomanic switch in patients treated with antidepressants. Furthermore, lithium is the only mood stabilizer to demonstrate a decrease in suicide and self-harm in patients with mood disorders.<ref>{{Cite journal|last1=Cipriani|first1=A.|last2=Hawton|first2=K.|last3=Stockton|first3=S.|last4=Geddes|first4=J. R.|date=2013-06-27|title=Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis|journal=BMJ|volume=346|issue=jun27 4|article-number=f3646|doi=10.1136/bmj.f3646|pmid=23814104|s2cid=25843596|issn=1756-1833|doi-access=free}}</ref> In addition to preventing suicide, lithium also decreases death from all causes in people with mood disorders.<ref>{{Cite journal |last=Cipriani |first=Andrea |last2=Pretty |first2=Heather |last3=Hawton |first3=Keith |last4=Geddes |first4=John R. |date=October 2005 |title=Lithium in the Prevention of Suicidal Behavior and All-Cause Mortality in Patients With Mood Disorders: A Systematic Review of Randomized Trials |url=https://psychiatryonline.org/doi/full/10.1176/appi.ajp.162.10.1805 |journal=American Journal of Psychiatry |volume=162 |pages=1805–1819 |doi=10.1176/appi.ajp.162.10.1805|url-access=subscription }}</ref> Due to lithium's narrow therapeutic index, lithium levels must be monitored regularly for prevention of lithium toxicity.

There is also evidence that the anticonvulsants valproate, lamotrigine, carbamazepine, and topiramate are effective in the reduction of symptoms of hypomanic and depressive episodes of bipolar disorder. Potential mechanisms contributing to these effects include a decrease in brain excitation due to blockage of low-voltage sodium-gated channels, decrease in glutamate and excitatory amino acids, and potentiation of levels of GABA.<ref>{{Citation|title=Guideline Watch: Practice Guideline for the Treatment of Patients With Bipolar Disorder, 2nd Edition|work=APA Practice Guidelines for the Treatment of Psychiatric Disorders: Comprehensive Guidelines and Guideline Watches|year=2006|volume=1|place=Arlington, VA|publisher=American Psychiatric Association|doi=10.1176/appi.books.9780890423363.148430|isbn=0-89042-336-9}}</ref> There is evidence that lamotrigine decreases the risk of relapse in rapid-cycling BP-II. It is more effective in BP-II than BP-I, suggesting that lamotrigine is more effective for the treatment of depressive rather than manic episodes. Doses ranging from 100 to 200&nbsp;mg have been reported to have the most efficacy, while experimental doses of 400&nbsp;mg have rendered little response.<ref name="pmid15291656">{{cite journal | vauthors = Hahn CG, Gyulai L, Baldassano CF, Lenox RH | title = The current understanding of lamotrigine as a mood stabilizer | journal = The Journal of Clinical Psychiatry | volume = 65 | issue = 6 | pages = 791–804 | date = June 2004 | pmid = 15291656 | doi = 10.4088/JCP.v65n0610 | url = https://www.researchgate.net/publication/8418259 }}</ref> A large, multicenter trial comparing carbamazepine and lithium over two and a half years found that carbamazepine was superior in terms of preventing future episodes of BP-II, although lithium was superior in individuals with BP-I.{{citation needed|date=February 2026}} There is also some evidence for the use of valproate and topiramate, although the results for the use of gabapentin have been disappointing.{{citation needed|date=February 2026}}

====Antipsychotics==== {{Further|Atypical antipsychotic}} [[File:Seroquel 100 25.jpg|thumb|Quetiapine (Seroquel) is an atypical antipsychotic that is used to treat acute BP-II depression]]

Atypical antipsychotics are utilized as a second line option for hypomanic episodes, typically indicated patients who do not respond to mood stabilizers.<ref name="Bobo 1532–1551" /> However, quetiapine is the only antipsychotic that has demonstrated efficacy in multiple meta-analyses of randomized controlled trials for treating acute BP-II depression, and is a first-line option for patients with BP-II depression.<ref name="Sadock 2017" />{{rp|1697}}<ref>{{cite journal|last1=McIntyre|first1=Roger S|last2=Berk|first2=Michael|last3=Brietzke|first3=Elisa|last4=Goldstein|first4=Benjamin I|last5=López-Jaramillo|first5=Carlos|last6=Kessing|first6=Lars Vedel|last7=Malhi|first7=Gin S|last8=Nierenberg|first8=Andrew A|last9=Rosenblat|first9=Joshua D|last10=Majeed|first10=Amna|last11=Vieta|first11=Eduard|name-list-style=vanc|date=December 2020|title=Bipolar disorders|url=https://linkinghub.elsevier.com/retrieve/pii/S0140673620315440|journal=The Lancet|language=en|volume=396|issue=10265|pages=1841–1856|doi=10.1016/S0140-6736(20)31544-0|pmid=33278937|s2cid=227258944|url-access=subscription}}</ref><ref>{{Cite journal|title=The CANMAT and ISBD Guidelines for the Treatment of Bipolar Disorder: Summary and a 2023 Update of Evidence|url=https://psychiatryonline.org/doi/full/10.1176/appi.focus.20230009|journal=Focus|date=October 2023|pmc=11058959|pmid=38695002|pages=344–353|volume=21|doi=10.1176/appi.focus.20230009|first=Kamyar|last=Keramatian|first2=Nellai K.|last2=Chithra|first3=Lakshmi N.|last3=Yatham}}</ref> Other atypical antipsychotics that are used to treat BP-II include lurasidone, olanzapine, cariprazine, aripiprazole, asenapine, paliperidone, risperidone, ziprasidone. First generation antipsychotics used for treatment are haloperidol and chlorpromazine.<ref>{{Citation |last1=Chokhawala |first1=Krutika |title=Antipsychotic Medications |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK519503/ |access-date=2024-07-05 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30137788 |last2=Stevens |first2=Lee}}</ref> As a class, the first generation antipsychotics are associated with movement disorders, along with anticholinergic side effects compared to second generation antipsychotics (atypical antipsychotics).<ref name="Bobo 1532–1551">{{Cite journal|last=Bobo|first=WV|date=October 2017|title=The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update|journal=Mayo Clinic Proceedings|volume=92|issue=10|pages=1532–1551|doi=10.1016/j.mayocp.2017.06.022|issn=1942-5546|pmid=28888714|s2cid=34182938|doi-access=free}}</ref>

====Antidepressants==== {{See also|SSRI#Bipolar switch|Bipolar disorder#Antidepressants}}

There is evidence to support the use of SSRI and SNRI antidepressants in BP-II, but the use of these treatments is controversial.<ref name=":7">{{Cite journal |last=Gitlin |first=Michael J. |date=2018-12-01 |title=Antidepressants in bipolar depression: an enduring controversy |journal=International Journal of Bipolar Disorders |volume=6 |issue=1 |article-number=25 |doi=10.1186/s40345-018-0133-9 |issn=2194-7511 |pmc=6269438 |pmid=30506151 |doi-access=free }}</ref><ref name="nordic">{{cite journal|vauthors=Skeppar P, Adolfsson R|date=1 January 2006|title=Bipolar II and the bipolar spectrum|journal=Nordic Journal of Psychiatry|volume=60|issue=1|pages=7–26|doi=10.1080/08039480500504685|pmid=16500795|s2cid=31045895}}</ref> Potential risks of antidepressant pharmacotherapy in patients with bipolar disorder include increased mood cycling, development of rapid cycling, dysphoria, and switch to hypomania.<ref name=":8">{{cite journal| last1=Sandlin| first1= Emily KL|first2= Yonglin | last2=Gao| first3= Rif S. | last3=El-Mallakh | s2cid= 31900250| name-list-style = vanc | title=Pharmacotherapy of bipolar disorder: current status and emerging options| journal= Clinical Practice |volume=11| number=1 |year=2014| pages=39–48 | doi= 10.2217/cpr.13.85}}</ref> In addition, the evidence for their efficacy in bipolar depression is mixed. Thus, in most cases, antidepressant monotherapy in patients with BP-II is not recommended. However, antidepressants may provide benefit to some patients when used in addition to mood stabilizers and atypical antipsychotics, as these drugs reduce the risk of manic/hypomanic switching.<ref name="Bobo 1532–1551" /> However, the risk still exists, and antidepressants should be used with caution.<ref name="pmid17162626" />

===Non-pharmaceutical therapies=== {{Further|Therapy|Psychotherapy}} Although medication therapy is the standard of care for treatment of both BP-I and BP-II, additional non-pharmaceutical therapies can also help those with the illness. Benefits include prevention of relapse and improved maintenance medication adherence. These include psychotherapy (e.g. cognitive behavioral therapy, psychodynamic therapy, psychoanalysis, interpersonal therapy, behavioral therapy, cognitive therapy, and family-focused therapy), social rhythm therapy, art therapy, music therapy, psychoeducation, mindfulness, and light therapy.

Meta-analyses in the literature has shown that psychotherapy plus pharmacotherapy was associated with a lower relapse rate compared with patients treated with pharmacotherapy alone.<ref>{{Cite journal|last1=Scott|first1=Jan|last2=Colom|first2=Francesc|last3=Vieta|first3=Eduard|date=February 2007|title=A meta-analysis of relapse rates with adjunctive psychological therapies compared to usual psychiatric treatment for bipolar disorders|journal=The International Journal of Neuropsychopharmacology|volume=10|issue=1|pages=123–129|doi=10.1017/S1461145706006900|issn=1461-1457|pmid=16787554|doi-access=free}}</ref> However, relapse can still occur, despite continued medication and therapy.<ref name="Understanding Bipolar Disorder -- Treatment">{{cite web| title= Understanding Bipolar Disorder – Treatment| website= WedMD.com| url=http://www.webmd.com/bipolar-disorder/guide/understanding-bipolar-disorder-treatment?page=2|access-date=22 November 2011}}</ref> People with bipolar disorder may develop dissociation to match each mood they experience. For some, this is done intentionally, as a means by which to escape trauma or pain from a depressive period, or simply to better organize one's life by setting boundaries for one's perceptions and behaviors.<ref name="Smith">{{cite book|last=Smith|first=Meg|url=https://archive.org/details/bipolariidisorde00park|title=Bipolar II Disorder: Modelling, Measuring, and Managing|publisher=Cambridge University Press|year=2008|isbn=978-0-521-87314-7|editor-last=Parker|editor-first=Gordan|editor-link=Gordon Parker (psychiatrist)|location=Cambridge, England|pages=[https://archive.org/details/bipolariidisorde00park/page/n209 195]–203|chapter=Survival Strategies for Managing and Prospering with Bipolar II Disorder|url-access=limited|name-list-style=vanc}}</ref>

==Prognosis== There is evidence to suggest that BP-II has a more chronic course of illness than BP-I.<ref name="Carol">{{Cite thesis |degree= PhD |chapter= Chapter 1 |title= Neuropsychological emotion processing abnormalities in bipolar disorder I and II |chapter-url= http://digitalcommons.library.unlv.edu/thesesdissertations/843/ |last= Randall |first= Carol | name-list-style = vanc |year= 2010 |publisher= University of Nevada |access-date= 19 October 2011 |archive-url= https://web.archive.org/web/20120108012948/http://digitalcommons.library.unlv.edu/thesesdissertations/843/ |archive-date= 8 January 2012 }}</ref> This constant and pervasive course of the illness leads to an increased risk in suicide and more hypomanic and major depressive episodes with shorter periods between episodes than BP-I patients experience.<ref name="Carol" /> The natural course of BP-II, when left untreated, leads to patients spending the majority of their lives with some symptoms, primarily stemming from depression.<ref name="George">{{cite book|last1=Hadjipavlou|first1=George | first2 = Lakshmi N. | last2 = Yatham | name-list-style = vanc |title=Bipolar II Disorder: Modelling, Measuring, and Managing |url=https://archive.org/details/bipolariidisorde00park|url-access=limited|year=2008 |publisher=Cambridge University Press |location=Cambridge, England |isbn=978-0-521-87314-7 |pages=[https://archive.org/details/bipolariidisorde00park/page/n75 61]–74 | chapter =Bipolar II Disorder in Context: epidemiology, disability, and economic burden|editor-first = Gordan | editor-last = Parker|editor-link=Gordon Parker (psychiatrist)}}</ref> Their recurrent depression results in personal distress and disability.<ref name="George" />

This disability can present itself in the form of psychosocial impairment, which has been suggested to be worse in BP-II patients than in BP-I patients.<ref name="psychosocial">{{cite journal | vauthors = Ruggero CJ, Chelminski I, Young D, Zimmerman M | title = Psychosocial impairment associated with bipolar II disorder | journal = Journal of Affective Disorders | volume = 104 | issue = 1–3 | pages = 53–60 | date = December 2007 | pmid = 17337067 | pmc = 2147679 | doi = 10.1016/j.jad.2007.01.035 }}</ref> Another facet of this illness that is associated with a poorer prognosis is rapid cycling, which denotes the occurrence of four or more major Depressive, Hypomanic, and/or mixed episodes in a 12-month period.<ref name="Carol" /> Rapid cycling is quite common in those with BP-II, much more so in women than in men (70% vs. 40%), and without treatment leads to added sources of disability and an increased risk of suicide.<ref name="George" /> Women are more prone to rapid cycling between hypomanic episodes and depressive episodes.<ref>{{Cite book|last1=Bridley|first1=Alexis|url=https://opentext.wsu.edu/abnormal-psych/wp-content/uploads/sites/41/2018/05/Abnormal-Psychology-2nd-Edition.pdf|title=Abnormal Psychology 2nd edition|last2=Daffin Jr.|first2=Lee W.|publisher=Washington State University|year=2020|pages=4–12}}</ref>

To improve a patient's prognosis, long-term therapy is most favorably recommended for controlling symptoms, maintaining remission and preventing relapses.<ref name="relapse">{{cite journal | vauthors = McAllister-Williams RH | title = Relapse prevention in bipolar disorder: a critical review of current guidelines | journal = Journal of Psychopharmacology | volume = 20 | issue = 2 Suppl | pages = 12–6 | date = March 2006 | pmid = 16551667 | doi = 10.1177/1359786806063071 | s2cid = 20569865 }}</ref> With treatment, patients have been shown to present a decreased risk of suicide (especially when treated with lithium) and a reduction of frequency and severity of their episodes, which in turn moves them toward a stable life and reduces the time they spend ill.<ref name="George2">{{cite book|last=Hadjipavlou|first=George| name-list-style = vanc |title=Bipolar II Disorder: Modelling, Measuring, and Managing|url=https://archive.org/details/bipolariidisorde00park|url-access=limited|year=2008|publisher=Cambridge University Press|location=Cambridge, England |isbn=978-0-521-87314-7|pages=[https://archive.org/details/bipolariidisorde00park/page/n134 120]–132| chapter = Mood Stabilisers in treatment of Bipolar II Disorder|editor-first = Gordon | editor-last = Parker |editor-link=Gordon Parker (psychiatrist) }}</ref> To maintain their state of balance, therapy is often continued indefinitely, as around 50% of the patients who discontinue it relapse quickly and experience either full-blown episodes or sub-syndromal symptoms that bring significant functional impairments.<ref name="relapse" />

===Functioning=== The deficits in functioning associated with BP-II stem mostly from the recurrent depression that BP-II patients experience. Depressive symptoms are much more disabling than hypomanic symptoms and are potentially as, or more disabling than mania symptoms.<ref name="psychosocial" /> Functional impairment has been shown to be directly linked with increasing percentages of depressive symptoms, and because sub-syndromal symptoms are more common—and frequent—in BP-II, they have been implicated heavily as a major cause of psychosocial disability.<ref name="George" />

There is evidence that shows the mild depressive symptoms, or even sub-syndromal symptoms, are responsible for the non-recovery of social functioning, which furthers the idea that residual depressive symptoms are detrimental for functional recovery in patients being treated for BP-II.<ref name="correlates">{{cite journal | vauthors = Wingo AP, Baldessarini RJ, Compton MT, Harvey PD | title = Correlates of recovery of social functioning in types I and II bipolar disorder patients | journal = Psychiatry Research | volume = 177 | issue = 1–2 | pages = 131–4 | date = May 2010 | pmid = 20334933 | pmc = 2859974 | doi = 10.1016/j.psychres.2010.02.020 }}</ref> It has been suggested that symptom interference in relation to social and interpersonal relationships in BP-II is worse than symptom interference in other chronic medical illnesses such as cancer.<ref name="correlates" /> This social impairment can last for years, even after treatment that has resulted in a resolution of mood symptoms.<ref name="correlates" />

The factors related to this persistent social impairment are residual depressive symptoms, limited illness insight (a very common occurrence in patients with BP-II), and impaired executive functioning.<ref name="correlates" /> Impaired ability in executive functions is directly tied to poor psychosocial functioning, a common side-effect in patients with BP-II.<ref name="Functional">{{cite journal | vauthors = Rosa AR, Bonnín CM, Vázquez GH, Reinares M, Solé B, Tabarés-Seisdedos R, Balanzá-Martínez V, González-Pinto A, Sánchez-Moreno J, Vieta E | title = Functional impairment in bipolar II disorder: is it as disabling as bipolar I? | journal = Journal of Affective Disorders | volume = 127 | issue = 1–3 | pages = 71–6 | date = December 2010 | pmid = 20538343 | doi = 10.1016/j.jad.2010.05.014 }}</ref>

The impact on a patient's psychosocial functioning stems from the depressive symptoms (more common in BP-II than BP-I).<ref name="psychosocial" /> An increase in these symptoms' severity seems to correlate with a significant increase in psychosocial disability.<ref name="Functional" /> Psychosocial disability can present itself in poor semantic memory, which in turn affects other cognitive domains like verbal memory and (as mentioned earlier) executive functioning leading to a direct and persisting impact on psychosocial functioning.<ref name="memory">{{cite journal | vauthors = Chang JS, Choi S, Ha K, Ha TH, Cho HS, Choi JE, Cha B, Moon E | title = Differential pattern of semantic memory organization between bipolar I and II disorders | journal = Progress in Neuro-Psychopharmacology & Biological Psychiatry | volume = 35 | issue = 4 | pages = 1053–8 | date = June 2011 | pmid = 21371517 | doi = 10.1016/j.pnpbp.2011.02.020 | s2cid = 42808093 }}</ref>

An abnormal semantic memory organization can manipulate thoughts and lead to the formation of delusions and possibly affect speech and communication problems, which can lead to interpersonal issues.<ref name="memory" /> BP-II patients have also been shown to present worse cognitive functioning than those patients with BP-I, though they demonstrate about the same disability when it comes to occupational functioning, interpersonal relationships, and autonomy.<ref name="Functional" /> This disruption in cognitive functioning takes a toll on their ability to function in the workplace, which leads to high rates of work loss in BP-II patient populations.<ref name="psychosocial" /> After treatment and while in remission, BP-II patients tend to report a good psychosocial functioning but they still score less than patients without the disorder.<ref name="George" /> These lasting impacts further suggest that a prolonged period of untreated BP-II can lead to permanent adverse effects on functioning.<ref name="correlates" />

===Recovery and recurrence=== BP-II has a chronic relapsing nature.<ref name="relapse" /> It has been suggested that BP-II patients have a higher degree of relapse than BP-I patients.<ref name="Carol" /> Generally, within four years of an episode, around 60% of patients will relapse into another episode.<ref name="relapse" /> Some patients are symptomatic half the time, either with full on episodes or symptoms that fall just below the threshold of an episode.<ref name="relapse" />

Because of the nature of the illness, long-term therapy is the best option and aims to not only control the symptoms but to maintain sustained remission and prevent relapses from occurring.<ref name="relapse" /> Even with treatment, patients do not always regain full functioning, especially in the social realm.<ref name="correlates" /> There is a very clear gap between symptomatic recovery and full functional recovery for both BP-I and BP-II patients.<ref name="Functional" /> As such, and because those with BP-II spend more time with depressive symptoms that do not quite qualify as a major depressive episode, the best chance for recovery is to have therapeutic interventions that focus on the residual depressive symptoms and to aim for improvement in psychosocial and cognitive functioning.<ref name="Functional" /> Even with treatment, a certain amount of responsibility is placed in the patient's hands; they have to be able to assume responsibility for their illness by accepting their diagnosis, taking the required medication, and seeking help when needed to do well in the future.<ref name="Orum4">{{cite book|last=Orum|first=Margo|title=Bipolar II Disorder: Modelling, Measuring, and Managing|publisher=Cambridge University Press|year=2008|isbn=978-0-521-87314-7|editor-last=Parker|editor-first=Gordon|editor-link=Gordon Parker (psychiatrist)|others=Eyers K (collaborator)|location=Cambridge, England|chapter=The Role of Wellbeing Plans in Managing Bipolar II Disorder|chapter-url={{GBurl|id=eNcqJpOQ6aIC|p=151}}|pages=151–165|name-list-style=vanc}}</ref>

Treatment often lasts after remission is achieved, and the treatment that worked is continued during the continuation phase (lasting anywhere from 6–12 months) and maintenance can last 1–2 years or, in some cases, indefinitely.<ref name="commentary">{{cite book|last=Benazzi|first=Franco| name-list-style = vanc |title=Bipolar II Disorder: Modelling, Measuring, and Managing|url=https://archive.org/details/bipolariidisorde00park|url-access=limited|year=2008|publisher=Cambridge University Press|location=Cambridge, England|isbn=978-0-521-87314-7|pages=[https://archive.org/details/bipolariidisorde00park/page/n246 232]–236|chapter=Management Commentary|editor-first = Gordan | editor-last = Parker }}</ref> One of the treatments of choice is lithium, which has been shown to be very beneficial in reducing the frequency and severity of depressive episodes.<ref name="George2" /> Lithium prevents mood relapse and works especially well in BP-II patients who experience rapid-cycling.<ref name="George2" /> Almost all BP-II patients who take lithium have a decrease in the amount of time they spend ill and a decrease in mood episodes.<ref name="George2" />

Along with medication, other forms of therapy have been shown to be beneficial for BP-II patients. A treatment called a "well-being plan" serves several purposes: it informs the patients, protects them from future episodes, teaches them to add value to their life, and works toward building a strong sense of self to fend off depression and reduce the desire to succumb to the seductive hypomanic highs.<ref name="Orum4" /> The plan has to aim high. Otherwise, patients will relapse into depression.<ref name="Orum4" /> A large part of this plan involves the patient being very aware of warning signs and stress triggers so that they take an active role in their recovery and prevention of relapse.<ref name="Orum4" />

===Relapse=== {{Cleanup|date=March 2026|reason=This subsection needs to be merged with the one above such that there are not two subsections about the same subtopic}} Bipolar disorder is a lifelong condition, and patients should be followed up regularly for relapse prevention.<ref name=":4" /> Although BP-II is thought to be less severe than BP-I in regard to symptom intensity, BP-II is associated with higher frequencies of rapid cycling and depressive episodes.<ref name="Baek" /> In the case of a relapse, patients may experience new onset sleep disturbance, racing thoughts and/or speech, anxiety, irritability, and increase in emotional intensity. Family and/or friends may notice that patients are arguing more frequently with them, spending more money than usual, are increasing their binging on food, drugs, or alcohol, and may suddenly start taking on many projects at once. These symptoms often occur and are considered early warning signs.<ref name="Orum4" />

Psychosocial factors in a person's life can trigger a relapse in patients with BP-II. These include stressful life events, criticism from peers or relatives, and a disrupted circadian rhythm. In addition, the addition of antidepressant medications can trigger a hypomanic episode.<ref name="Proudfoot3">{{cite journal|vauthors=Proudfoot J, Doran J, Manicavasagar V, Parker G|date=October 2011|title=The precipitants of manic/hypomanic episodes in the context of bipolar disorder: a review|journal=Journal of Affective Disorders|volume=133|issue=3|pages=381–7|doi=10.1016/j.jad.2010.10.051|pmid=21106249|doi-access=free}}</ref>

===Mortality=== Several studies have shown that the risk of suicide is slightly higher in patients who have BP-II than those with BP-I.

In results of a summary of several lifetime study experiments, it was found that 32.4% of BP-I patients experienced suicidal ideation or suicide attempts compared to 36% in BP-II patients.<ref>{{cite journal | pmc=4536929 | year=2010 | last1=Novick | first1=D. M. | last2=Swartz | first2=H. A. | last3=Frank | first3=E. | title=Suicide attempts in bipolar I and bipolar II disorder: A review and meta-analysis of the evidence | journal=Bipolar Disorders | volume=12 | issue=1 | pages=1–9 | doi=10.1111/j.1399-5618.2009.00786.x | pmid=20148862 }}</ref> Bipolar disorders, in general, are the third leading cause of death in 15- to 24-year-olds.<ref name="breakthrough">{{cite book|last=Fieve|first=Ronald R.|author-link=Ronald R. Fieve|name-list-style=vanc|title=Bipolar Breakthrough: The Essential Guide to Going Beyond Moodswings to Harness Your Highs, Escape the Cycles of Recurrent Depression, and Thrive with Bipolar II|year=2009|publisher=Rodale|location=New York|isbn=978-1-60529-645-6|pages=[https://archive.org/details/isbn_9781605296456/page/232 232]|url-access=registration|url=https://archive.org/details/isbn_9781605296456/page/232}}</ref> BP-II patients were also found to employ more lethal means and have more complete suicides overall.<ref name=George/> Approximately 15-20% of people with bipolar disorder die by suicide.<ref>{{Cite journal |last1=Gergel |first1=Tania |last2=Adiukwu |first2=Frances |last3=McInnis |first3=Melvin |date=2024-10-01 |title=Suicide and bipolar disorder: opportunities to change the agenda |url=https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(24)00172-X/abstract |journal=The Lancet Psychiatry |language=English |volume=11 |issue=10 |pages=781–784 |doi=10.1016/S2215-0366(24)00172-X |issn=2215-0366 |pmid=38885666|url-access=subscription }}</ref>

BP-II patients have several risk factors that increase their risk of suicide. The illness is very recurrent and results in severe disabilities, interpersonal relationship problems, barriers to academic, financial, and vocational goals, and a loss of social standing in their community, all of which increase the likelihood of suicide.<ref name="intervention">{{cite book|last=Manicavasagar |first=Vijaya |editor-last=Parker |editor-first=Gordon |editor-link=Gordon Parker (psychiatrist) |name-list-style=vanc |title=Bipolar II Disorder: Modelling, Measuring, and Managing|url=https://archive.org/details/bipolariidisorde00park |url-access=limited |year=2008|publisher=Cambridge University Press|location=Cambridge, England|isbn=978-0-521-87314-7|pages=[https://archive.org/details/bipolariidisorde00park/page/n165 151]–176|chapter=The role of psychological interventions in managing Bipolar II Disorder}}</ref> Mixed symptoms and rapid-cycling, both very common in BP-II, are also associated with an increased risk of suicide.<ref name=George/> The tendency for BP-II to be misdiagnosed and treated ineffectively, or not at all in some cases, leads to an increased risk.<ref name="bipolar">{{cite journal | vauthors = MacQueen GM, Young LT | title = Bipolar II disorder: symptoms, course, and response to treatment | journal = Psychiatric Services | volume = 52 | issue = 3 | pages = 358–61 | date = March 2001 | pmid = 11239105 | doi = 10.1176/appi.ps.52.3.358 }}</ref>

As a result of the high suicide risk for this group, reducing the risk and preventing attempts remains a main part of the treatment; a combination of self-monitoring, close supervision by a therapist, and faithful adherence to their medication regimen will help to reduce the risk and prevent the likelihood of suicide.<ref name=intervention/>

Suicide is a common cause of death for many patients with severe psychiatric illness. The mood disorders (depression and bipolar) are by far the most common psychiatric conditions associated with suicide. At least 25% to 50% of patients with bipolar disorder also attempt suicide at least once. Aside from lithium—which is the most demonstrably effective treatment against suicide—little is known about contributions of specific mood-altering treatments to minimizing mortality rates in persons with either major mood disorders or bipolar depression specifically. Suicide is usually a manifestation of severe psychiatric distress that is often associated with a diagnosable and treatable form of depression or other mental illness. In a clinical setting, an assessment of suicidal risk must precede any attempt to treat psychiatric illness.<ref>{{cite journal | vauthors = Jamison KR | title = Suicide and bipolar disorder | journal = The Journal of Clinical Psychiatry | volume = 61 |issue=Suppl 9 | pages = 47–51 | date = 2000 | pmid = 10826661 }}</ref>

== Epidemiology == The global estimated lifetime prevalence of bipolar disorder among adults range from 1 to 3 percent.<ref>{{Cite journal|last1=Pedersen|first1=Carsten Bøcker|last2=Mors|first2=Ole|last3=Bertelsen|first3=Aksel|last4=Waltoft|first4=Berit Lindum|last5=Agerbo|first5=Esben|last6=McGrath|first6=John J.|last7=Mortensen|first7=Preben Bo|last8=Eaton|first8=William W.|date=May 2014|title=A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders |journal=JAMA Psychiatry|volume=71|issue=5|pages=573–581|doi=10.1001/jamapsychiatry.2014.16|issn=2168-6238|pmid=24806211|doi-access=free}}</ref> The annual incidence is estimated to vary from 0.3 to 1.2 percent worldwide.<ref name=":03" /> According to the World Mental Health Survey Initiative, the lifetime prevalence of BP-II was found to be 0.4%, with a 12-month prevalence of 0.3%.<ref name=":3">{{Cite journal|last1=Merikangas|first1=Kathleen R.|author-link1=Kathleen Merikangas|last2=Jin|first2=Robert|last3=He|first3=Jian-Ping|last4=Kessler|first4=Ronald C.|author-link4=Ronald C. Kessler|last5=Lee|first5=Sing|last6=Sampson|first6=Nancy A.|last7=Viana|first7=Maria Carmen|last8=Andrade|first8=Laura Helena|last9=Hu|first9=Chiyi|last10=Karam|first10=Elie G.|last11=Ladea|first11=Maria|date=March 2011|title=Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative|journal=Archives of General Psychiatry|volume=68|issue=3|pages=241–251|doi=10.1001/archgenpsychiatry.2011.12|issn=1538-3636|pmc=3486639|pmid=21383262}}</ref> Other meta-analyses have found lifetime prevalence of BP-II up to 1.57%.<ref>{{Cite journal|last1=Clemente|first1=Adauto S.|last2=Diniz|first2=Breno S.|last3=Nicolato|first3=Rodrigo|last4=Kapczinski|first4=Flavio P.|last5=Soares|first5=Jair C.|last6=Firmo|first6=Josélia O.|last7=Castro-Costa|first7=Érico|date=April 2015|title=Bipolar disorder prevalence: a systematic review and meta-analysis of the literature|journal=Revista Brasileira de Psiquiatria (Sao Paulo, Brazil: 1999)|volume=37|issue=2|pages=155–161|doi=10.1590/1516-4446-2012-1693|issn=1809-452X|pmid=25946396|doi-access=free}}</ref> In the United States, the estimated lifetime prevalence of BP-II was found to be 1.1%, with a 12-month prevalence of 0.8%.<ref name=":3"/> The mean age of onset for BP-II was 20 years. Thus far, there have been no studies that have conclusively demonstrated that an unequal distribution of bipolar disorders across sex and ethnicity exists.<ref>{{Cite journal|last1=Rowland|first1=Tobias A.|last2=Marwaha|first2=Steven|date=September 2018|title=Epidemiology and risk factors for bipolar disorder|journal=Therapeutic Advances in Psychopharmacology|volume=8|issue=9|pages=251–269|doi=10.1177/2045125318769235|issn=2045-1253|pmc=6116765|pmid=30181867}}</ref>

A vast majority of studies and meta-analysis do not differentiate between BP-I and BP-II, and current epidemiology data may not accurately describe true prevalence and incidence.<ref>{{Cite journal|last1=Rowland|first1=Tobias A.|last2=Marwaha|first2=Steven|date=26 April 2018|title=Epidemiology and risk factors for bipolar disorder|journal=Therapeutic Advances in Psychopharmacology|volume=8|issue=9|pages=251–269|doi=10.1177/2045125318769235|issn=2045-1253|pmc=6116765|pmid=30181867}}</ref> In addition, BP-II is underdiagnosed in practice, and it is easy to miss milder forms of the condition.<ref name=":3"/> The prevalence of the larger category of bipolar spectrum disorder has been estimated to be as much as 6% of the population.<ref>{{Cite journal |last1=Merikangas |first1=Kathleen R. |last2=Akiskal |first2=Hagop S. |last3=Angst |first3=Jules |last4=Greenberg |first4=Paul E. |last5=Robert M. A. Hirschfeld |last6=Petukhova |first6=Maria |last7=Kessler |first7=Ronald C. |date=2007-05-01 |title=Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication |journal=Archives of General Psychiatry |language=en |volume=64 |issue=5 |pages=543–552 |doi=10.1001/archpsyc.64.5.543 |pmid=17485606 |pmc=1931566 |issn=0003-990X }}</ref><ref>{{Cite journal |last1=Angst |first1=Jules |last2=Gamma |first2=Alex |last3=Benazzi |first3=Franco |last4=Ajdacic |first4=Vladeta |last5=Eich |first5=Dominique |last6=Rössler |first6=Wulf |date=Jan 2003 |title=Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania |journal=Journal of Affective Disorders |volume=73 |issue=1–2 |pages=133–146 |doi=10.1016/s0165-0327(02)00322-1 |issn=0165-0327 |pmid=12507746}}</ref><ref>{{Cite journal |last1=Judd |first1=Lewis L. |last2=Akiskal |first2=Hagop S. |date=Jan 2003 |title=The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases |journal=Journal of Affective Disorders |volume=73 |issue=1–2 |pages=123–131 |doi=10.1016/s0165-0327(02)00332-4 |issn=0165-0327 |pmid=12507745}}</ref>

===Comorbid conditions=== Comorbid conditions are extremely common in individuals with BP-II. In fact, individuals are twice as likely to present a comorbid disorder than not.<ref name="Dodd2" /> These include anxiety, autism, eating, personality (cluster B), and substance use disorders.<ref name="Dodd2" /><ref name="Mak2" /> For BP-II, the most conservative estimate of lifetime prevalence of alcohol or other substance use disorders is 20%. In patients with comorbid substance use disorder and BP-II, episodes have a longer duration and treatment compliance decreases. Preliminary studies suggest that comorbid substance use is also linked to increased risk of suicidality.<ref name="Cerullo">{{cite journal | vauthors = Cerullo MA, Strakowski SM | title = The prevalence and significance of substance use disorders in bipolar type I and II disorder | journal = Substance Abuse Treatment, Prevention, and Policy | volume = 2 | article-number = 29 | date = October 2007 | pmid = 17908301 | pmc = 2094705 | doi = 10.1186/1747-597X-2-29 | doi-access = free }}</ref>

== History == {{Main|History of bipolar disorder}}

In 19th century psychiatry, mania covered a broad range of intensity, and hypomania was equated by some to concepts of 'partial insanity' or monomania. A more specific usage was advanced by the German neuro-psychiatrist Emanuel Ernst Mendel in 1881, who wrote "I recommend (taking under consideration the word used by Hippocrates) to name those types of mania that show a less severe phenomenological picture, 'hypomania'".<ref>{{cite book | first = Edward | last = Shorter | name-list-style = vanc | title=A historical dictionary of psychiatry |publisher=Oxford University Press |isbn=978-0-19-803923-5 | url = https://books.google.com/books?id=M49pEDoEpl0C&pg=PA133 | page = 132 | date = 2005-02-17 }}</ref>

The first diagnostic distinction to be made between manic-depression involving mania and involving hypomania came from Carl Gustav Jung in 1903.<ref name="Thompson">{{cite book | last=Thompson | first=JR | title=A Jungian Approach to Bipolar Disorder: Rejoining The Split Archetype | publisher=Soul Books | year=2012 | url=https://books.google.com/books?id=m7o0DwAAQBAJ | access-date=16 February 2022 | page=}}</ref><ref name = "Jung_1903">{{cite book | vauthors = Jung CG | year = 1903 | chapter = On manic mood disorder | pages = 109–111 | title = Psychiatric Studies | volume = 1 Collected works | edition = second | others = translated by R.F.C Hull. Routledge and Kegan Paul (1970) }}</ref> In his paper, Jung introduced the non-psychotic version of the illness with the statement, "I would like to publish a number of cases whose peculiarity consists in chronic hypomanic behavior" where "it is not a question of real mania at all but of a hypomanic state which cannot be regarded as psychotic."<ref name="Thompson" /><ref name = "Jung_1903" /> Jung illustrated the hypomanic variation with five case histories, each involving hypomanic behavior, occasional bouts of depression, and mixed mood states, which involved personal and interpersonal upheaval for each patient.<ref name="Thompson" />

Narrower operational definitions of hypomania were developed from the 1960s/1970s. In 1975, Jung's original distinction between mania and hypomania gained support. Fieve and Dunner published an article recognizing that only individuals in a manic state require hospitalization. It was proposed that the presentation of either the one state or the other differentiates two distinct diseases; the proposition was initially met with skepticism. However, studies since confirm that BP-II is a phenomenologically distinct disorder.<ref name="Mak2"/>

Empirical evidence, combined with treatment considerations, led the DSM-IV Mood Disorders Work Group to add BP-II as its own entity in the 1994 publication. Only one other mood disorder was added to this edition, indicating the conservative nature of the DSM-IV work group.

In May 2013, the DSM-5 was released. Two revisions to the existing BP-II criteria were anticipated. The first expected change was to reduce the required duration of a hypomanic state from four to two days. The second change allowed for hypomania to be diagnosed without the manifestation of elevated mood; that is, increased energy/activity will be sufficient. The rationale behind the latter revision is that some individuals with BP-II manifest only visible changes in energy. Without presenting elevated mood, these individuals are commonly misdiagnosed with major depressive disorder. Consequently, they receive prescriptions for antidepressants, which unaccompanied by mood stabilizers, may induce rapid cycling or mixed states.<ref name="Frances">{{cite journal | vauthors = Frances A, Jones KD | title = Bipolar disorder type II revisited | journal = Bipolar Disorders | volume = 14 | issue = 5 | pages = 474–7 | date = August 2012 | pmid = 22834459 | doi = 10.1111/j.1399-5618.2012.01038.x }}</ref>

==Society and culture== {{Main|List of people with bipolar disorder}} * John Adams, president of the United States{{cn|date=May 2026}} * Heath Black revealed in his autobiography, ''Black'', that he has been diagnosed with BP-II.<ref>{{cite news|title=Hell and Black|date=6 April 2012|first=Rohan |last=Connolly | name-list-style = vanc |url=http://www.theage.com.au/afl/afl-news/hell-and-black-20120405-1wfrg.html | work = The Age }}</ref> * Maria Bamford has been diagnosed with BP-II.<ref>{{cite web |url=http://www.sltrib.com/sltrib/entertainment/52050618-81/maria-utah-bamford-comic.html.csp |title=Comic Maria Bamford will cross personal boundaries at Utah show| first = David | last = Burger |work=The Salt Lake Tribune |date=June 22, 2011 |quote=I was re-diagnosed (after a three-day stay at the hospital) as Bipolar II}}</ref> * Geoff Bullock, singer-songwriter, was diagnosed with BP-II.<ref name="Allen">{{cite web | url = http://www.christianfaith.com/resources/geoff-bullock-opens-up | title = Geoff Bullock Opens Up | last = Allen | first = Terry | name-list-style = vanc | website = ChristianFaith.com | date = 29 September 2010 | access-date = 23 October 2014 | archive-date = 23 October 2014 | archive-url = https://web.archive.org/web/20141023175500/http://www.christianfaith.com/resources/geoff-bullock-opens-up }}</ref> * Mariah Carey was diagnosed with BP-II in 2001. In 2018, publicly revealed and actively seeking treatment in the form of therapy and medication.<ref>{{Cite news|url=http://people.com/music/mariah-carey-bipolar-disorder-diagnosis-exclusive/|last=Cagle |first=Jess|title=Mariah Carey: My Battle with Bipolar Disorder|work=People|access-date=2018-04-11|language=en}}</ref> *Charmaine Dragun, former Australian journalist/newsreader. Inquest concluded she had BP-II.<ref name=inquest>{{cite news |last=Bennett |first=Jennifer |url=http://wentworth-courier.whereilive.com.au/news/story/gap-suicide-preventable/| title=Gap suicide 'preventable' |date=2010-10-20 |access-date=2010-10-25 |work=Wentworth Courier|archive-url=https://web.archive.org/web/20101029032229/http://wentworth-courier.whereilive.com.au/news/story/gap-suicide-preventable/|archive-date=2010-10-29}}</ref> * Joe Gilgun has been diagnosed with BP-II.<ref>{{cite web|title=You Wouldn't Believe Joe Gilgun's Life Story – So He Spun It into TV|last=Ewens|first=Hannah| name-list-style = vanc |date=29 August 2019|work=Vice| url=https://www.vice.com/en/article/joe-gilgun-interview-2019-brassic-preacher-pride-lancashire/}}</ref> * Shane Hmiel has been diagnosed with BP-II.<ref name=RaceHub-Shane-Part1>{{cite web|title=Shane Hmiel's Story on NASCAR Race-Hub Part 1|url=https://www.youtube.com/watch?v=1ISYqCtBsaM |archive-url=https://ghostarchive.org/varchive/youtube/20211212/1ISYqCtBsaM| archive-date=2021-12-12 |url-status=live|website=YouTube.com|publisher=Fox Sports, SPEED, NASCAR Race Hub|access-date=4 October 2014|date=July 21, 2011}}{{cbignore}}</ref> * Jesse Jackson Jr. has been diagnosed with BP-II.<ref>{{cite news|title=Rep. Jackson Jr. treated for bipolar disorder| newspaper= USA Today |date= August 13, 2012| url = http://content.usatoday.com/communities/onpolitics/post/2012/08/jesse-jackson-jr-bipolar-disorder-/1|access-date=August 13, 2012}}</ref> *Thomas Eagleton received a diagnosis of BP-II from Dr. Frederick K. Goodwin.<ref>{{cite web|url=https://www.nytimes.com/2012/07/24/us/politics/eagleton-pick-in-1972-colors-todays-vice-president-hunt.html|title=Hasty and Ruinous 1972 Pick Colors Today's Hunt for a No. 2|last=Altman|first=Lawrence K.| name-list-style = vanc |date=July 23, 2012|access-date=June 24, 2017|work=The New York Times}}</ref> * Carrie Fisher had been diagnosed with BP-II.<ref>{{cite news| url=http://usatoday30.usatoday.com/news/health/spotlight/2002/05/29-fisher.htm | work=USA Today | title=Carie Fisher 'Strikes Back' at Mental Illness |last1=Slaughter|first1=Adele | date=30 May 2002}}</ref> * Demi Lovato has been diagnosed with BP-II.<ref>{{cite web|title=Demi Lovato: I Have Bipolar Disorder|last=Cotliar|first=Sharon| name-list-style = vanc |date=20 April 2011|work=People| url=https://people.com/celebrity/demi-lovato-has-bipolar-disorder/}}</ref><ref>{{cite web|title=Demi Lovato Has Bipolar Disorder|work=MTV News|first=Jocelyn| last=Vena | name-list-style = vanc |date=20 April 2011| url=http://www.mtv.com/news/articles/1662394/demi-lovato-bipolar-disorder.jhtml| archive-url=https://web.archive.org/web/20110424050535/http://www.mtv.com/news/articles/1662394/demi-lovato-bipolar-disorder.jhtml| archive-date=April 24, 2011}}</ref> *Evan Perry, subject of the documentary ''Boy Interrupted'', was diagnosed with BP-II.<ref>{{cite video|title=Boy Interrupted|year=2009|medium=DVD|publisher=HBO Films}}</ref> *Richard Rossi, filmmaker, musician, and maverick minister was diagnosed with BP-II.<ref>{{cite interview |title=The Lynn Cullen Show |date= June 5, 2008 |quote=my father was bi-polar one, and I'm bi-polar two.|first= Richard |last=Rossi | name-list-style = vanc | interviewer= Lynn Cullen}}</ref> *Rumer has been diagnosed with BP-II.<ref>{{cite magazine|title=U.K. Singer-Songwriter Rumer on Battling Depression & Bipolar 2 to Create 'Into Colour'|last=Graff|first=Gary|date=23 January 2015|magazine=Billboard| url=https://www.billboard.com/articles/6450760/rumer-battling-depression-create-into-colour}}</ref> *Catherine Zeta-Jones received treatment for BP-II after dealing with the stress of her husband's throat cancer. According to her publicist, Zeta-Jones made a decision to check into a mental health facility for a brief stay.<ref>{{cite news| url=https://www.bbc.co.uk/news/uk-wales-13073676 | work=BBC News | title=Catherine Zeta-Jones treated for bipolar disorder | date=14 April 2011}}</ref> *Chappell Roan has been diagnosed with BP-II.<ref>{{Cite news |date=2023-10-14 |title=Chappell Roan doesn't care if she's going to hell |url=https://www.washingtonpost.com/entertainment/music/2023/10/14/chappell-roan-queer-pop/ |access-date=2025-09-15 |newspaper=The Washington Post |language=en-US |issn=0190-8286}}</ref>

== See also == {{Portal|Psychiatry|Psychology|Medicine}} <!-- Please keep entries in alphabetical order & add a short description WP:SEEALSO --> {{div col}} * United States President John Adams had bipolar disorder * Outline of bipolar disorder * Bipolar disorder * Bipolar I disorder * Bipolar NOS * Cyclothymia * Detailed listing of DSM-IV-TR bipolar disorder diagnostics codes * International Society for Bipolar Disorders * Emotional dysregulation {{div col end}} <!-- please keep entries in alphabetical order -->

== References == {{Reflist}}

{{Medical resources | DiseasesDB = | ICD11 = {{ICD11|6A61}} | ICD10 = {{ICD10|F|31|8|f|30}} | ICD9 = | OMIM = | MedlinePlus = | ICDO = | eMedicineSubj = | eMedicineTopic = | MeshID = }}

{{authority control}} {{Bipolar disorder}}{{Mental disorders}}

Category:Bipolar spectrum Category:Depression (mood) Category:Mood disorders