Bipolar II Disorder: Causes, Symptoms and Treatment

Bipolar II Disorder, a fascinating and complex facet of the broad spectrum of human emotional experience, is a mental health condition characterized by recurrent episodes of depression punctuated by periods of elevated mood or energy known as hypomania. It is distinct from its relative, Bipolar I Disorder, by the absence of full-blown manic episodes, which are marked by extreme and often disruptive elevations in mood and energy.

Its unique presentation encapsulates the paradox of human emotion – the capacity to oscillate between periods of intense energy, creativity, and productivity, and the depths of despair, lethargy, and incapacitation.  The interplay between these poles makes Bipolar II Disorder a compelling area of study and therapeutic intervention. With ongoing research efforts and novel treatment modalities on the horizon, the landscape of Bipolar II Disorder continues to evolve, offering insights into the complexity of mood disorders and a testament to human resilience.

Causes of Bipolar II Disorder

Bipolar II Disorder is a complex psychiatric disorder whose etiology is still not fully understood. However, current scientific literature suggests that it results from an intricate interplay of genetic, neurobiological and environmental factors.

Genetic factors: Family and twin studies have consistently identified a significant genetic component to Bipolar II Disorder. Relatives of individuals with Bipolar II Disorder are at an elevated risk of developing the disorder, indicating a hereditary predisposition. Several specific genes, including ANK3 and CACNA1C, have been implicated in the disorder, but none have been definitively proven as causative. It is more likely that multiple genes, each contributing a small effect, combine to create a significant risk for the development of the disorder.

Neurobiological factors: Dysregulation in various neurochemical systems is believed to play a role in the pathophysiology of Bipolar II Disorder. Key among these is the dysregulation of the monoaminergic system, involving neurotransmitters like dopamine, norepinephrine, and serotonin. Neuroimaging studies have also implicated structural and functional brain abnormalities, particularly in areas associated with mood regulation, such as the prefrontal cortex and the limbic system. Altered circadian rhythms may also play a role, as evidenced by the significant sleep disturbances seen in individuals with the disorder.

Environmental factors: The role of environmental factors in the onset and course of Bipolar II Disorder has been increasingly recognized. Stressful life events can trigger episodes of hypomania or depression in susceptible individuals. Other factors that have been associated with the onset of bipolar symptoms include substance abuse, irregular sleep-wake cycles and certain medical conditions.

Epigenetic factors: Epigenetics, the study of changes in gene expression or cellular phenotype caused by mechanisms other than changes in the underlying DNA sequence, has also been implicated in Bipolar II Disorder. Epigenetic modifications,  such as DNA methylation and histone modification, can alter gene expression in response to environmental stimuli. This means that even if an individual has a genetic predisposition to Bipolar II Disorder, certain environmental factors can switch these genes on or off, affecting the likelihood of developing the disorder.

Symptoms of Bipolar II Disorder

Bipolar II Disorder marked by periods of mood swings. These phases include depressive episodes, and hypomanic episodes – a less severe form of mania. It is vital to note that Bipolar II Disorder differs from Bipolar I Disorder in that the individual does not experience full-blown manic episodes.

1. Depressive episode symptoms

Depressive episodes in Bipolar II Disorder can be characterized by the following symptoms, which must be present nearly every day for at least two weeks for a diagnosis:

1. Depressed mood: The individual might feel sad, empty, hopeless, or tearful. In children and adolescents, the mood can be persistently irritable rather than depressed.
2. Diminished interest or pleasure: There may be noticeably less interest or pleasure in all, or almost all, activities.
3. Significant weight changes or appetite disturbance: The individual might experience considerable weight loss when not dieting, weight gain, or decrease or increase in appetite.
4. Sleep disturbances: Insomnia or hypersomnia could occur almost every day.
5. Psychomotor agitation or retardation: The person might display restlessness or slowed behavior.
6. Fatigue or loss of energy: Persistent fatigue or loss of energy could be present.
7. Feelings of worthlessness or excessive guilt: The individual may experience feelings of worthlessness or disproportionately large guilt.
8. Diminished ability to concentrate or indecisiveness: The person could have a reduced ability to think, concentrate, or indecisiveness.
9. Recurrent thoughts of death: The individual might have recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

2. Hypomanic episode symptoms

Hypomanic episodes in Bipolar II Disorder can be identified by the following symptoms:

1. Elevated, expansive, or irritable mood: The individual might experience a persistently elevated, expansive, or irritable mood, lasting at least four consecutive days.
2. Increased goal-directed activity or energy: The person might exhibit increased goal-directed activity or energy.
3. Increased talkativeness: There could be a pressure to keep talking.
4. Flight of ideas or racing thoughts: The individual may experience racing thoughts or ideas that move quickly from one to another.
5. Decreased need for sleep: There might be a reduced need for sleep, such as feeling rested after only a few hours of sleep.
6. Distractibility: The individual could be easily distracted by unimportant or irrelevant external stimuli.
7. Excessive involvement in activities with a high potential for painful consequences: The individual might get involved in activities that could have serious repercussions, like engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments.

These symptoms must not be severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization and there must be an absence of psychotic features.

Given the severe impact these symptoms can have on an individual’s life,  it is critical to seek professional mental health services if one suspects they or a loved one may be suffering from Bipolar II Disorder. Early detection and appropriate intervention can significantly improve the long-term prognosis of this disorder.

How to diagnose Bipolar II Disorder

Diagnosing Bipolar II Disorder requires a comprehensive clinical assessment carried out by a qualified mental health professional, often a psychiatrist. The process involves several steps that help to discern the nature and pattern of mood episodes, and to rule out other potential causes of the symptoms.

Clinical interview: The process begins with a thorough clinical interview, where the professional gathers detailed information about the individual’s current symptoms, personal and family psychiatric history, and overall health status. During this interview, the clinician would be particularly interested in discerning any patterns of mood and energy fluctuations and episodes of depression and hypomania.

Diagnostic criteria: The diagnosis of Bipolar II Disorder relies heavily on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), published by the American Psychiatric Association. To meet the DSM-5 criteria for Bipolar II Disorder, a person must have experienced one or more episodes of major depression and at least one hypomanic episode.

• Depressive episode criteria: To be diagnosed with a depressive episode, a person must experience five or more of the following symptoms nearly every day for at least two weeks: depressed mood, diminished interest or pleasure, significant weight loss or gain or changes in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate or indecisiveness, and recurrent thoughts of death or suicidal ideation.
• Hypomanic episode criteria: For a hypomanic episode, the individual must have experienced a period of elevated, expansive, or irritable mood and increased activity or energy for at least four days, and also present three or more of the following symptoms: inflated self-esteem or grandiosity, decreased need for sleep, increased talkativeness, flight of ideas or subjective experience that thoughts are racing, distractibility, increased goal-directed activity or psychomotor agitation, and excessive involvement in activities that have a high potential for painful consequences.

Medical evaluation: The professional will also conduct a medical evaluation to rule out other potential causes of the symptoms. This may include laboratory tests to exclude conditions such as thyroid disease or substance-induced mood disorder. The clinician may also consider the possibility of medication-induced mood symptoms.

Psychosocial evaluation: A psychosocial evaluation may be conducted to understand the individual’s coping strategies, social supports, and the impact of symptoms on their daily life and relationships.

Use of assessment scales: The professional might use validated assessment scales such as the Mood Disorder Questionnaire (MDQ) or the Hypomania Checklist (HCL-32) as supplementary tools to aid in the diagnosis.

Gathering information from close contacts: With the individual’s permission, gathering information from close family members or friends can provide additional insight into the person’s behavior patterns.

Diagnosing Bipolar II Disorder can be challenging due to its overlapping symptoms with other mood disorders, and its episodic nature, which can lead to under-reporting of hypomanic episodes.  It requires a skilled clinician to tease apart the subtleties in symptom presentation and reach an accurate diagnosis.

How to treat Bipolar II Disorder

Bipolar II Disorder, like other forms of bipolar disorder, is a lifelong condition that requires long-term management. Treatment is typically multi-faceted, combining medication, psychotherapy, lifestyle adjustments, and sometimes complementary therapies.  The primary goals are to stabilize mood, reduce the frequency and severity of episodes, and help the individual to function well in daily life.

1. Pharmacotherapy

Medications are often a crucial part of treatment for Bipolar II Disorder. The most commonly prescribed include:

• Mood stabilizers, such as lithium or valproate, can help to control or prevent episodes of hypomania and depression.
• Atypical antipsychotics, such as quetiapine, lurasidone, or olanzapine, are often effective in treating both poles of the disorder.
• Antidepressants are used with caution due to the risk of inducing a switch to hypomania or rapid cycling. If used, they are typically combined with a mood stabilizer or atypical antipsychotic.
• Antidepressant-antipsychotic is a drug that combines the antidepressant fluoxetine and the antipsychotic olanzapine. It’s intended to treat depressive episodes related to Bipolar I Disorder.

The choice of medication, or combination of medications, is individualized based on the person’s symptom profile, presence of co-occurring disorders and tolerability.

2. Psychotherapy

Psychotherapy, or talk therapy, is another essential component of treatment for Bipolar II Disorder. The most effective types include:

• Cognitive-behavioral therapy (CBT) focuses on identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It also helps to identify what triggers bipolar episodes.
• Interpersonal and social rhythm therapy (IPSRT) helps individuals improve their relationships and manage their daily routines, thereby stabilizing their moods.
• Family-focused therapy involves family members and aims to enhance family coping strategies, communication and problem-solving.

3. Lifestyle management

A regular routine and healthy lifestyle can help to manage bipolar symptoms and prevent relapse. This includes maintaining a regular sleep schedule, eating a balanced diet, getting regular physical activity, and avoiding alcohol, caffeine and illicit substances.

4. Psychoeducation

Educating individuals and their families about Bipolar II Disorder is crucial. Understanding the nature of the disorder, recognizing early warning signs of an episode, and knowing how to manage symptoms can significantly improve the course of the disorder.

5. Complementary Therapies

Certain complementary therapies may be beneficial when used alongside conventional treatments. These can include mindfulness, meditation, yoga, and other relaxation techniques. However, their use should always be discussed with a healthcare provider.

Finally, LotusBuddhas please note that treatment for Bipolar II Disorder is usually a long-term commitment, and it may take time to find the best treatment plan for each individual. Regular follow-ups and adjustments may be necessary. We have to work closely with a healthcare provider and communicate openly about side effects, concerns, and preferences to ensure the most effective treatment plan.

Can children have Bipolar II Disorder?

Children can develop Bipolar II Disorder, although it is more commonly diagnosed in adolescence or adulthood. The American Academy of Child and Adolescent Psychiatry recognizes that bipolar disorder, including Bipolar II, can occur in children,  although the diagnosis in this population can be complex and requires careful consideration.

Bipolar disorder in children, often referred to as early-onset bipolar disorder, might manifest differently than it does in adults. In contrast to distinct periods of depression and hypomania typical in adults, children and adolescents might exhibit rapid mood swings, high levels of irritability, and disruptive behavior that can occur more frequently within a single day. They may also exhibit symptoms of other psychiatric conditions such as attention-deficit/hyperactivity disorder (ADHD) or conduct disorder, which can complicate the diagnostic process.

Making a diagnosis of Bipolar II Disorder in children involves a thorough evaluation, including a detailed psychiatric history, observation of the child’s behavior, and gathering information from parents and teachers or other key individuals in the child’s life. The child’s symptoms must meet the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), including the presence of one or more depressive episodes and at least one hypomanic episode.

The treatment of Bipolar II Disorder in children typically involves a combination of pharmacotherapy and psychotherapy, tailored to the child’s age, symptom severity, and overall functioning. It’s critical that treatment be initiated promptly to minimize the disorder’s impact on the child’s development and quality of life.

Because of the potential for misdiagnosis and the serious implications of a bipolar disorder diagnosis in children, it is crucial that such a diagnosis be made by a qualified child and adolescent psychiatrist.  Close monitoring and regular follow-up are essential to ensure the best possible outcome for the child. It’s also important to note that research into early-onset bipolar disorder is ongoing, and our understanding of the disorder’s presentation and treatment in children continues to evolve.