APA refers bipolar II disorder, as a disorder in which the individual fluctuates between major depressive and hypomanic episodes; and cyclothymic disorder. The former official name for bipolar disorders, manic-depressive illness, is still in frequent use. Bipolar II disorder, in which major depressive episodes alternate with hypomanic episodes rather than full manic episodes.
However, in bipolar II disorder, the “up” moods never reach full-blown mania. The less-intense elevated moods in bipolar II disorder are also called hypomanic episodes, or hypomania.
A person affected by bipolar II disorder has had at least one hypomanic episode in their life. Most people with bipolar II disorder suffer more often from episodes of depression. This is where the term “manic depression” comes from.
Diagnostic Criteria for Bipolar II Disorder.
A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode. Criteria for a hypomanic episode are identical to those for a manic episode with the following distinctions:
- Minimum duration is 4 days;
- Although the episode represents a definite change in functioning, it is not severe enough to cause marked social or occupational impairment or hospitalization;
- There are no psychotic features.
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and also other psychotic disorder.
D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Specify current or most recent episode:
- Hypomanic: If currently (or most recently) in a hypomanic episode
- Depressed: If currently (or most recently) in a major depressive episode
- Specify if:
With anxious distress
With mixed features
With rapid cycling
With mood-congruent psychotic features
With mood-incongruent psychotic features
With peripartum onset
With seasonal pattern
- Specify course if full criteria for a mood episode are not currently met: In full remission, in partial remission
- Specify severity if full criteria for a mood episode are currently met: Mild, moderate, severe.
During a hypomanic episode, elevated mood can manifest itself as either euphoria (feeling “high”) or as irritability.
Symptoms during hypomanic episodes include:
- Flying suddenly from one idea to the next
- Having exaggerated self confidence
- Rapid, “pressured” (uninterruptible) and loud speech
- Increased energy, with hyperactivity and a decreased need for sleep
Causes of Bipolar II disorder.
The cause of bipolar II disorder is unknown, but research has shown that it can have a genetic component and run in families. Multiple factors – including stress, lack of sleep, and alcohol or substance abuse – may interact to trigger abnormal brain circuit function. Bipolar disorder often runs in families, and research suggests this is mostly explained by heredity—people with certain genes are more likely to develop bipolar disorder than others. Many genes are involved, and no one gene can cause the disorder.
Hypomania often masquerades as happiness and relentless optimism. When hypomania is not causing unhealthy behavior, it often may go unnoticed and therefore remain untreated. This is in contrast to full mania, which by definition causes problems in functioning and requires treatment with medications and possibly hospitalizations.
- Mood Stabilizers- Lithium (Eskalith, Lithobid): This simple metal in pill form is highly effective at controlling mood swings (particularly highs) in bipolar disorder. Lithium has been used for more than 60 years to treat bipolar disorder. Lithium can take weeks to work fully, making it better for long-term treatment than for acute hypomanic episodes.
- Antipsychotics- By definition, hypomanic episodes do not involve psychosis and do not interfere with functioning. Antipsychotic drugs, such as aripiprazole (Abilify), asenapine (Saphris), cariprazine (Vraylar), and ziprasidone (Geodon) and others, are nevertheless sometimes used in hypomania and some (notably, Seroquel) are used for depression in bipolar II disorder.
- Benzodiazepines- This class of drugs includes alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan) and is commonly referred to as minor tranquilizers. They are used for short-term control of acute symptoms associated with hypomania such as insomnia or agitation.