Q. I always thought I was depressed, but recently my doctor diagnosed me as Bipolar II. I understand that this is different from Bipolar I, but I still find it rather frightening. Can you tell me more about the difference between the disorders?
A. It is not unusual for a doctor to diagnose someone who is bipolar as depressed. Few people complain to their doctors when they are feeling good, so they usually only hear about the depressive complaints.
People with bipolar I experience periods of depression followed by periods of mania. During the manic phase, bipolar I patients usually have hallucinations or delusions, may become verbally or physically abusive to others, have angry outburst and even become suicidal. Whereas, the depression is more severe in those with bipolar II, most people with bipolar I also experience periods of depression, but they may be milder and less frequent.
People with bipolar II experience periods of serious depression followed by periods of hypomania. During the hypomanic phase, people may sleep less than usual, spend more money, talk fast, sleep little, have heightened sexual feelings and make grandiose plans that are unlikely to come to fruition. Those with bipolar II are more likely to experience severe episodes of major depression; however, the hypomania is less likely than the mania to interfere with daily functioning and does not involve hallucination or delusions.
Like every other mental health disorder, bipolar disorders are on a continuum. Some people may only have a less severe but more chronic condition, referred to as cyclothymic disorder. Someone who is cyclothymic alternates between episodes of hypomania and moderate depression for at least 2 years before a diagnosis can be made. The periods of depression can interfere with daily function, and if left untreated, raises the risk of the condition becoming bipolar I or II.
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The length to time between the hypomania or mania and depression varies greatly from one person to the next. Some people are in a manic or hypomanic state for several months before they gradually enter the depressive stage. However, the most common pattern is for episodes to become closer together the longer one has the condition. Four or more cycles per year are referred to as rapid cycling bipolar, and it becomes more difficult to treat.
Since you are diagnosed as bipolar II, your doctor will likely take you off your anti-depressant or reduce the dose and add a mood stabilizer. Some of the ones used most often are Lamictal, Depakote and Tegretol. Lithium still works for some people, but it has more serious side effects. It is also the only one of the drugs processed through the kidney, so patients should have their kidney function checked on a regular basis if they are prescribe Lithium.
Medication is the mainstay of treatment for any bipolar disorder. However, it is also important to see a mental health professional and to engage in self-help activities. Be certain you are exercising, getting enough sleep, eating properly, lowering stress levels whenever possible and surrounding yourself with supportive people.
I would also suggest that you check out the numerous resources online and read “An Unquiet Mind” by Kay Redfield Jamison. She has been bipolar I since childhood, and has become one of the top psychologist and authors in her field.
Nancy Ryburn holds a doctorate degree in psychology from Yeshiva University in New York City. She teaches psychology at Southeast Arkansas College and maintains a private practice. You can reach her at nancyryburn@gmail.com.