Bipolar II Disorder in Adults

A Review of Management Options

Mary Soliman, PharmD; Soheyla Mahdavian, PharmD; Marlon Honeywell, PharmD; Tiffany Welch, PA


US Pharmacist 

In This Article

Abstract and Introduction


Bipolar disorder is characterized by pathologic variations in mood, with periods of mania, hypomania, psychosis, and depression. The two most common types, bipolar I and bipolar II, differ in the presentation of mood variations. The course of bipolar II is less well studied and less understood than bipolar I disorder. Patients with bipolar I disorder have episodes of full mania alternating with episodes of major depression,[1,2] whereas patients with bipolar II disorder present with one or more episodes of major depression with at least one hypomanic episode.[1] Bipolar II can also manifest itself as a mixed state, which is the presence of both depressive and mood elevated symptoms simultaneously.[3] Patients with bipolar II disorder display fewer manic symptoms than those with bipolar I disorder; both conditions may have an equivalent impact on quality of life and may also be associated with increased suicide risk.[3] Patients may also present with rapid-cycling bipolar disorder, which consists of at least four discrete episodes of mania or depression in a single year, demarcated by clear periods of remission or by switches to episodes of opposite polarity.[4]

The criteria for mania and hypomania are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).[4]

Bipolar II disorder shares some similarities with bipolar I disorder (Figure 1). Approximately 60% to 70% of the hypomanic episodes that occur in patients with bipolar II disorder occur immediately before or after a major depressive episode, with characteristic patterns that are unique to each individual.[4] As with bipolar I disorder, the interval between episodes seems to decrease with age, though approximately 5% to 15% of patients experience rapid cycling.[4] The more episodes a patient experiences, the poorer the prognosis. Fortunately, the majority of patients return to a normal functional level between episodes, yet 15% of patients continue to experience mood lability between episodes.[4] Some evidence has shown that sleep-wake cycle disturbances can precipitate or exacerbate a hypomanic or depressive episode. If a patient experiences a manic episode, an episode of psychosis, or a mixed episode, the diagnosis changes to bipolar I disorder.

Figure 1.

Bipolar I and Bipolar II Similarities and Differences
Source: Reference 1.


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