Bipolar II: Everything You Need To Know

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Bipolar disorder affects about 5.7 million adult Americans, as reported by the National Institute of Mental Health. Within this broad category is Bipolar II disorder. Unlike Bipolar I, Bipolar II features periods of high energy or hypomanic episodes mixed with times of severe depression. 

Let’s explore Bipolar II, including how professionals diagnose it, its symptoms, treatment options, and ways to cope, to provide you with clear and helpful information that can light the way to recovery and better health.

Understanding Bipolar II Disorder

Bipolar II disorder is a mental health disorder characterized by a pattern of mood changes that include emotional highs, known as hypomanic episodes, and lows, or severe depression. Hypomanic episodes are less extreme than full-blown manic episodes. During a hypomanic episode, someone might feel more energetic, talkative, and confident. They might have many ideas and feel they can take on more than usual.

Bipolar II depressive episodes are intense and more challenging to manage than hypomanic ones. The depression phase can bring feelings of sadness, hopelessness, and a loss of interest in daily activities.

Bipolar 2 Diagnostic Criteria

Bipolar disorder has a long history of misdiagnosis, with 69 percent of patients with bipolar disorder being initially misdiagnosed, and more than one-third remained misdiagnosed for ten years or more. 

To diagnose Bipolar II Disorder accurately, mental health professionals rely on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). According to the DSM-5, for a Bipolar II diagnosis, there must be evidence of at least one hypomanic episode and one major depressive episode:

  • Hypomanic Episodes: A hypomanic episode is a distinct period of abnormally and persistently elevated mood and persistently increased activity or energy, lasting at least four consecutive days. During this period, the mood and behavior changes are noticeable to others but are not severe enough to cause significant impairment in social functioning or to necessitate hospitalization.
  • Depressive Episodes: For a Bipolar II diagnosis, there must also be a history of at least one major depressive episode lasting at least two weeks. During this episode, individuals experience a depressed mood or a significant loss of interest or pleasure in nearly all activities, which can disrupt their ability to function in social and occupational settings significantly.

Symptoms and Signs of Bipolar II

Bipolar II Disorder presents a range of symptoms that can vary significantly from person to person. Understanding these symptoms is essential for differentiating Bipolar II from Bipolar I Disorder, as the two can have distinct manifestations and implications for treatment. 

Recognizing these signs is also crucial for those seeking understanding and treatment for themselves, close friends, and loved ones who may notice the symptoms in someone they care about.

Hypomanic Episode Symptoms

During a hypomanic episode, individuals might experience a noticeable shift in their mood and behavior, including:

  • Elevated Mood: Feelings of euphoria or extreme optimism, often out of context with real-life events.
  • Increased Talkativeness: A noticeable increase in the desire to speak, often rapidly or more than usual.
  • Racing Thoughts: The experience of thoughts rapidly moving through the mind, often making it hard to focus.
  • Overactivity or Restlessness: An increase in energy leading to over-scheduling or starting numerous projects.
  • Enhanced Social Behavior: A marked increase in socializing, sexual activity, or interpersonal engagement beyond the person’s usual behavior.
  • Decreased Need for Sleep: Feeling rested after only a few hours or a reduced need for sleep without experiencing fatigue.

Depressive Episode Symptoms

The depressive phase of Bipolar II can be particularly debilitating, with symptoms that significantly impact daily functioning:

  • Persistent Sadness or Hopelessness: A profound sense of despair that doesn’t lift, often described as feeling empty.
  • Loss of Interest: A noticeable decrease in interest or pleasure in all or most daily activities, including hobbies, work, or relationships.
  • Significant Weight Changes: Unintended significant weight loss or gain or changes in appetite.
  • Sleep Disturbances: Insomnia or sleeping too much, difficulty staying asleep, or sleeping at inappropriate times.
  • Fatigue or Loss of Energy: Persistent tiredness, sluggishness, or a lack of energy to engage in even minor tasks.
  • Feelings of Worthlessness or Excessive Guilt: Harsh criticism of oneself for perceived faults or mistakes.
  • Difficulty Concentrating: Challenges in focusing, making decisions, or remembering things.
  • Thoughts of Death or Suicide: Frequent thoughts about death, dying, or suicide, which may include planning or attempting suicide.

Bipolar Disorder Symptoms in Females

Research indicates that bipolar disorder symptoms can present differently in females, including in the frequency and pattern of mood episodes. Females with Bipolar II are more likely to experience:

  • More Frequent Depressive Episodes: A higher prevalence of depressive episodes compared to their male counterparts.
  • Rapid Cycling: The occurrence of four or more mood episodes within a year, which is seen more commonly in females.
  • Thyroid Function Impact: A potential link between thyroid function and bipolar symptoms, with hypothyroidism being more common among females with bipolar disorder.
  • Comorbid Conditions: An increased likelihood of co-occurring disorders such as thyroid disease, migraines, and anxiety disorders.

Bipolar 2 Treatment Options

Effective management of Bipolar II Disorder involves a comprehensive treatment plan tailored to the individual’s symptoms and needs. While there is no cure for Bipolar II, a combination of therapies can significantly reduce the severity of symptoms and improve quality of life. Treatment typically includes medication, psychotherapy, and lifestyle adjustments.


Medications are a cornerstone of Bipolar II treatment, aiming to stabilize mood and reduce the frequency and severity of hypomanic and depressive episodes.  

  • Mood Stabilizers: Lithium is often the first line of treatment for reducing mood swings. Other mood stabilizers include valproate (Depakote), lamotrigine (Lamictal), and carbamazepine (Tegretol).
  • Antidepressants: Used cautiously and typically in combination with a mood stabilizer to prevent a switch to hypomania or rapid cycling. The choice of antidepressants depends on the individual’s specific symptoms and history.
  • Antipsychotic Medications: In some cases, antipsychotic medications may be recommended, especially if symptoms are severe or other medications have not been effective.


Psychotherapy, or “talk therapy,” is another essential component of treatment, offering strategies to manage symptoms, cope with stress, and improve relationships. Types of psychotherapy shown to be effective in treating Bipolar II include:

  • Cognitive Behavioral Therapy (CBT): Helps individuals identify and change negative thought patterns and behaviors associated with mood swings.
  • Interpersonal and Social Rhythm Therapy (IPSRT): This therapy focuses on stabilizing daily rhythms such as sleeping, eating, and activity schedules, which can help manage mood swings.
  • Family-Focused Therapy: Involves family members in treatment, educating them about the disorder and teaching strategies to improve communication and support.

Lifestyle Adjustments and Support

Lifestyle changes and support networks play a critical role in managing Bipolar II Disorder. These can include:

  • Regular Exercise: Physical activity can help reduce depressive symptoms and improve overall mood.
  • Sleep Hygiene: Maintaining a regular sleep schedule is crucial for stabilizing mood.
  • Stress Reduction Techniques: Practices such as mindfulness, meditation, and yoga can help manage stress and reduce mood swings.
  • Support Groups: Joining a support group can provide a sense of community and shared experience, offering practical advice and emotional support from others who understand what it’s like to live with Bipolar II.

Living with Bipolar II

Individuals living with Bipolar II must navigate the complexities of mood swings while striving to maintain stability in their personal, professional, and social lives. Understanding and acceptance play critical roles in managing the disorder effectively.

Recognizing Personal Triggers

One of the keys to managing Bipolar II is identifying personal triggers that may precipitate mood episodes. Triggers can vary widely among individuals but often include stress, sleep disruptions, significant life changes, and substance use. By recognizing these triggers, individuals can develop strategies to mitigate their impact or avoid them altogether.

Maintaining a Healthy Routine

Regular sleep patterns, healthy eating habits, and consistent exercise can help stabilize mood swings and contribute to overall well-being. Structuring the day and setting realistic goals can also provide a sense of control and accomplishment.

Building a Support System

Family, friends, healthcare providers, and support groups can offer invaluable emotional support, understanding, and practical help. Open communication with loved ones about the disorder, its symptoms, and how they can offer support is essential for building a network of allies.

Navigating Professional Life

Bipolar II can impact one’s professional life, making it necessary to adopt strategies for success in the workplace. Strategies include seeking accommodations to create a more flexible work environment, setting boundaries to manage stress, and utilizing time management techniques to ensure productivity during both hypomanic and depressive phases.

Embracing Self-Compassion and Patience

Recognizing that mood episodes are not a sign of personal failure but rather part of the disorder can foster a more forgiving attitude towards oneself. Patience during treatment—acknowledging that finding the right combination of therapies can take time—is equally important.

Continual Learning and Adaptation

Living with Bipolar II is an ongoing journey of learning and adaptation. Staying informed about the disorder, being proactive in treatment, and adapting coping strategies over time can help individuals lead fulfilling lives.

Coping Strategies and Support

Here are some key strategies and forms of support that can facilitate a better quality of life for those with Bipolar II.

For Individuals:

  • Develop a Wellness Plan: This plan can include medication management, appointment schedules, and personalized strategies for dealing with stress and triggers.
  • Educate Yourself: Understanding Bipolar II symptoms and treatment options empowers individuals to take an active role in their care. Knowledge can also reduce the stigma and misconceptions associated with the disorder.
  • Practice Self-Monitoring: Keeping a mood diary or using mood-tracking apps can help individuals recognize early signs of mood shifts. 
  • Seek Regular Therapy: Regular psychotherapy sessions provide a space to explore feelings, develop coping strategies, and constructively work through life’s challenges.

For Loved Ones:

  • Learn About the Disorder: Gaining a thorough understanding of Bipolar II can help loved ones offer more effective support, foster empathy, and reduce misunderstandings.
  • Encourage Treatment: Support your loved one in sticking with their treatment plan and encourage them to communicate openly with their healthcare team.
  • Offer Emotional Support: Listen without judgment, offering encouragement and understanding. Remember, your support can significantly impact your loved one’s treatment journey.
  • Establish Healthy Boundaries: Loved ones must maintain their mental and emotional well-being and avoid burnout.

The Importance of Professional Help

Navigating Bipolar II Disorder is a journey that requires more than just individual effort and the support of loved ones. Professional help is pivotal in diagnosing, treating, and managing the condition. Mental health professionals offer expertise, support, and personalized care plans essential for achieving stability and improving quality of life.

For anyone suspecting they or a loved one might be experiencing symptoms of Bipolar II, reaching out to a mental health professional is a critical first step. It’s equally important for individuals already diagnosed to maintain their treatment plans and keep open lines of communication with their healthcare providers.

Written by: Onyx Behavioral Health Admin

The Onyx Behavioral Health Editorial Team includes content experts that contribute to this online publication. Editors and mental health experts review our blogs carefully for accuracy and relevance. We reference authority organizations such as The National Institute of Mental Health and NAMI for the latest research, data, and news to provide our readers with the most up-to-date mental illness and recovery-related content.

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