What is Bipolar Disorder? Psychopharmacologic Treatment of Bipolar II Depression       

    What is Bipolar II Depression? 

Some patients with bipolar illness experience depressive episodes. Depression caused by bipolar disorder can be controlled with medication, therapy, and other methods.

Mood, energy, and activity level changes are hallmarks of bipolar disorder, a psychiatric illness.

Some forms of bipolar disorder are characterized by depressive episodes that make it difficult to function normally.

These depressive symptoms are shared by several other mood disorders, not just severe depression. However, manic or hypomanic episodes are also possible in people with bipolar disorder.

Even though bipolar illness is a chronic condition, its depressive and manic symptoms are treatable, and its complications can be avoided.

Mood and activity levels fluctuate a hallmark of all bipolar disorders.

Hypomania is a phase of increased mood and behaviour characteristic of bipolar II. Hypomanic symptoms can include elevated mood, increased energy, and even irritability.

Mania, brought on by bipolar type I, is a more extreme form of joy than hypomania.

To better characterize and treat this illness, the term “bipolar II disorder” was coined by experts in 1994.

Some researchers have argued that the distinction between kinds I and II should be abandoned in light of new information about the disease.

Bipolar disorder, they suggest, is better understood as part of a continuum that includes the severity of manic episodes is a crucial distinction between bipolar I and bipolar II. However, there is some grey area between the two.

One manic episode, with or without an accompanying depressive episode, is diagnostic of Bipolar I disorder. Psychosis, such as hallucinations or delusions, can accompany a manic episode. Mania often necessitates hospitalization.

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Symptoms of Bipolar II:

 Symptoms of at least one major depressive disorder hypomania (which does not include psychosis), according to a reputable database from the National Institutes of Health. Typically, depressive feelings will predominate.

More than half of persons diagnosed with bipolar II also suffer from depression, while only around a third of those diagnosed with bipolar I also experience depression.

Signs, cycles, and degrees of intensity.

Hypomanic and depressed phases describe Bipolar Disorder Type II. There is considerable individual variation in the frequency, severity, and length of these episodes and associated symptoms.

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The Following Symptoms are Associated with Hypomania, Which Typically Lasts For a Few Days:

• increased vitality and assurance
• thinking and acting more quickly and creatively;
•  experiencing increased social and sexual activity
• becoming more prone to irritation when distracted
• expressing oneself hastily and more than usual, 
• irritability
• engaging in potentially damaging activities like shopping or arguing
• Improving One’s Coffee or Alcohol Intake
• increased drug use or cigarette use

A person with hypomania may have an elevated mood and increased productivity. Yet, their actions may stand out to those around them. A depressive episode may follow a period of happiness.

Possible Signs of a Depressed Episode Are:

• sadness, emptiness, or hopelessness; 
• lack of motivation
•  loss of interest in previously enjoyed activities
• insomnia or fatigue due to lack of sleep
• less sleeping or oversleeping
• experiencing emotions of worthlessness and remorse, 
• Difficulty concentrating, 
• Weight gain or loss without effort, 
• Suicidal ideation or behaviour

Although symptoms typically onset in early adulthood, the illness can manifest at younger ages, particularly adolescence.

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Epidemic depression

Major depressive episode symptoms include persistent sadness and an inability to function normally. An episode is defined by the presence of five or more of the following symptoms:

Feelings of sadness, emptiness, hopelessness, or tears (irritability in children and adolescents)

Depression is characterized by a profound lack of interest or enjoyment in virtually all activities.

Lack of predicted weight gain in children can indicate sadness, as can a significant weight change in either direction when dieting hasn’t been done.

It’s either sleeplessness or hypersomnia.

Either inactivity or agitation

energy depletion or exhaustion

Negative emotions, such as self-loathing or excessive guilt

mental impairment, indecision, or failure to focus and think clearly

Suicidal ideation, planning, or behavior 

Bipolar illness has additional symptoms, that Types I and II of bipolar disorder share several symptoms.

 And signs and symptoms of bipolar I and bipolar II disorders; thus, symptoms including anxiety, depression, and even psychosis are possible. Mixed or rapid cycling are two possible diagnostic classifications for symptom timing. Pregnancy and seasonal changes can also trigger manic-depressive episodes.

Signs and Symptoms in Young People

Identifying bipolar disorder in young people is challenging. It’s not always easy to identify if someone is experiencing life’s regular ups and downs, the effects of stress or trauma, or something else on the mental health spectrum.

Unlike the pattern seen in adults with bipolar illness, children and adolescents may experience significant depression and manic or hypomanic episodes. And during episodes, emotions might change quickly. Some youngsters may go long stretches without experiencing any mood problems at all.

Extreme and uncharacteristic shifts in mood may be the most noticeable feature of bipolar disorder in young people.

Reasons to Visit the Doctor

People with bipolar disorder don’t always obtain the therapy they need because they don’t realize how much their emotional instability affects their lives and those close to them, despite the severity of their mood swings.

Some persons with bipolar disorder, like yourself, may find the periods of elevated mood and increased productivity particularly enjoyable. This high, however, is always followed by a low that can leave you feeling dejected, exhausted, and possibly in legal, financial, or interpersonal hot water.

Seek medical or mental health attention if you experience symptoms of depression or mania. There is no natural cure for bipolar disease. Your symptoms of bipolar disorder can be managed together with the aid of a professional mental health care provider.

Understanding When to Get Help in a Dangerous Situation

Suicidal ideation and conduct is a common problem for people with bipolar disorder. If you’re feeling suicidal, talk to someone right away, whether it’s a professional or a loved one you trust. Additionally, a suicide hotline is available.

Anyone in the United States can call the 988 Suicide & Crisis Lifeline at any time, day or night, seven days a week. If you like, you can also prefer and use the Lifeline Chat. Everything is done in complete privacy and at no cost to the customer.

Recognizing the Signs of Imminent Danger and Knowing When to Seek Assistance

People with bipolar disorder frequently contemplate or attempt suicide. Please get professional help or talk to a trusted friend or family member immediately if you have suicidal thoughts. Also provided is a suicide prevention hotline.

The 988 Suicide & Crisis Lifeline is available 24/7/365 across the United States through phone calls and text messages. You can also use the Lifeline Chat service. Nothing is done openly or without the consent of the customer.

Factors that Increase the Danger

The specific causes of bipolar disorder are unknown, although the following may have a role, according to doctors:

• several contributors to genetics
• external influences
• components of the brain’s structure

A close family with bipolar disorder increases a person’s risk of developing the disease.

Furthermore, a genetic predisposition might be triggered by stress and traumatic situations.

The Institute of Mental Health reports that for some women, postpartum is when symptoms first arise.

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Diagnosis

A person must have experienced both major depressive episodes and hypomanic episodes before a diagnosis of bipolar II can be made.

It is common for people to avoid medical attention during hypomania but to seek it out after depression. Trusted source 

Bipolar disorder type II is frequently misdiagnosed as depression because of this.

A doctor will typically perform the following while making a diagnosis:

• Inquire about the ancestors
• Have a checkup done
• and order diagnostic procedures like blood tests to rule out other potential explanations
• After that, criteria are used.

It concerns the criteria in the Diagnostic and Statistical Manual of Mental Disorders.

 I am using criteria established by the Diagnostic and Statistical Manual of Mental Disorders.

Hypomania can also be diagnosed with the use of a checklist by the doctor.

After making a correct diagnosis of acute bipolar II depression using the DSM-5 criteria (which we examined in detail in a recent Psychiatric TimesTM column1), the challenge of choosing an appropriate drug for therapy arises.

 The issue is that your supporting evidence could be more precise.

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Treatment Foer Bipolar Disorder

Only three of the eleven treatment guidelines for bipolar disorders reviewed in the United States and elsewhere that included specific recommendations for bipolar II ilness were found to be based on evidence.

2. When the other 8 guidelines mentioned bipolar II, it was only in passing. In only one case, they specified that one should follow the recommendations for bipolar I depression.

Lamotrigine and lithium were mentioned as having evidence for maintenance (but not acute) treatment in the other three guidelines. Quetiapine, carbamazepine, and other antidepressants were also mentioned as potential therapies.

In a 2019 publication, editor Gordon Parker, MD, MBBS, DSc, PhD, sought the opinions of 18 specialists on the best ways to treat bipolar II depression. 

3. Reviewing the many suggestions was incredible because there was no agreement.

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Only quetiapine and lumateperone have been approved by the FDA for treating severe bipolar II depression. Five drugs have been licensed for the treatment of acute bipolar I depression. These are quetiapine, lumateperone, lurasidone, cariprazine, and the combination product of olanzapine and fluoxetine.

A recent systematic analysis, however, found that quetiapine is more effective for bipolar I depression than bipolar II,

4. An editorial examining the results of lumateperone as a treatment for bipolar II found that its efficacy was not adequately shown.

5. A recent meta-analysis compared the effectiveness of acute lithium treatment for bipolar II illness to that of antidepressant studies involving sertraline and venlafaxine.

6. Response rates to the antidepressants were not significantly different from response rates to lithium (P =.76). Although therapists anticipate higher adverse effects and dropouts with lithium, there was no difference in the all-cause discontinuation rates between the antidepressants and lithium.

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However, it is worth noting that evidence does not support lithium monotherapy in acute bipolar depression, even though there were no placebo controls in these investigations. Therefore, it’s safe to assume the same about these mood stabilizers. Despite lacking convincing evidence, many doctors still prescribe antidepressants for bipolar II depression.

Ultimately, this author suggests that bipolar II depression be treated in the same way as through consultations through the National Bipolar Disorder Telehealth Program of the U.S. Veterans Department Affairs (which has handled over 4000 consultation requests over the previous 11 years), as in the case of bipolar I depression primarily due to diagnostic conundrums and treatment resistance).

As the more recent studies above have not provided any reason to alter our opinion, we agree with 8 of the 11 guidelines discussed above.

The most well-established treatments for bipolar I depression cannot be assumed to be equally successful for bipolar II depression. In conclusion, the following are our current suggestions.

To treat severe depression, the first-line medications include quetiapine, lurasidone, cariprazine, lumateperone, and the combination of lithium and lamotrigine (after considering electroconvulsive therapy, of course). The olanzapine component of olanzapine/fluoxetine is not advised due to the unacceptable risks of long-term side effects.

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