Bipolar I sufferers have MANIC episodes, Bipolar II sufferers have hypomanic episodes. The difference between Mania and Hypomania is severity. Mania describes abnormal moods, increased activity as well as elevated energy. It is important to note that someone with Bipolar I can have Hypomanic episodes, but someone with Bipolar II can not have Manic episodes. If a Manic episode occurs then the diagnosis is changed to Bipolar I.
Mania includes psychotic episodes, delusions and/or hallucinations, Hypomania does not include psychotic symptoms. A period of hospitalisation can be necessary for Bipolar I because of the severity of the illness and symptoms. Because of the extremes involved in Mania, the chances of residential care are greater.
Mood Stabilisers are often used as part of the treatment process.
- Lithium, the mainstay in the management of bipolar disorder, but it has a narrow therapeutic range and typically requires monitoring
- Anticonvulsants, such as Sodium Valproate, Carbamazepine or Lamotrigine
- Antipsychotics, such as Quetiapine, Risperidone, Olanzapine or Aripiprazole
- Electroconvulsive Therapy, a psychiatric treatment in which seizures are electrically induced in anesthetized patients for thereputic effect!
Bipolar II is similar to Bipolar I. Sufferers experience moods cycling between High and Low, over periods of time! There is one key difference. With Bipolar II, the sufferer will never reach total, full-blown MANIA. Those people with Bipolar II, experience less intense, elevated moods. These are called, HYPOMANIC EPISODES or HYPOMANIA ! A person with Bipolar II, will suffer at least one HYPOMANIC episode in their life time. It is more common for BPII sufferers to experience depression more often.
Most people with Bipolar II lead normal lives inbetween episodes of HYPOMANIA and DEPRESSION.
It is estimated that between 2 and 2.5 percent of the population suffer with some form of Bipolar. Most people are diagnosed during their teens or early 20s. Almost all sufferers are diagnosed before the age of 50. It would seem that there is also an hereditary element involved here. Someone who has an immediate family member who has Bipolar, is at a much higher risk!
During Hypomania there are symptoms to be aware of. Sufferers will require less and less sleep, and not feel tired! They will feel Irritable and notice a change in body temperature, as well as risky behaviour, such as reckless spending. A noticeable change in speech, becoming more pressured, louder and racing thoughts, making understanding difficult!
Depressive episodes can be easier to attribute.
1. Feeling depressed most of the day, every day for long periods.
2. Huge weight loss or gain over short periods of time. Measured at around 5% weight gain or loss a in one month period.
3, Insomnia every day!
4. Agitation every day!
5. Loss of energy, every day!
6. Lack of decisiveness, unable to concentrate, every day!
7. Suicidal thoughts. Planning ones own death. Thoughts of death or dying!
Bipolar II can be difficult to diagnose. Hypomania can often be seen as periods of high function or indeed attributed to personality. Often those being assessed are unaware of hypomanic episodes and therefore providing the right informatiin to a consultant can be difficult!
Mixed depressive states also occur. A sufferers mood is depressed, although hypomania is present as well. It is my opinion that this is the most dangerous state. Suicidal thoughts and tendancies are always increased at this time, as I can testify as a sufferer!
- Lithium - There is strong evidence that lithium is effective in treating both the depressive and hypomanic symptoms in bipolar II. In addition, its action as a mood stabilizer can be used to decrease the risk of hypomanic switch in patients treated with antidepressants.
- Anticonvulsants - there is evidence that lamotrigine decreases the risk of relapse in rapid cycling bipolar II. It appears to be more effective in bipolar II than bipolar I, suggesting that Lamotrigine is more effective for the treatment of depressive rather than manic episodes. A large, multicentre trial comparing Carbamazepine and lithium over two and a half years found that Carbamazepine was superior in terms of preventing future episodes of bipolar II, although lithium was superior in individuals with bipolar I. There is also some evidence for the use of Valproate and Topiramate, although the results for the use of Gabapentin, have been disappointing.
- Antidepressants - there is evidence to support the use of SSRI and SNRI antidepressants in bipolar II. Indeed, some sources consider them to be one of the first line treatments. However, antidepressants also pose significant risks, including a switch to mania, rapid cycling, and dysphoria and so many psychiatrists advise against their use for bipolar. When used, antidepressants are typically combined with a mood stabilizer.
- Antipsychotics - there is good evidence for the use of Quetiapine, and it has been approved by the FDA for this indication. There is also some evidence for the use of Risperidone, although the relevant trial was not placebo controlled and was complicated by the use of other medications in some of the patients.
- Dopamine Agonists - there is evidence for the efficacy of Pramipexole from one RCT.
It is important to note that rapid cycling can also be a severe problem in Bipolar II. 24% of sufferers try to commit suicide, compared to 17% with Bipolar I. The longevity of Bipolar II, the alienation felt by sufferers. Unrealised goals in education and the work place and the severe disability involved. ineffective treatment, increased mixed symptoms and misdiagnosis all add up to make Bipolar II more dangerous than Bipolar I. All of these effects add up to a much more increased risk of suicide!
I was personally diagnosed with Bipolar I. I have had more than one severe Manic episode that has endangered both my life and that of my partners. Diagnosis for me was a long process. It took about 8 years in total, having changed from Bipolar II to Bipolar I, after that Manic episode.
Today I am still awaiting word from The Access Team at College Keep, the mental health unit involved in diagnosis and control. I am waiting for new medication, after the failure of my current pills. They wanted an increase in Quetiapine, which I have declined. I do not want to be sedated any more than I have to be, certainly not throughout the course of the day. I have also refused Lithium, for obvious reasons, so I just continue to wait, hopeful that they make a decision soon!