But What IS Bipolar II Disorder?

     So what is Bipolar II Disorder, besides a huge pain in the butt? To put it simply, it is a biological illness associated with the structural and functional abnormalities in the brain and is caused, at least in part, by problems with the brain’s chemical messengers (neurotransmitters). Even though we know how Bipolar II is affecting the brain, it is still widely misunderstood and often mistaken for being a “milder” version of Bipolar I. BPII is defined by lengthy and recurrent periods of depression, comorbid anxiety disorders, and high rates of substance or alcohol abuse. Occasional hypomanias are not as severe as BPI, but can overlap periods of depression making it even more distressing. Both BPI and BPII create difficulty maintaining a job, relationships, and have a high suicide rate. Annoyingly, an issue facing those of us with Bipolar II is that most reading material is geared towards the education on and treatment of Bipolar I, where full remission between episodes is experienced. I guess BPII is just constant suffering… at least that’s what it feels like sometimes.

BPI and BPII have two key differences: depression and mania. While not a necessary part of the diagnosis for BPI, depressive episodes are quintessential for BPII. And while individuals do experience mania with both, BPII has a distinctive hypomania (where symptoms are not as severe or impairing). Let’s break down both of those components:

 Depressive episodes are characterized by feeling down, sad, and/or much less interested in things for most of the day, every day, for at least two weeks. At least four other symptoms are required for a diagnosis: weight loss/gain, insomnia/hypersomnia, restlessness/agitation or feeling very slowed down, fatigue/loss of energy, feelings of worthlessness or guilt, trouble concentrating/making decisions, and thoughts of death/suicide ideation. It’s more than just the blues, or having a bad day every now and then. Do you remember that commercial for an anti-depressant that had a woman holding up a smiley face while behind it she was totally miserable? That’s a pretty good example of “masking” during depression. If you can even muster the energy to do it - sometimes even that is too much.

Mania is characterized by either elevated mood or extreme irritability along with at least three other symptoms over most of a day for about a week (abnormally high self esteem, decreased need for sleep, feeling more talkative or pressure to keep talking, racing thoughts or more ideas than usual, distractability, an increase in goal-directed behavior, or involvement in activities that have a high likelihood to have negative consequences). The difference between mania and a good mood is the impairment to daily activities like work, school, social functions, hygiene, etc. I personally don’t suffer from mania often, and when I do it is definitely not as bad as I know it can be with those who have Bipolar I. Most of the time I just happen to be in a good mood and find that so rare that it throws me off and I’m not sure what is going on.

Interestingly, the Diathesis-stress model suggests that conditions such as BPII are affected by both the person’s genes and environment, meaning more likely to react negatively to everyday stressors than someone without the condition because of a lower threshold of tolerance. Which explains why I sometimes feel like I am “extra sensitive.” Turns out, I am!

Finally, treatment for Bipolar II includes medication and therapy. Medications commonly prescribed are lithium and anticonvulsants. Personally, I am on the latter because the former made me feel like a zombie. Anti-depressants can sometimes be prescribed as well, but it is my understanding that there isn’t much evidence to suggest them actually being helpful. Let’s not forget the anxiety, either, which must be treated by yet another, separate drug.

So there we have our little educational moment!. I am learning a lot, and things keep clicking into place the more I learn. If you have any questions or would like some recommendations on reading material, feel free to reach out to me. (It’s kind of my thing 👻)