# Bipolar I Disorder versus Bipolar II Disorder



## David Baxter PhD (Aug 16, 2006)

Bipolar I Disorder

Diagnosis of this Bipolar Disorder requires at least one Manic or Mixed episode, but there may be episodes of Hypomania or Major Depression as well. (This diagnosis conforms to the classic concept of manic depressive illness.) 

Bipolar II Disorder

Diagnosis of this Bipolar Disorder requires neither a Manic nor a Mixed Episode, but does require at least one episode of hypomania in addition to an episode of Major Depression.



> *Diagnostic criteria for 296.89 Bipolar II Disorder*
> 
> A. Presence (or history) of one or more Major Depressive Episodes.
> 
> ...


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## stargazer (Aug 16, 2006)

Thanks for posting this info, David. I'd read these descriptions in the DSM IV, and also similar accounts and descriptions on various sites. I think I can accept that my diagnosis is Bipolar I & Hypomanic, as they usually tell me. Last summer (2005) when I began treatment briefly before re-locating in the Bay Area for my job, the doctor in Stockton said she wasn't convinced I was Bipolar I. But she didn't say if she thought I was Bipolar II or not. It will be interesting to see what the doctor says on Friday.


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## foghlaim (Sep 6, 2006)

the actual word bipolar... 
means?????


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## ThatLady (Sep 6, 2006)

In this context, it means having two distinct emotional states, nsa, one manic, the other depressed.


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## foghlaim (Sep 6, 2006)

Thank you TL...

I figured as much but wanted to be sure...


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## stargazer (Sep 15, 2006)

Is there a Bipolar III disorder?  I was talking with my friend Barbara the other day, and she said they had her bipolar something-or-another, but she doesn't think it's I or II.  They used to have her on lamictal, but took her off of it, and now she only takes clonazepam as needed.


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## David Baxter PhD (Sep 15, 2006)

There's no Bipolar III to my knowledge, SG. She mat be thinking of cyclothymia.


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## stargazer (Sep 15, 2006)

I think that's what she's thinking of.  I said "schizothymic" because I couldn't remember the word, but now it hits me, "cyclothymic."  When I said, "schizothymic," it didn't sound quite right to either of us.


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## healthbound (Sep 16, 2006)

And I suppose that if someone alternates from "normal" to depressed, but doesn't experience hypomania or a manic episode, they have major depressive disorder?


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## stargazer (Sep 16, 2006)

That would make sense to me, but my knowledge is limited.  I'd be interested in hearing what Dr. Baxter would say.  I *have* read that bipolar people do experience periods of feeling "normal" --not just (hypo)manic or depressed--and that makes sense with my experience.


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## healthbound (Sep 16, 2006)

And, I guess some might argue that my "normal" time wasn't that normal.  I didn't hallucinate or have any psychosis, but I certainly over-achieved and managed to maintain a very busy lifestyle.

I could acheive so much.  I actually miss those times and wonder if I will ever return them.


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## David Baxter PhD (Sep 17, 2006)

If there has never been even a single hypomanic or manic episode, then the diagnosis would be *Major Depressive Disorder, Recurrent*.


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## healthbound (Sep 18, 2006)

What constitutes a hypomanic episode?

_edit:_
I just found this from HealthyPlace.com

A.  A distinct period of persistently elevated, expansive; or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

B.  During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: 

1.	inflated self-esteem or grandiosity 

2.	decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

3.	more talkative than usual or pressure to keep talking

4.	flight of ideas or subjective experience that thoughts are racing

5.	distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6.	increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

7.	excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)


C.  The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D.  The disturbance in mood and the change in functioning are observable by others. 

E.  The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F.  The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.


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## David Baxter PhD (Sep 18, 2006)

Yes. And note this part:



> F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) *or a general medical condition (e.g., hyperthyroidism)*.


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## healthbound (Sep 18, 2006)

Heh heh...I know...I saw it   thanks.


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## stargazer (Sep 18, 2006)

You or someone you know has hyperthyroid?  One of my best friends had, I think, "hypothyroid" -- whichever one makes you slow down and lose your hair and start talking like you're drunk all the time.  We all thought it was just the way he was.  Then they gave him some medication, and his energy returned to normal level.  That was about 10 years ago.  Now he's actually rather high-energy, in general.


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## healthbound (Sep 18, 2006)

I recently had blood taken showing that I have hyperthyroidism.  I've definitely been showing signs of it recently but after reading the symptoms could have sworn I had *hypo*thyroidism over the past 2 years.

I guess it just goes to show how much crossover there is when it comes to a certain set of symptoms.

The weird thing is that I got my thyroid tested on August 1 and it showed that I was in the normal range.  But, I'd already started feeling symptoms that might indicated hyperthyroidism.  I just thought I was finally coming out of my depression.  And that may still be.  I quit using a medication that I was on for over a decade a couple of months ago and it seems I've had a few symptoms become noticible since then.  I've read that the medication I was on could mask some of them...so, who knows.  I also got off all of the sedating drugs I was on a few months back and am only on 300mg/day of effexor now.  So that could also be contributing to my recent mood changes.

I definitely have been feeling better ---my mind seems to be working again, I'm planning and doing things that will effect my future (instead of acting as if there will be no future), and I have energy.  BUT I'm still sleeping A LOT, but I'm also drinking A LOT.  I'm acting very "extreme" and am certainly engaging in many activities that are dangerous and destructive.  This is concerning especially since it seems to be getting to the point where I'm not caring as much about whether my son is home or not (ie: I will drink after he goes to sleep) which is VERY out of charecter for me.

And while I just slept for a day, night and day, I feel pretty shaky and "speedy" right now.  

Bizarro.  Anway, I'm just about to make an appointment with my GP.  I'll see what he says (I was going to see him Friday, but didn't).


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## David Baxter PhD (Sep 18, 2006)

HB, your thyroid has probably been alternating between hypothyroidism and hyperthyroidism for a few years. That is usually the case by the time someone is diagnosed. The thyroid basically tries to regulate itself initially by "speeding up" and then "slowing down", which is one of the reasons that thyroid function should be tested whenever bipolar disorder is suspected.

It is also common in women who have been pregnant.


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## healthbound (Sep 18, 2006)

> HB, your thyroid has probably been alternating between hypothyroidism and hyperthyroidism for a few years.



Well, actually that would make perfect sense becuase I feel like I've had more HYPOthyroid symptoms over the past 2 years.  Although there are a few times I've felt like this over the past 2 years, but only for about 1-2 months at a time.  I just equated it with anxiety --especially because I felt a lump in my throat and sometimes felt like I was choking.  Maybe it is my thyroid gland though?

Anyway, there has absolutly been a distinct difference in the way I've been feeling and acting withing the last couple of months.  I've been very impulsive and drinking lots with little concern for consequences.

I'm also still waiting for an appointment with a otoligist/neurologist because I have tinnitus and I'm feeling pressure inside my head.  I thought I remembered reading that the thyroid is somehow connected to the hypothalamus, pituitary, serotonin and norepinephrine.  Maybe the tinnitus and head pressure are connected.


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## stargazer (Sep 18, 2006)

healthbound said:


> I could acheive so much.  I actually miss those times and wonder if I will ever return to them.



What I've noticed for myself is that, in slowing down, I actually accomplish more.  But it can't just be a total slow-down, without faith or confidence.  It has to have faith and confidence, otherwise it's just a burn-out.  And there has to be self-care, and the love of that.

In speeding up (which has been my usual tendency), I tend to scatter my energies, and accomplish less, though I'm functioning at a faster pace.  So I don't know if that will help or not.  I've spoken with friends of mine who are in 12-Step programs such as AA who report the same phenomenon.


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## prayerbear (Oct 29, 2007)

Miss ex-clean is being treated for OCD, bipolar II, and PTSD, and I am wondering with bipolar II, I am taking klonopin which makes me feel quite calm! How many people acutally get addicted to klonopin(I am taking the smalles dose to 1 gram a day)

  Also, how do you know if with bipolar II you are in a very good mood or it is just hypomanic?
  What is the most amount of medicine you have ever given anyone?

Is it accurate to say that with an OCD/bipolar II individual that the ups are considered manic and when I am down, I am very OCD?


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## David Baxter PhD (Oct 29, 2007)

miss ex-clean said:


> I am taking klonopin which makes me feel quite calm! How many people actually get addicted to klonopin (I am taking the smalles dose to 1 gram a day)



Klonipin (clonazepam) is a mild tranquilizer (benzopdiazepine). It is intended to make you feel less anxious, more calm. All benzodiazepines have some potential for addiction but at the low doses (you mean up to 1 mg, not 1 gram, by the way) you are taking, there is little danger as long as you stay within your doctor's orders as to dose.



miss ex-clean said:


> Also, how do you know if with bipolar II you are in a very good mood or it is just hypomanic?



Hypomania is a little more than  just a good mood. One of the ways to check is to solicit feedback from others who know you well.



miss ex-clean said:


> What is the most amount of medicine you have ever given anyone?



In Canada, psychologists can not prescribe medications.



miss ex-clean said:


> Is it accurate to say that with an OCD/bipolar II individual that the ups are considered manic and when I am down, I am very OCD?



No, it's not that simple, Your OCD symptoms are likely to become more intense or severe under stress or elevated anxiety. With bipolar, the other end of the manic/hypomanic dimension is depression rather than anxiety.


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## stargazer (Oct 30, 2007)

miss ex-clean said:


> Miss ex-clean is being treated for OCD, bipolar II, and PTSD, and I am wondering with bipolar II, I am taking klonopin which makes me feel quite calm! How many people acutally get addicted to klonopin(I am taking the smalles dose to 1 gram a day)



I'd like to address this from personal (not professional) experience, and maybe someone can fill in the gaps.  My guess is that everyone's physiology is different as to the addictive potential of benzodiazepines.  In my case, I was given klonopin in 1992, at first at a low dosage, yet prescribed to be taken regularly (the same dosage each day).  I think the dosage was 1.5mg a day.  (I was told this was a low dose.)

It wasn't very long before the same psychiatrist had me at 6mg a day, which I was told was the highest permissible dosage in the United States.  (Later someone told me that higher dosages were all right for certain conditions).  I asked the psychiatrist if I were "addicted," and she said, "no, but you are _dependent_."  I was definitely habituated.  I felt that if I were not to take it, something would somehow go wrong.  If there was a foul-up and I didn't get a refill on time, I started feeling hyper, and there were uncomfortable changes in my breathing.  

They later fired the psychiatrist.  This is significant only because I think she mis-diagnosed a lot of people.  She had me at Generalized Anxiety Disorder, then when they gave me to a new doctor, he diagnosed me bipolar, started to wean me off of the klonopin, and wanted to give me depakote.  But I didn't believe him, and after I got down to 2.5mg a day of klonopin, I was so hyper I couldn't stand it anymore.  I attributed all of this to klonopin addiction.  So I went back up to 5mg a day, and eventually back to 6mg a day.  I couldn't function without it.

I've discussed this all in earlier posts.  I know the exact date when I stopped taking klonopin: May 10, 2004.  Although I stopped cold turkey, this is not to be recommended.  I could have had a seizure, but I didn't.  The dosage from which I stopped at that time was 4mg a day.  I'd recently been in the psych ward for 9 days because I was having a manic episode, and the doctor there took the dosage from 6mg down to 4mg.  I slowly lost my Kaiser insurance during the episode, and I simply took the 4mg per day until I ran out and couldn't obtain any more.

There were other factors, but this is the gist.  I basically thank God that I got off of this stuff, and it's been over three years now.  I still have a prescription for valium, but I hardly ever take it, and I don't enjoy it when I do.  The last time I took a valium was over 6 weeks ago.  My experiences with klonopin have left me with a permanent aversion to benzodizepines.

This is my own subjective experience, but there are probably those who share similar experiences with these drugs, so I did feel compelled to share.  Good luck to you.


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## David Baxter PhD (Oct 30, 2007)

I wouldn't like to see anyone remaining on 6 mg of clonazepam or lorazepam for any extended period of time either, Stargazer.

However, people can and do remain on these medications for extended periods of time without suffering adverse side-effects and they are very effective in treating certain kinds of anxiety. The key factors to monitor are (1) the development of tolerance for the drug, where the patient finds that the dose needs to be increased stepwise over time in order to be effective; and (2) the development of excessive fatigue. In my experience, for most people this will not be an issue at doses in the range of 0.5 to 2.0 mg per day.

On the other hand, as with many other medications, abrupt discontinuation of benzodiazepines is not advisable. One is likely to experience a rebound (spike) in anxiety and insomnia for a period of time until the individual withdraws from the medication. Most or all of this can be avoided by gradually tapering off the medication under the supervision of your physician.


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## stargazer (Oct 30, 2007)

That all makes sense with my personal subjective experience as well.  I think that, had I still had medical insurance and a doctor at the time, the doctor would probably have set up a schedule for me to get off of the final 4mg/day klonopin more gradually.  But because I lost my Kaiser health insurance shortly after being released from St. Joseph's, I didn't have that benefit.

Also, because I was having a manic episode at the time, I wasn't thinking quite clearly around the subject.  It's somewhat remarkable that I didn't experience noticeable withdrawal symptoms after going off of 4mg/day "cold turkey," but let's put it this way: other people noticed stuff that I didn't notice, because I wasn't very in touch with my behaviour at the time.

Also, I hope I didn't discourage Miss Clean -- if you're fine at the lower dosage, I wouldn't worry about getting addicted.  Also, I don't know a whole lot about OCD.  I'm bipolar I, and that also might be a difference to be considered.


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## prayerbear (Oct 30, 2007)

I sure won't go above the reccomended dose,and sorry Stargazer about that bad experience with that psychologist! The first time I took Klonopin, I felt REALLY GOOD!
  I know what hypomanic is, but what is it like having to be hospitialized for being manic? If you are comfortable replying, my sister was bipolar I! She would get up on the roof and smile at lots of strange men and act hypersexual-scary.
  Aren't the lows really low? Like major depressive disorder to the ninth degree? Don't all bipolar I dismiss taking meds when they are feeling really high?
  OCD is major anxiety, along with a fear of losing control.

                        bye for now,
                    miss ex-clean,
                      (a recovering cleaning addict)


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## stargazer (Oct 30, 2007)

miss ex-clean said:


> If you are comfortable replying, my sister was bipolar I! She would get up on the roof and smile at lots of strange men and act hypersexual-scary.



I'm comfortable replying, but can't do so right now because I'm at work, and time is limited.  I'll prepare something, though, and probably post it in a day or so.  Hyper-sexuality was definitely involved, as well as hyper-reliogisity.  It scared a lot of people, although I didn't think anything was wrong at the time.



miss ex-clean said:


> OCD is major anxiety, along with a fear of losing control.



I understand.  I have a friend who is OCD and has described some of his symptoms.  I just don't have personal experience in that area.


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## finetime (Aug 10, 2008)

this link mite help

YouTube - It's a Brain Thing: Bipolar Disorder Part 2 of 6


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## stargazer (Aug 10, 2008)

I was directed back here by an email notification, and I haven't watched the YouTube yet, but I am surprised I wrote all the things that I did earlier in this thread.  I can sure be long-winded.

I'm on new meds now, and I think I am writing fewer words and less often than usual, in general.  I also find myself making fewer phone calls, and I think I am more content within myself.  I don't feel as compelled to buzz people as often as I used to, or in an angry way that would sometimes come out of the blue.

I think the meds are fine, and I'm not experiencing periods of unusual agitation, anger, or severe mood swings.  I'm getting a lot of work, I like my living situation, and life is good.  I make it to my appointments regularly, and go to church every Sunday, and am generally more easy-going than earlier.  My family relationships are a little more positive -- brother, sister, daughter (I don't know about stepdaughter.)

I think this mix of meds has a lot to do with it -- and yes, I am continuing to avoid benzodiazepines.  Not good for me, though I'm sure they are beneficial to others, in the right dose.


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## David Baxter PhD (Aug 10, 2008)

That's excellent news, stargazer. Thank you for the update. :2thumbs:


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## stargazer (Aug 10, 2008)

Thanks, David.  The only unpleasant side effect I've noticed from the meds is that my fingers shake a lot.  Not sure why that is.  But I feel healthy overall, mentally and physically.


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## ladylore (Aug 10, 2008)

That is great news!


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## stargazer (Aug 10, 2008)

Thanks, ladylore.  Indeed it is.


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## Halo (Aug 10, 2008)

That is so great to hear SG :2thumbs: I am really happy for you


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## stargazer (Aug 11, 2008)

Thanks, Halo.


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## sister-ray (Aug 11, 2008)

Im happy to hear all is well for you stargazer that is brillant news


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## stargazer (Aug 11, 2008)

Thanks.


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## finetime (Aug 12, 2008)

What is Bipolar II 

Bipolar II is a psychological disorder that involves mood swings from depressed to hypomanic states. Unlike bipolar I, also called manic depression, bipolar II does not involve manic states. However, like bipolar I, the person afflicted suffers from varying degrees of mood. Bipolar II may create depression or anxiety so great that risk of suicide is increased over those who suffer from Bipolar I.

In order to properly diagnose Bipolar II, patients and their doctors must be able to recognize what constitutes hypomania. People in a hypomanic state may experience increased anxiety, sleeplessness, good mood, or irritability. The hypomanic state can last for four days or longer, and patients will note a significant difference in feelings from when they are in a depressed state. 

Hypomania may also cause people to feel more talkative, result in inflated self-esteem, make people feel as though their thoughts are racing, and in some cases result in rash choices, such as indiscriminate sexual activity or inappropriate spending sprees. Often, the person who feels anxious or irritable and also has bouts of depression is diagnosed with anxiety disorder with depression, or merely anxiety disorder. As such, they do not receive the proper treatment, because if given an anti-depressant alone, the hypomanic state can progress to a manic state, or periods of rapid cycling of mood can occur and cause further emotional disturbance.What is Bipolar II?

Manic states differ from hypomania because perception of self is generally so deluded as to cause a person to act unsafely and take actions potentially permanently destructive to one’s relationships. Additionally, the manic person may be either paranoid or delusional. Those with mania may feel they are invincible. High manic states often require hospitalization to protect the patient from hurting himself or others. 

Conversely, hypomanic patients may find themselves extremely productive and happy during hypomanic periods. This can further complicate diagnosis. If a patient is taking anti-depressants, hypomania may be thought of as a sign that the anti-depressants are working.

Ultimately, though, those with bipolar II find that anti-depressants alone do not provide relief, particularly since anti-depressants can aggravate the condition. Another hallmark of bipolar II is rapid cycling between depressed and hypomanic states. If this symptom is misdiagnosed, sedatives may be added to anti-depressants, further creating mood dysfunction.

The frequent misdiagnosis of bipolar II likely creates more risk of suicidal tendencies during depressed states. Patients legitimately trying to seek treatment may feel initial benefits from improper medication, but then bottom out when treatments no longer work. The fact that multiple medications may be tried before the correct diagnosis is made can fuel despair and depression.

Depression associated with either bipolar I or II is severe. In many cases, depression creates an inability to function normally. Patients suffering from major depression describe feeling as though things will never feel right again.

Severely depressed patients may not leave their homes or their beds. Appetite can significantly increase or decrease. Sleeping patterns may be disrupted, and people may sleep much longer than usual. 

This type of depression does not respond to reason or talking it out, because it is of chemical origin. Though therapy can improve the way a person deals with depression, it cannot remove chemically based depression. Because of what seems an inescapable mood and a feeling that things will never improve, patients frequently contemplate and often attempt suicide.

Once accurate diagnosis is made, treatment consists of many of the same medications used to treat bipolar I. These medications typically include mood stabilizers like lithium or anticonvulsants like carbamazepine (tegretol?), and many people also benefit from a low dose of an antidepressant. Those with bipolar II rarely need antipsychotic medications since they are not prone to psychotic symptoms or behavior. Even with appropriate medication, it may take some time to stabilize a patient and find the right dosage. When patients have demonstrated suicidal tendencies, hospitalization may be necessary to provide a safe environment where medications can be adjusted accordingly.

*When medication is combined with cognitive behavioral therapy, patients seem to respond more quickly and have the most success.* Though bipolar II is not thought to be caused by traumatic events, such factors as a history of abuse can affect recovery. By approaching bipolar II with both therapy and medication, the patient is likely to recover fully.

With treatment, those with bipolar I or II can live healthy normal lives and attain success in work and relationships. Many anticonvulsant medications are related to a high incidence of birth defects, however. Patients who are on medication and considering a pregnancy should seek the advice of both their psychiatrist and obstetrician before becoming pregnant.
__________________


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## David Baxter PhD (Aug 12, 2008)

finetime, the definition of Bipolar II you cite is somewhat misleading. Bipolar II may not include full blown manic states but it does include the presence of at least one hypomanic episode. Hypomania is like mania only less severe.

Here are the criteria from DSM-IV:



> *Diagnostic criteria for 296.89 Bipolar II Disorder*
> 
> A. Presence (or history) of one or more Major Depressive Episodes.
> 
> ...


Specify: 

Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern (applies only to the pattern of Major Depressive Episodes) 
With Rapid Cycling


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## Always Changing (Jul 1, 2009)

> Those with bipolar II rarely need antipsychotic medications since they are not prone to psychotic symptoms or behavior.


These days antipsychotic medication is being used in the treatment of bipolar ll and schizophrenia.    
eg: Zyprexa, is an atypical antipsychotic which I am taking to stabilise my mood swings. Not on it long enough to say it is working, but I am hoping this proves to be the case.


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## stargazer (Jul 1, 2009)

I am neither Bipolar II nor an expert; but it sort of seems to me that if a hypomanic episode had *not* been involved, there wouldn't be a "high" to contrast the "low," and so it wouldn't fall under a bipolar category.  Without the evidence of hypomania, rapid cycling, and so forth; it doesn't seem to me that it would differ a whole lot from Major Depression.  *Something* has to make it bipolar, after all.  

Bipolar II seems to differ from Bipolar I in that it specifically must *not* have included a major manic episode.  I, being Bipolar I, have had a huge first-time manic episode in which I was basically out of my mind for a good four or five months.  This took place in the year 2004.  So I'm definitely not Bipolar II, but I can see from the set of symptoms cited in the DSM-IV that to be Bipolar II, one must have at least some hypomania in one's experience.


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