Demographic Characteristics Baseline Illness Severity And Clinical History
Demographic characteristics in the pooled ITT population were broadly similar between bipolar I and II patients . More than half the patients in both bipolar I and II subgroups were female and the mean age was approximately 39 years in both populations. Mean body weight was lower in the bipolar II than bipolar I population , but there was large interpatient variation. Patients with bipolar I and II disorders had similar clinical histories for the number of recent and lifetime mood episodes .
The Benefits Of Intensive Treatment And Long
While short-term residential treatment programs may be suitable for some, long-term residential care is often necessary for those with more severe or complex needs. Longer duration of care means more opportunities for clinicians to observe mood episodes and tailor pharmacological treatment to address them. Simultaneously, you can begin to deeply explore the roots of your distress and replace damaging emotional and behavioral patterns with healthy alternatives, expanding your ability to effectively cope with your disorder, so you can live the life you want to live.
But one of the most powerful tools we have for healing isnt found in a therapy room or a prescription padits found in everyday living. Within the context of a therapeutic community, your everyday life can become a profound therapeutic experience, giving you continuous opportunities to learn from others who are on their own healing journeys. In the company of peers who understand your struggles, you can share stories, responsibilities, meals, joys, conflicts, and accomplishments.
Types Of Bipolar Disorder
All types of bipolar disorders involve changes in energy, activity levels, and mood. These moods can be very manic, which is energized, elated, or irritable, or depressive, which is sad, indifferent, or hopeless. People with bipolar can also have hypomanic episodes, which are similar to manic episodes but not as severe.
What is bipolar 1?
In bipolar 1, people have manic episodes that last at least seven days or are so severe they need to be hospitalized immediately. They also usually have depressive episodes that last at least two weeks as well. It’s also possible for people to have episodes with features of both manic and depressive symptoms at the same time.
What is bipolar 2?
People with bipolar 2 have hypomanic episodes, which are similar to manic episodes but not as severe. People with bipolar 2 disorder usually return to normal function between episodes. They can have severe depressive symptoms, which is often why they first get treated.
- Being tired, not have any energy
- Having a hard time concentrating or making decisions
- Frequently thinking about death or feeling suicidal
Symptoms of bipolar 2
If you have bipolar 2, you will have the symptoms of depressive episodes as above, but instead of a manic episode, you’ll have hypomanic episodes, which are similar to manic episodes. They are not as severe as manic episodes. They last at least four days, but they don’t cause the severe problems that manic episodes do.
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Living With Bipolar Disorder
Living with bipolar disorder can be challenging. Chronic symptoms can lead to a lower quality of life. Relapse is common and can happen even when a person maintains their treatment. Suicide risk is estimated to be ten to 30 times higher for people with bipolar disorder. However, bipolar disorder is manageable with the right treatment. A stable lifestyle is important for good symptom management. Routines can keep a person focused on regular sleep, exercise, nutrition and treatment.
The Nobu mental wellness app offers a suite of evidence-based tools and resources developed by clinical professionals. For an added fee, you can meet with a licensed therapist and get one-on-one support all in one app. Start your journey to greater mental wellness today.
Edited by Erica Weiman
Erica Weiman graduated from Pace University in 2014 with a masters in Publishing, and has been writing and editing ever since. She has written and edited content across many niches, including psychology & mental health, health & wellness, food, technology, and workplace culture. She is passionate about making information about addiction accessible to anyone whos on a journey to recovery and their loved ones. When Erica isnt writing or editing, she is working as a social media manager, cooking or traveling.
Medically Reviewed by Dr. Angela Phillips
What Are The Symptoms Of Bipolar Ii Disorder
During a hypomanic episode, elevated mood can manifest itself as either euphoria or as irritability.
Symptoms during hypomanic episodes include:
- Flying suddenly from one idea to the next
- Having exaggerated self confidence
- Rapid, “pressured” and loud speech
- Increased energy, with hyperactivity and a decreased need for sleep
People experiencing hypomanic episodes are often quite pleasant to be around. They can often seem like the “life of the party” — making jokes, taking an intense interest in other people and activities, and infecting others with their positive mood.
What’s so bad about that, you might ask? Hypomania can also lead to erratic and unhealthy behavior. Hypomanic episodes can sometimes progress onward to full manias that affect a person’s ability to function . In mania, people might spend money they don’t have, seek out sex with people they normally wouldn’t, and engage in other impulsive or risky behaviors with the potential for dangerous consequences.
The vast majority of people with bipolar II disorder experience more time with depressive than hypomanic symptoms. Depressions can occur soon after hypomania subsides, or much later. Some people cycle back and forth between hypomania and depression, while others have long periods of normal mood in between episodes.
Untreated, an episode of hypomania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months.
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Substance/medication Induced Bipolar Disorder
Recent evidence has shown that some people treated with antidepressants may develop manic or hypomanic states. These episodes emerge during antidepressant treatment, such as taking medication or electroconvulsive therapy, but persist beyond the physiological effect of the treatment.
Taking illicit drugs e.g. cocaine or amphetamines can also cause medication induced Bipolar disorder signs this is occurring may include mood elevation that clearly outlasts the clearance of the provoking drug.
Substance and medication induced Bipolar disorder is complex and needs careful diagnosis by a Psychiatrist who is an expert in the field of Bipolar. If you are experiencing adverse reactions whilst taking medication it is important to seek help as early as possible.
I felt completely at ease with Dr Surguladze his reassurances that my condition was treatable with the right medication were incredibly comforting. His treatment plan has been a huge success for me I never dreamt it could make such an impact.
Study Design And Patients
Retrospective pooled analyses were performed on 2873 patients who participated in five multicenter, fixed-dose, double-blind, randomized, placebo-controlled studies of quetiapine IR or XR in acute depressive episodes of bipolar I or II disorder . Each study enrolled male or female patients aged 1865 years with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of bipolar I or II disorder, most recent episode major depression . The diagnosis was confirmed by the Structured Clinical Interview for DSM–IV . Additional inclusion criteria in all studies were a Hamilton depression rating scale 17-item score 20, HAM-D item 1 score 2, and Young mania rating scale score 12 . Hence, based on the HAM-D scale, these study populations can be considered to have depressive episodes of at least moderate severity . Patients were excluded from the studies if they were diagnosed with Axis I disorder in addition to bipolar disorder.
The study designs, enrollment details, ethical approvals, and inclusion/exclusion criteria are described in detail in the original publications . Patients in all five trials underwent a washout period of up to 28 days for antipsychotic, antidepressant, and mood-stabilizing medications prior to baseline assessments.
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Symptoms That Lead To A Diagnosis
If youre suffering from any kind of mental health disorder, its important that you identify and understand your symptoms in order for our doctors to correctly diagnose you. Bipolar disorder consists of both manic and depressive episodes that create an unstable mood.
Mania can be extreme changes in mood, or you can have hypomania which is typically less severe. Symptoms of mania include:
Difficulty sleeping Extreme energy Increased self-esteem Difficulty concentrating Racing thoughts
On the opposite end of the spectrum, depression can change your emotional highs to hopeless lows. If you have bipolar disorder with depression, symptoms you may experience include:
Fatigue Sadness Decreased energy Overeating or loss of appetite Suicidal thoughts
Our team at Boston MindCare take a detailed history to decipher your symptoms and give you a definitive diagnosis. With that, we can also form a customized treatment plan for you.
The Similarities Between Bipolar I And Bipolar Ii
I have found that there are many similarities between those of us living with bipolar I and bipolar II. One commonality is the age where the symptoms of bipolar disorder began to surface. Many of my friends living with bipolar I or bipolar II started noticing signs in their late teens which worsened into their early twenties. Statistically, the average age in which bipolar symptoms surface is 21.
The experience of going to a mental hospital is also something those of us living with bipolar disorder have in common. The treatment of both types of bipolar disorder are also similar, if not the same. Most of the bipolar medications I have been given have also been prescribed to the people I have met with bipolar 1.
Our way of thinking, emotional extremes, lack of sleep, and dealing with the highs and lows are what we have most in common. The way the stigma of mental illness has negatively affected our lives is very similar. Self-stigmatizing is present in all of our experiences and played a pivotal role in our delay in seeking treatment. In general, those of us living with both bipolar I or bipolar II are similar in many ways however the symptoms of mania in bipolar 1 is where we differ with extremes.
So now, onto answering the question: Is bipolar I worse than bipolar II?
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Are There Any Other Types Of Bipolar Disorder
While bipolar I and bipolar II are the most common types of bipolar disorder, they aren’t the only ones. The DSM-5 lists two additional types of bipolar disorders:
Those with cyclothymia experience hypomania and depressive symptoms that do not meet the criteria for hypomanic or depressive episodes. Although the severity of the symptoms is not as severe as bipolar I or II, the symptoms generally last longer.
The mood episodes can last two years or longer in adults and a year or longer in children.
While the symptoms of these types of bipolar disorders may not be as severe as bipolar I or II, it’s still important to get treatment as these symptoms can impact your social or occupational functioning.
Other specified and unspecified bipolar and related disorders
Those with other specified and unspecified bipolar disorders may experience some symptoms associated with bipolar, such as mania or depression. However, their symptoms won’t fit into the defined categories of the other bipolar types.
Specified bipolar and related disorders are diagnosed when the doctor chooses to communicate exactly why the presentation does not meet the criteria of the other categories. For example, the person might have hypomania without the corresponding episodes of depression experienced with bipolar II. Or they might experience short durations of hypomanic episodes and major depressive episodes.
What Are The Signs Of Depression
With both bipolar I and bipolar II, the depression is the same. Symptoms may include:
Feeling sad. Often, you dont want to do anythingincluding activities you once loved. You can feel hopeless, empty, and unworthy.
Endless exhaustion. People who are depressed feel so lethargic they dont even get out of bed, even after a full eight hours of shuteye.
Sleep issues. If you’re depressed, you may have difficulty falling asleep or may wake up before morning, unable to fall back to sleep. Or you might snooze too much, because a full nights rest doesnt feel like enough.
Difficulty concentrating. Simple questions seem too much to think about.
Appetite changes. People in a depressed state can eat either too much or too little.
Suicidal thoughts. The depression can get so bad, people with depression may even contemplate suicide. The International Journal of Bipolar Disorders reports that suicide risk in people with bipolar is 20 times that of the general population and is strongly associated with depressive phases, especially with mixed or psychotic features. If this is you, contact a professional immediately, or call the National Suicide Prevention Hotline at 1-800-273-8255.
To read more about the symptoms of depression , .
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Bipolar I Vs Bipolar Ii: What Are The Differences
The two most common types are bipolar I and bipolar II. What differentiates them is the intensity of the manic episodes.
The mania for a person with bipolar I is obvious to everyone around them. Its usually so debilitating that the person is unable to function and may even need to be hospitalized.
Mania for bipolar II, called hypomania, is less severe and sometimes even mild enough that the person experiencing it may still be able to function day to day. Occasionally it can even be so subtle that nobody around them notices that anything is significantly off.
Another difference between bipolar I and II: A person with bipolar I may or may not experience a depressive state in fact, one episode of mania is all thats required for a diagnosis of bipolar I. But if the person does have depressive episodeswhich most dothey usually last at least two weeks.
For a diagnosis of bipolar II, you must have experienced at least one major depressive episode as well as a manic episode.
Risk Factors Of Bipolar 1 Disorder
There are several risk factors associated with bipolar I disorder including:
- Having family members who have the illness
- Exposure to environmental toxins during fetal development
- Psychiatric disorders like schizophrenia, ADHD, PTSD, and major depression in childhood or when they first started.
- If you have a mental health condition like agoraphobia, where it is hard to get away when you have a panic attack and social phobia, embarrassmentfear in front of other people. Developing another mental health disorder is also possible.
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Change In Illness Severity During Treatment
Patients randomized to 8-week treatment in the five pooled clinical trials received quetiapine , placebo , lithium , or paroxetine . Rates of study discontinuation in these treatment groups were quetiapine , placebo , lithium , and paroxetine .
Treatment group comparisons
Early improvement in depressive symptoms, assessed by MADRS score change from baseline at weeks 2 and 4, was most rapid in the quetiapine group in both bipolar I and II patients, while symptom improvement was slowest in bipolar II patients treated with lithium or placebo . Least squares mean MADRS score changes at weeks 2 and 4 in bipolar I patients were 11.46 and 15.01 in quetiapine, 8.29 and 11.16 in lithium, 9.83 and 12.01 in paroxetine, and 8.65 and 11.31 in placebo groups. Changes in MADRS score at weeks 2 and 4 in patients with bipolar II were 10.66 and 13.96 , 6.43 and 10.46 , 11.67 and 13.38 , and 7.52 and 10.17 , respectively.
Least squares mean change from baseline to week 8 in MADRS total score , BPI and BPII groups. Rating scale range: MADRS: total score range 060. A reduction in score represents improvement in depressive symptoms
Similarities Between Bipolar 1 And Bipolar 2
We understand by now that there are similarities between bipolar 1 and bipolar 2.
For one, the symptoms are similar, as we discussed with the differences in mania and hypomania.
For another, diagnostic criteria are also similar. to diagnose bipolar II disorder, one or more major depressive episodes must occur. In bipolar I disorder, a major depressive episode usually occurs, but it is not required.
Euthymia is also present in both mental health conditions. Euthymia is what we can consider middle ground, when the condition is adequately controlled, and symptom-free. This is when mania, hypomania, and depression is not present, and the person suffering is in their normal state.
Also, both types of bipolar are considered disabling. It is a common misconception that bipolar 1 is more disabling than bipolar 2 as the manic episodes are more severe. While this is indeed true, evidence suggests that bipolar 2 is characterized by more severe episodes of depression.
One study suggested that people with bipolar II become less likely to return to fully normal functioning between episodes. Yet another stated, bipolar type II was linked to a poorer health-related quality of life compared to type I this remained true even during long periods of euthymia.
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What Are The Causes Of Bipolar Disorder
There is no one known cause of bipolar disorder. However, there are several factors that experts believe could contribute to the development of the condition, including:
- Genetics: There is evidence to suggest that bipolar disorder runs in families. According to the American Psychiatric Association, 8090% of people with bipolar disorder have a relative with bipolar disorder or depression.
- Stress: High stress events such as an illness, a divorce, financial difficulties, or a death in the family could trigger a manic or depressive episode. Not processing stress effectively could also lead to the development of bipolar disorder.
- Brain structure and function: When examining people with bipolar disorder, some researchers have detected differences in brain structure compared with people without bipolar disorder. Additional research is needed to see how these differences can play a role in understanding bipolar disorder and developing effective treatments.