DSM-IV-TR Diagnostic Criteria

In order to get this classification as stated before, the person must experience at least one hypomanic episode and one major depression episode. If a hypermanic episode has occurred the diagnosis for Bipolar II will not be made. Also there can never be a mixed episode where both mania and depression are occurring at the same time. Furthermore, the symptoms are not attributed to another disorder such as schizoaffective disorder, schizophrenia, delusional disorder or any other order non-specified illness. The symptoms of this illness will cause distress in social, work related, home or other areas of human functioning.

Treatment

What works best with Bipolar II sufferers is medication. The most common form of medications is mood stabilizers. Mood stabilizers are affective in evening out moods so that the there are less episode switching from hypomania to depression and back. These mood enhancers are effective for the mania characteristic of Bipolar II. They help to eliminate the hypomania, however they are less effective in treating the symptoms of depression. Usually anti depressants are required in addition to mood enhancers to effectively treat depressions. Having said that, there are exceptions to this rule. Lithium, which is the oldest medication for Bipolar Disorder has proven to be successful in treating both mania and depression.

Recently researchers have found that anticonvulsants normally used to treat seizures in patients having brain disorders such as epilepsy or brain damage in some way is also effective in treating mania. This discovery is rather exciting and has put a new face onto the treatment for Bipolar Disorder. This new medication holds great promise for patients who in the past did not respond to lithium. Now, there is a treatment that will help them manage their symptoms and live normal lives.

Finding just the right treatment for Bipolar Disorder is not always easy. In the beginning there will be a lot mixing and experimenting with different medications until the right one will be found. Some medications will have no affect at all; others just need to be increased in dosage. Ethical doctors will always start with the lowest dosage of any medication to see if it is effective rather than start off high and cause possible harmful side affects. Furthermore, the medication itself at the minimal dosage may have uncomfortable side affects and deemed not suitable for a particular patient. Everyone is different and so the treatment medication must be found to suit that individual.s body and brain chemistry. It could take quite some time before the proper medication can be found. Do not go off your medication even if it is causing side effects. It is important that you discuss all the symptoms you are experiencing since your doctor prescribed the medication. It will be his or her job to decide if you should continue with the medication or not. He or she may choose to change your medication, or keep you on it for just a bit longer. Some medications are known to have side effects in the beginning but the symptoms disappear after a couple of weeks.

In Bipolar II the state of mania is never as far-reaching as what would be experienced in hypermania or full-blown mania. However, in Bipolar II the patient still experiences .a high energy level that still impairs judgment, and is a precursor to some questionable or reckless behavior, but it does not have the most severe symptoms including hallucinations and delusions which is found in Bipolar I or hypermania.

Symptoms of hypomania

People living with Bipolar II will have at least one episode of hypomania and one episode of major depression in their lives. They will usually be high functioning individuals with quite a bit of energy. They can be quite cranky and irritable, yet are goal driven and possess a high level of creativity. Many people with Bipolar II disorder find rewarding jobs within the arts, as it is a chance to make use of their creative juices. They can be film directors, dancers, musicians, producers, marketing specialists, graphic artists, artists, just about anything which requires a high level of creativity.

People going through the hypomania phase of the disorder will have racing thoughts, jumping from one idea to another, which can actually be an asset in a job which requires creativity. It can also be a deficit in a job where there is only one way to perform on think on the job. A person who has hypomania symptoms would not be happy in a factory job assembling boxes since there is no room for change or creativity.

People experiencing hypomania will also experience loud, pressured and rapid speech making it sometimes annoying for the people around them. On the other hand, they are often a party pleaser, laughing and joking and genuinely taking an interest in others.

Unfortunately the party attitude can lead to erratic or reckless behavior, such as having sex with people they normal would not have a sexual relationship with, going on spending sprees, buying drinks in the club for the whole gang, lavishing expensive gifts upon people and so on.

Many times after a hypomanic episode, the individual will slump into a depressive episode right after the hypomanic episode or they can have periods of normal behavior in between. These episodes can be rapidly changing or there could be a really long time of normal, stable moods between episodes. This part of the illness is individual in nature.

If hypomania is left untreated it can lead to the more severe hypermania over time. The length of a hypomanic episode can lasts, days, weeks, months, or for several years before the mood shifts.

The symptoms for the cycle of the depression is the same as that of clinical depression except that clinical depression is unipolar meaning there is no mania involved. That is why the two types of depression are considered a different disorder. Bipolar II sufferers can exhibit low energy, loss interest in the things that were once important to them, avoid all social contact, and entertain thoughts of death and suicide will having a depressive episode.

Sometimes it is very difficult to detect Bipolar II hypomania as the symptoms can be easily confused by a person who may feel very happy and onlookers just feel that he or she is having a very good time. Although it is evident on the outside the person is having a real good time it is often the aftereffects of that good time that causes regret in these individuals. These individuals are often goodhearted to the point that it becomes a fault. They like to have a good time and they want everyone else to have a good time around them. That could translate to spending lavishly on other people, or over extending themselves to do chores and other favors. They may find that after all is said and done they are now overextended on their credit cards or they are physically and emotionally drained.

The other side of a hypomanic episode is the very creative and very temperamental hypomanic individual. They are usually the brilliant minds whereby you must tread lightly when around them because the slightest thing could send them into a whirlwind of slurs and accusations. These are the people who must have everything done according to their specifications often on time schedules that are very hard to accomplish. These people are high energy and high goal oriented and lose patience with people who cannot keep up with them.

If the hypomania episode is not too noticeable or does not cause any unhealthy behavior it often goes unnoticed and therefore remains untreated. However, it can lead to full-blown mania in which case it should to be treated to avoid the devastating symptoms of hypermania. Sufferers with hypermania can be so out of touch with reality that they can experience hallucinations and delusions. People suffering from hypermania are often hospitalized to get their moods under control with medication.

However, people who have episodes of hypomania can still benefit from medication. Medication will circumvent the possibility of the illness developing into the more severe symptoms of hypermania. It will even out the moods and lessen the possibility for a depressive episode.

Types of medications used for Bipolar II

Mood Stabilizers

The most common form of medication given to Bipolar II patients is mood stabilizers. Lithium has been used for century as an effective mood stabilizer for manic and depressive episodes. Lithium is a metal, which is prescribed in pill form. It takes a while for lithium to work and so it is deemed a good long-term approach for treating mania. Lithium will also treat depressive episodes. Lithium works by leveling off the moods so they are more normal. However, lithium does have many side effects and doctors now monitor the blood to keep the amount of lithium in the body down, and to lessen or prevent some of the known side effects.

Depakote is an anti seizure drug which is effective in regulating moods swings. Depakote does not take as long to work as lithium does and it has also been found that Depakote is a good preventative medication. Lamictal, Tegretol, Topamaxare, Gabitril, Neurontin, and Trileptal, are used.

Newer antipsychotic drugs such as Abilify, Zyprexa and Seroquel are used as effective mood regulators.

Antidepressants

Zoloft, Paxil, and Prozac can also be used as an effective mood stabilizer as well. What usually happens is that the patient is started on Lithium, Depakote or an antipsychotic medication. If they fail to take effect, an antidepressant may be tried.

Benzodiazepines can be used for a short-term treatment for acute hypomania. Benzodiazepines are tranquilers such as valium or Xanax and Ativan.

People with Bipolar II disorder will benefit from psychotherapy, or cognitive behavioral therapy to help them cope with the stressors of life and learn better coping skills.

Hypomania is a condition where the sufferer is in a constant state of elation. They can be in a high-energy feeling on top of the world good mood, or they can be high energy and irritable as well. People who are experiencing hypomania have racing thoughts and ideas running through their head all the time. They have trouble focusing or concentrating on one idea at a time. They often lose focus because they have so many thoughts and ideas going on in their brain. They are very goal oriented people and can be highly creative. They can also get irritated or even angry at people they feel are dimwitted or slower than they are. Everything has to be done at a fast pace.

People in a hypomania mood are task driven and wanting to get everything done at once. They may not be able to delegate chores or work with other people because they feel they can do it better and faster. They are impatient and want everything immediately. They also require less sleep than other people because they don.t want to miss out on anything that they can be doing. They also are prone to be adventurous and daring. Their moods are not as extreme as found in the condition called hypermania. They do not get into such reckless behavior that could lead to seriously hurting themselves or others. They don.t have hallucinations and delusions and they are not usually hospitalized. People experiencing episodes of hypomania are fully functional.

Hypomania is a feature of Bipolar II Disorder, and Cyclothymia. Hypomania can also be present in schizoaffective disorder.

According to the DSM-IV-TR the symptoms of hypomania which relates to a very good or elated mood must be present for at least four days and must include at least three of the following symptoms to be considered hypomania: rapid talking (or pressured speech), grandiose thinking or inflated ego, very little requirement for sleep, racing thoughts, and many ideas, attention deficit (poor concentration), distractibility, psychomotor activity such as pacing the room, wringing hands, and pleasurable but reckless behavior such as sexual encounters, spending money, and risky business deals.

People in this state often feel they cannot slow their mind down. They can improvise, talk in rhymes on the spot, and do many things they don.t normally do that require quick thinking. People in the hypomanic phase are still in touch with reality and so they do not have delusions or hallucinations, but they can still make poor judgments. They overestimate their capabilities and can take on more than they can handle. People who are in the hypomania stage may have a lot of good ideas that they want to accomplish, but do not follow through on them. They may be great people to be around as long as they have their own way. If not they can become very cranky and irritable. Usually people in a hypomanic state do not seek medical help. They will when they are in a depressive state. Then they are likely only to report the symptoms of depression and will more than likely be given a diagnosis of depression only.

If the hypomanic phase is left untreated, over time it may develop into the more severe state of mania known as hypermania.

There seems to be some benefits of this state of euphoria. People in the hypomania state are high energy, very creative; goals oriented, and are able to accomplish great things. They are positive thinkers and willing to take on challenges without fear and doubt. These people are often visionaries able to think outside of the box.

Bipolar I is the category for people who suffer from major severe mania (hypermania) and major depression. Bipolar II is the designation for people with milder mania (hypomania) and major depression. Cyclothymia is the designation for people who swing between episodes of hypomania and milder episodes of depression.