People with bipolar I disorder experience manic episodes, while people with bipolar II disorder experience less severe hypomanic episodes. Both condition types have certain symptoms in common and similar symptom frequency.

People with bipolar disorder experience extreme highs or lows in mood. During a “high,” also known as a manic episode, people feel intense energy or excitement.

During a “low” or depressive episode, they experience symptoms of depression, such as excessive guilt, frequent tearfulness, and lack of interest in enjoyable activities.

There are four distinct types of bipolar disorder:

  • bipolar I disorder
  • bipolar II disorder
  • cyclothymic disorder, or cyclothymia
  • other specified and unspecified bipolar disorder

A doctor can diagnose a person with one of the above types based on the duration and intensity of their symptoms.

Bipolar I and bipolar II are the most widespread forms of bipolar disorder. Although they are distinct from one another, they are typically the more severe bipolar disorders and share many similar symptoms.

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Bipolar I disorder and bipolar II disorder have similar symptoms and symptom patterns. However, people who have bipolar II typically experience less severeTrusted Source manic episodes than people with bipolar I. Doctors refer to these less severe periods of mania as hypomania.

To receive a diagnosis of bipolar II, a person must experience cycles of hypomanic and depressive episodes without ever having a full manic episode.

By contrast, a doctor can diagnose bipolar I based on the presence of a manic episode alone. People with bipolar I disorder have at least one manic episode that persists for a week or longer or severe mania that requires hospitalization.

Those with bipolar II disorder do not generally require hospitalization during hypomanic periods. Doctors sometimes misdiagnoseTrusted Source bipolar II as depression because the hypomanic symptoms can be very subtle. They may also misdiagnose periods of sudden joy as hypomania.

In between episodes of mania and depression, people who have either of these types of bipolar disorder may experience periods of stable mood.

They may also alternate between symptoms of depression and mania at the same time. This is known as bipolar with mixed features.

The main symptomsTrusted Source of bipolar I disorder and bipolar II disorder are mania, hypomania, and depression.

Mania

During a manic episode, people can experience:

  • intense enthusiasm, happiness, or excitement
  • anger, restlessness, or irritability
  • increased energy
  • less need for sleep and difficulty sleeping
  • racing thoughts
  • difficulty concentrating and making decisions
  • excessive pleasure-seeking behaviors

Hypomania

In a state of hypomania, people experience symptoms similar to those in mania, except less severe.

Hypomania can still interfere with a person’s quality of life, and family and friends may notice that the person is experiencing mood changes.

Depression

People with bipolar disorder may experience depressive symptoms, including the following:

  • low or depressed mood
  • hopelessness
  • low energy and fatigue
  • changes in sleeping patterns
  • changes in appetite
  • difficulty concentrating
  • loss of interest in formerly enjoyable activities
  • low self-esteem
  • thoughts of suicide or death
  • suicidal behavior

Doctors consider these symptoms a depressive episode if they persist for 2 weeks or moreTrusted Source.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

According to the World Health Organization, around 40 millionTrusted Source people globally received a bipolar disorder diagnosis in 2019.

The condition affects males and females almost equally, but females may have a slightly higher diagnosis rate.

The onset typically occursTrusted Source either between the ages of 15 and 24 years or 45 and 54 years. However, it can happen to people of any age.

Bipolar disorder I and bipolar disorder II are severe types of bipolar disorder that involve periods of mania or hypomania and depression.

People with cyclothymia have a chronically unstable mood, but their symptoms will never reachTrusted Source the clinical criteria for depressive, manic, or hypomanic episodes.

Cyclothymia is less severe than bipolar I and II. It may involveTrusted Source nonspecific symptoms that can contribute to misdiagnosis.

For a bipolar disorder diagnosis, people will need to see a psychiatrist, psychologist, or supervised counselor. They will review the person’s medical history and symptoms and may seek to exclude other potential causes.

This psychiatric assessment will focus on a person’s thoughts, feelings, and behaviors. They may also assess how others respond to the individual in social situations.

The psychiatrist or psychologist may also ask a person to keep a mood diary to track their moods, sleep patterns, and other symptoms to help with a diagnosis.

They will compare the person’s symptoms to the criteria for bipolar disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).

They may also carry out blood tests, a physical examination, or brain imaging tests to rule out other causes of the symptoms.

Treatment for bipolar I disorder and bipolar II disorder typically consistsTrusted Source of medications, psychotherapy, and lifestyle changes. People with bipolar I disorder may require hospitalization during a manic episode.

As bipolar disorder is a long-term condition, treatment will be long lasting. Some people may have a treatment team that includes a psychologist, psychiatrist, therapist, and psychiatric nurse practitioner.

Medications

Doctors may prescribeTrusted Source mood stabilizers, such as lithium, for bipolar disorder. They may also prescribe antipsychotic drugs for manic episodes and antidepressants for depression.

As antidepressant medications may trigger manic episodes in some people, doctors might recommend a combination of antidepressant and antipsychotic drugs to reduce depression while stabilizing mood.

For people with anxiety or sleep problems, anti-anxiety medications, such as benzodiazepines, may help. However, this strategy may come with a risk of dependence on benzodiazepines.

A person’s healthcare team may adjust their medications depending on their symptoms. People should follow their doctor’s instructions when taking medication for bipolar disorder.

Psychotherapy

Psychotherapy can play a roleTrusted Source in bipolar I and II treatment plans. Therapy may occur in person or remotely.

Several different types of therapy can help, includingTrusted Source:

  • Interpersonal and social rhythm therapy (IPSRT): This focuses on establishing a structured routine to help people cope with symptoms.
  • Cognitive behavioral therapy (CBT): CBT helps people challenge negative thoughts and replace them with more realistic or objective ones.
  • Family-focused therapies: These therapies enhance communication with family members and help foster family support.

Psychotherapy is not aTrusted Source frontline treatment for bipolar disorders, but a doctor may suggest it alongside medication.

Lifestyle changes

The following lifestyle changes may help someone with bipolar disorder manage their symptoms and help stabilize their moods:

  • avoiding alcohol and drugs
  • exercising regularly
  • eating a balanced diet
  • establishing a regular sleep routine
  • attending a support group for people with mood-related disorders
  • practicing mindfulness and meditation
  • reducing stress where possible
  • learning more about their condition

Some people may also find it helpful to keep a daily mood diary. Journaling can allow people to see patterns in their thoughts, moods, and behaviors.

A mood diary also helps identify triggers for manic or depressive episodes. This may help a person take appropriate action before a slight mood change worsens.

Although bipolar I disorder and bipolar II disorder are long-term conditions, people may be able to manage their symptoms with medications, therapy, and lifestyle changes.

Maintaining regular contact with mental health professionals and seeking support from friends and family can make it easier to cope with challenging symptoms.

Anyone who thinks they may be experiencing symptoms of bipolar I or II should speak with a doctor for a proper diagnosis.