Bipolar 2 disorder: symptoms, diagnosis and treatment

The NHS says the main symptom of bipolar disorder is extreme changes to your mood. You sometimes have high moods (mania or hypomania) or low moods (depression), usually lasting a few days or weeks at a time, with times between when your mood is stable and you have no symptoms, which can last weeks, months or years.

In bipolar 2, the high moods are hypomania rather than full mania. NHS symptoms of high mood include feeling very happy and excited, very irritable, having a lot of energy or not needing much sleep, racing thoughts, speaking fast, feeling overly confident, being impulsive or extravagant, and saying or doing things that are not usual for you.

Symptoms of low mood include feeling sad or upset, losing interest in things you usually enjoy, low energy, sleeping a lot or having difficulty sleeping, eating too much or too little, low confidence, feeling worthless or hopeless, difficulty concentrating, avoiding other people and having suicidal thoughts or thoughts about harming yourself.

Bipolar UK describes bipolar disorder as a severe mental illness that causes extreme mood swings and changes in energy levels, which used to be called manic depression. Bipolar type 2 involves hypomania and long periods of depression. Someone with bipolar type 2 tends to experience more frequent and longer episodes of low mood, and if they experience hypomania they have clear symptoms but usually do not need to be treated in hospital.

NICE's information for the public explains that hypomania is a type of mania that is less severe, for example there are usually no symptoms of psychosis, and that moods of hypomania that change to moods of depression and then back to hypomania are known as bipolar II disorder. About two in five people with bipolar have bipolar type 2, according to Bipolar UK.

Bipolar UK distinguishes bipolar type 1, bipolar type 2 and cyclothymia, as set out below. It says that many people think type 2 is just a milder form of type 1, but this is a myth.

The NHS says that if a GP thinks you may have bipolar disorder or another mental health condition, they will refer you to a mental health specialist (psychiatrist), who will ask about your moods, behaviour, health and family history. It says bipolar disorder can take time to diagnose because it affects everyone differently and the symptoms are similar to other mental health conditions.

Bipolar UK suggests monitoring your moods and behaviour, explaining the problems your moods are causing, asking friends and family what they have noticed, and thinking about family history before an appointment. It says bipolar is partly genetic, and that you only meet the diagnostic criteria if it causes considerable problems in your life.

The NHS says bipolar disorder cannot be cured, but treatments can help manage it. A mental health specialist will work with you to create a treatment plan, which may include medicines to help stabilise your moods and talking therapy such as cognitive behavioural therapy (CBT). Some medicines you need to take all the time, others only when your symptoms get worse, and they can cause side effects.

The NHS says not to stop taking your bipolar disorder medicine unless you are told to by a doctor, even if you feel better, and that some medicines for bipolar disorder are not safe to take if you are pregnant, so talk to your doctor if you are pregnant or planning a pregnancy. If doctors are worried you are at risk of self-harm, suicide or harming someone else, you may need to stay in hospital or have support from a crisis team at home.

Bipolar UK says that with the right treatment and support, mood swings can be managed and people can live and function well.

The NHS says it is important to know what can trigger your high and low moods, such as feeling stressed, not getting enough sleep or being too busy. It suggests having a regular routine, getting plenty of sleep, eating a healthy diet, exercising regularly and trying to avoid and manage stress.

It also says not to take recreational drugs, smoke, drink too much alcohol, do shift work or work very long hours if you can avoid it, fly at night or across time zones if you can avoid it, or drink lots of caffeinated drinks.

Bipolar UK says bipolar symptoms are usually first noticeable in teenagers and young adults, and that research has found almost 50% of people get symptoms before the age of 21. It says bipolar affects people of all ages and backgrounds, with no differences in prevalence based on gender or ethnicity.

Bipolar UK also notes that more than half of people living with bipolar do not have a diagnosis (56% in the figures it cites). If you are worried about a young person, the NHS says to encourage them to speak to their GP.

The NHS says support is available if you or someone you know is having a mental health crisis or emergency, no matter what you are going through. See a GP if you have extreme changes in your moods that last a long time or impact your everyday life, or if you have been diagnosed and treatments are not helping.

Bipolar UK says that when someone is having symptoms of mania this is a psychiatric emergency, and that suicidal thinking can be a common symptom of low mood in bipolar. If you or someone else is in immediate danger of harm, call 999.

On the NHS, assessment begins with a GP, who can refer you to a psychiatrist or community mental health team. Treatment is planned with a mental health specialist, with appointments usually at a GP surgery, clinic or hospital.

Some people choose a private psychiatrist for assessment or a second opinion. Ask how medicines and monitoring will be shared with your GP, so there is one clear treatment plan.