Bipolar II disorder: symptoms, diagnosis and treatment

Bipolar disorder is a mental health condition in which you have extreme mood changes. The NHS describes high moods (mania or hypomania) and low moods (depression), each usually lasting days or weeks, with periods of stable mood in between that can last weeks, months or years. NICE explains that hypomania is a type of mania that is less severe, for example there are usually no symptoms of psychosis.

In bipolar II disorder the high moods are hypomanic rather than manic. Bipolar UK explains that someone with bipolar type 2 has had at least one period of severe depression and at least one period of hypomania lasting longer than four days, but not mania. Someone experiencing hypomania has clear symptoms but usually does not need to be treated in hospital. By contrast, a diagnosis of bipolar type 1 means at least one episode of mania lasting longer than a week.

The NHS lists the symptoms of high mood and low mood. In bipolar II, the high mood is hypomania, so the more severe features such as hallucinations are not typical, while the depressive periods can be severe and prolonged.

• Hypomania: feeling very happy, excited or energetic, needing less sleep, racing thoughts, talking fast or a lot, feeling overly confident, being impulsive or extravagant (NHS).

• Depression: feeling sad or hopeless, losing interest in things you usually enjoy, low energy, difficulty sleeping or sleeping a lot, eating too much or too little, low confidence, difficulty concentrating, avoiding other people (NHS).

• Thoughts of suicide or of harming yourself can occur during depression (NHS).

Bipolar UK sets out the key contrast and stresses that type 2 is not simply a lesser form. Both types carry a similar risk of suicidal thoughts and behaviours, and type 2 is more strongly linked to seasonal affective disorder and anxiety disorders.

Because people usually seek help when low, bipolar II is often first seen as depression. The NHS notes that bipolar disorder can take time to diagnose because symptoms are similar to other mental health conditions. Hypomania can feel like a productive, confident or energetic spell rather than an illness, and people may not think to mention it. Bringing someone who knows you well to the appointment, and describing times of unusually high energy, reduced need for sleep or unusual spending, can help a clinician see the whole pattern.

The NHS says that if a GP thinks you may have bipolar disorder they will refer you to a mental health specialist (a psychiatrist), who will ask about your moods, behaviour, health and family history. The NHS advises seeing a GP if you have extreme changes in mood that last a long time or affect everyday life, or if you have a diagnosis and treatments are not helping.

If you are in crisis or at risk of harming yourself, the NHS says support is available and points to urgent help for mental health, including NHS 111; call 999 or go to A&E in an emergency.

According to the NHS, a mental health specialist will work with you to create a treatment plan, which may include medicines to stabilise mood and talking therapy such as cognitive behavioural therapy. Some medicines need to be taken all the time and others only when symptoms get worse, and they can cause side effects. The NHS stresses not to stop taking bipolar medicine unless told to by a doctor, even if you feel better, and warns that some bipolar medicines are not safe in pregnancy, so it is important to speak to your doctor if you are pregnant or planning a pregnancy.

The NHS also lists things that can help keep moods stable: keeping a regular routine, getting plenty of sleep, eating a healthy diet, exercising regularly and managing stress, while avoiding recreational drugs, smoking, too much alcohol, shift work or very long hours where possible, flying at night or across time zones, and lots of caffeine. Knowing your personal triggers, such as stress or lack of sleep, is an important part of self-management.

The NHS says you will be supported by a mental health specialist or GP, and that charities including Bipolar UK, Mind and Rethink Mental Illness offer information and support, including support groups and online forums. Bipolar UK points out that with the right treatment and support mood swings can be managed and people can live and function well, and that getting a diagnosis can open the door to effective treatment and self-management.

On the NHS, assessment is via a GP referral to community mental health services or a psychiatrist, and treatment including medicines and talking therapy is available free at the point of use, though waiting times vary. Some people see a private psychiatrist for a faster assessment; if you do, it helps to ask that findings and medicines are shared with your GP so that monitoring, such as blood tests for some mood stabilisers, continues smoothly.