Bipolar 1 vs. bipolar 2: What's the difference?
Your bipolar disorder experience, including the intensity of mood swings, can differ based on what type you have.
Key takeaways
- Bipolar 1 is characterized primarily by mania, which can sometimes lead to psychosis.
- Bipolar 2 is characterized by severe depressive episodes, and less intense mania called hypomania.
- Medication, or a combination of them, can help treat mood changes and/or depressive symptoms.
Bipolar disorder is a mental health condition characterized by extreme “up” and “down” shifts in a person’s mood and activity levels that can interfere with their ability to function in day-to-day life. The “up” shifts are referred to as mania, or manic episodes, while the “down” shifts are depression, or depressive episodes.
There are two main types of bipolar disorder. While bipolar 1 and bipolar 2 have much in common, they also have important differences and occur at slightly different rates in the general population. BD-I, as it’s sometimes abbreviated, affects about 0.6% of people at some point in their lifetimes, while BD-II affects 0.4% of people.
Below, we’ll discuss the factors that distinguish bipolar I from bipolar II, as well as how they’re diagnosed and treated.
What is bipolar 1?
If you have bipolar I disorder, you’ll experience manic episodes lasting at least seven consecutive days. These manic episodes may happen almost constantly or just periodically.
When they end, they’re sometimes followed by periods of acute depression, typically lasting two weeks or more. But, depression isn’t always a part of bipolar 1.
Mania symptoms
During a manic episode, you may have delusions of grandeur, or think that you’re more powerful or capable than under normal circumstances. In this state, you might start to take on new creative tasks and pursue them relentlessly, with little to no regard for other matters in your life. Or you may spend large sums of money, make questionable investments, engage in risky sexual activities, or strike up conversations that may be inappropriate with acquaintances new and old.
You may also have racing thoughts and difficulty sleeping, be excessively active, agitated, irritable, or talkative, and generally have markedly higher energy levels than usual.
Psychosis
Mania may be so extreme that psychosis occurs and hospitalization becomes necessary. Psychotic symptoms can include hallucinations and grandiose delusions. Instead of thinking you’re more capable than usual, you may believe you’re actually superhuman or have special abilities.
If your depression causes psychosis, you may come to think that you’ve ruined your life or important relationships, for example.
Mixed episodes and rapid cycling
In addition, some people experience “mixed” episodes, in which symptoms of depression and mania are both present to some degree. Having four or more manic, depressive, or mixed episodes in a year is referred to as “rapid cycling.”
What is bipolar 2?
Bipolar 2 is different from bipolar 1 in two important ways. First, if you have bipolar 2, you’ll experience episodes of hypomania, not mania, followed by intense periods of depression.
Hypomania
These episodes will span four or more consecutive days. By definition, hypomania
- is significantly less intense than mania
- doesn’t severely impact your ability to live a normal life
- cannot cause psychosis
Instead, it might make you feel unnaturally happy or lead you to take on new projects at work or otherwise extend yourself in ways that you wouldn’t without elevated energy levels.
Hypomania won’t immediately throw a wrench in your life, but it may create some difficulties for you or change the way friends, family, and coworkers perceive you. Left untreated, it may even develop into a more severe form of mania.
Depression
Unlike bipolar 1, then, bipolar 2 always includes periods of depression. These may last two weeks or longer.
During a depressive episode, you may feel sad or unable to accomplish tasks large or small. You may have feeilngs of hopelessness, worthlessness, or a general a loss of interest in things. People with depression might also have insomnia and difficulty getting out of bed in the morning. Depressive episodes pose a higher average risk to life than their manic or hypomanic counterparts because they cause thoughts of self-harm.
Both bipolar 1 and 2 are commonly misdiagnosed as depression initially. This can create a number of problems for patients, including the fact that common antidepressants like SSRIs can induce mania in people living with bipolar disorder. That's why having an experienced doctor like a psychiatrist on your side is key to getting proper treatment.
Key differences between bipolar 1 and 2
Are bipolar 1 and 2 diagnosed differently?
When a psychiatrist assesses you for bipolar disorder, they’ll check to see if you have (or have previously had) three or more symptoms of a manic (bipolar II I) or hypomanic (bipolar II) episode. (If your mood is irritable, you’ll need to exhibit four or more symptoms.) Additionally, your psychiatrist may inquire about your family history, as people with parents or siblings with bipolar disorder are more likely to have it as well.
The symptoms listed below must last at least seven consecutive days to meet the threshold of bipolar I disorder or four consecutive days for bipolar II disorder.
- Excessive self-esteem
- Reduced need for sleep
- Compulsive or increased speaking
- Racing thoughts
- Pronounced distractibility
- Increased goal-oriented activity or psychomotor agitation (restlessness resulting in repetitive, automatic movements)
- Too much involvement in activities with potentially harmful consequences (spending sprees, bad or immoderate investments, risky sexual liaisons)
In bipolar II, the symptoms are not as severe as in bipolar 1, where a manic episode might need hospital care. Bipolar II also does not have psychotic symptoms. It's also important to remember that mania from medications or drugs does not count for a bipolar diagnosis.
Having a past or future depressive episode is common for people with bipolar I, but it's not needed to diagnose that type of bipolar disorder. On the other hand, a major depressive episode lasting at least two weeks is required for diagnosis of bipolar II.
It’s worth emphasizing that you don’t have to sift through this information by yourself. In fact, consulting with a qualified clinician is essential to receiving a diagnosis, if you have one, as well as treatment. If you’re not sure where to begin, one option is to take Talkiatry’s free online assessment.
How are they treated?
The approach to treating bipolar disorder can be divided into three sections: managing mania/hypomania, depressive symptoms, and maintenance.
Mania and hypomania treatment
Bipolar 1’s manic episodes are frequently treated with mood stabilizers – like lithium, Lamictal (lamotrigine), and Depakote (valproate) – which are especially effective at alleviating mania and hypomania and may also provide relief during episodes of depression or reduce their frequency. If you’re already taking lithium or another mood stabilizer when a manic episode begins, your doctor may prescribe a supplementary medication, such as aripiprazole, asenapine, olanzapine, quetiapine, or risperidone, all of which are from a class of medications called antipsychotics. On the other hand, your doctor may prescribe an antipsychotic as your first-line (primary) treatment, without a mood stabilizer.
Bipolar 2’s hypomanic episodes are often treated in much the same way, though the doses may differ and, by definition, a hypomanic episode will never reach the point of emergency.
Bipolar depression treatment
For episodes of acute depression, the treatment options are similar for bipolar 1 and 2. Your doctor may prescribe a mood stabilizer like lithium in combination with Lamictal or Depakote, for example.
On-going treatment
“Maintenance” is the term used to describe the treatment plan you and your doctor follow outside of episodes of mania (or hypomania) and depression. Lithium is a mainstay of maintenance, meaning that you may take it year-round to prevent the recurrence of manic and depressive episodes. However, other mood stabilizers and/or antipsychotics may be substituted depending on your particular circumstances.
To learn more, check out our guide to bipolar medications.
Therapy
A number of therapies may be used in conjunction with medication to treat aspects of BP-I and II, including the following:
- Cognitive behavioral therapy (CBT) helps patients learn to break or adapt harmful thought patterns and to change unwanted behaviors. For patients with bipolar disorder, it may specifically be enlisted to help alleviate depression-induced insomnia.
- Family-focused therapy (FFT) is when a person with bipolar disorder is joined by one or more family members. Across approximately 12 sessions, a therapist works to educate the group about the nature of the condition and imparts techniques for preventing episodes from worsening and handling conflicts within the family.
- Interpersonal and social rhythm therapy (ISRT) helps teach people with bipolar disorder how to keep track of their daily routines and regulate their schedules in pursuit of mood stability.
Additional treatment options
- Electroconvulsive therapy (ECT), in which electrical currents are passed through the brain, may be used when other treatment options have failed to improve a person’s condition or when immediate action is required to decrease the risk of suicide or catatonia.
- Repetitive transcranial magnetic stimulation (rTMS), which uses magnetic waves to treat depression, is less powerful than ECT but has fewer side effects and doesn’t require general anesthesia.
- Light therapy can be used to treat seasonal affective disorder (SAD), which can help people with bipolar disorder whose depression worsens during the winter.
This might seem like a lot of treatment options to keep track of, but don’t fret. You’re not in this alone. Psychiatrists are trained to work with you to determine, first of all, if you have bipolar disorder I or II and, second of all, what the best course of treatment is given your unique circumstances.
If you’re currently looking for a qualified clinician, one way forward is with Talkiatry. We’ll make sure we’re the right fit for you. Then, we’ll work to match you with the clinician who can give you the care you need. Complete this quick, free online assessment to book your first visit.
FAQs
Is bipolar II disorder the same as major depression?
No. In bipolar 2, episodes of depression alternate with episodes of hypomania. Mania, hypo or otherwise, is not a component of major depression. However, bipolar disorder may be misdiagnosed as major depression, and major depression may transition to bipolar disorder in some people.
What are the different types of bipolar disorder?
People with bipolar 1 experience manic episodes lasting at least seven days, and typically also periods of depression spanning two weeks or more. Those with bipolar 2 still experience depression, but the corresponding mania, called hypomania, is less intense than in bipolar 1. Cyclothymia, a third type of bipolar disorder, features hypomanic and depressive episodes that are less intense or shorter than those seen in bipolar 1 and 2.
How do I know which one I have?
Reading about symptoms of bipolar disorder can be a useful way of contextualizing your mental life. Ultimately, though, working with a qualified clinician is the only way to know which type of bipolar disorder you have, if any. You can learn more about how psychiatrists evaluate patients for bipolar disorder here.
Talkiatry is a mental health practice, and our clinicians review everything we write. However, articles are never a substitute for professional medical advice, diagnosis, or treatment. If you think you may need mental health help, talk to a psychiatrist. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.
