There are three bipolar disorder types - bipolar I, bipolar II, and cyclothymic disorder - depending on the type of mood and behavior changes that are predominant.

Continue reading to learn more about the different types of bipolar disorder.

Recognizing Bipolar Disorder

People with bipolar I and bipolar II experience extreme shifts in mood and activity levels. These unusual behaviors and mood episodes can affect a person’s ability to function in their personal life and society.

Bipolar disorder can even make it challenging to carry on activities of daily living. This mental health condition can contribute to job loss, relationship problems, family discord, and even suicide.

Although the symptoms of bipolar disorder come and go, it is a lifelong condition. While there is no cure for bipolar disorder, proper treatment with medications and counseling can help bipolar patients manage symptoms and regain their ability to carry on their daily responsibilities. That’s why an accurate diagnosis and treatment for bipolar disorder are vital for health outcomes and quality of life for people who have this mental illness.

Mental health providers use the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) to make a proper diagnosis of bipolar disorder. They can differentiate between bipolar 1 vs. bipolar 2 based on a person’s symptoms.

Mental health providers can also differentiate between other related disorders that can cause similar symptoms, for example, major depressive disorder versus acute bipolar depression.

What is the Difference Between Bipolar 1 and Bipolar 2?

There are three main bipolar disorder types: bipolar I, bipolar II, and cyclothymic disorder (cyclothymia).

In addition to these 3 main types, there are cases where symptoms don’t fit into these 3 bipolar categories. This is classified as type 4 or “other.” Alcohol or substance use and certain underlying health conditions are usually the contributing factors for type 4 bipolar disorder. Below are the key differences between bipolar I and II.

Bipolar I Disorder

Bipolar I disorder is characterized by manic episodes lasting for 7 days or more. The elevated mood and other manic symptoms are severe enough to require immediate medical care. Depressive episodes also occur in people with bipolar I. These can last 2 weeks or longer. There can be mixed depressive and manic symptoms during depressive periods.

The Role of Manic Episodes in Bipolar I

Mania is the main feature of bipolar I disorder. According to the American Psychiatric Association, manic episodes are characterized by high energy, euphoria, and excitement for a period of at least 7 days.

The elevated mood symptoms are present nearly every day and for most of the day during a manic episode. These extreme changes in mood are severe enough to interfere with work and home life and require medical attention.

A manic episode can be followed by a hypomanic episode or major depressive episode (acute bipolar depression).

When people with bipolar I experience four or more mania or depression episodes within 12 months, it is known as rapid cycling bipolar 1.

Characteristics of Manic Episodes

A marked increase in energy and activity levels
Elevated mood, such as feeling extremely happy
Being abnormally upbeat, wired, or jumpy
Agitation, irritability, explosive outbursts
Exaggerated confidence, self-esteem, grandiosity
Enhanced sense of well-being
Racing thoughts
Easily distracted
Unusually talkative
Changes in sleep patterns (decreased need for sleep)
Irresponsible decision-making, recklessness, outrageous behavior

Consequences of Manic Episodes

Mania is a more severe form of mood change compared to hypomania. It can cause significant problems at work and at home. Sometimes, mania can trigger episodes of psychotic symptoms (loss of contact with reality), which may require hospitalization. Learn about hypomania vs. mania.

Actions and decisions taken during manic and severe hypomanic episodes can have long-lasting consequences for the person and their family members. For example, a person may spend unusual amounts of money, make foolish investments, or engage in risky sexual behavior during a manic episode.

Bipolar II Disorder

Bipolar II disorder is characterized by alternating depressive episodes and hypomanic episodes. Symptoms during a hypomanic episode are less severe in bipolar II compared to symptoms during a manic episode in bipolar I disorder.

Hypomanic Episodes Explained

Hypomania is a milder form of mania with less severe symptoms that last for a shorter time. It is usually more manageable than mania in that it does not affect day-to-day activities so much. A person experiencing a hypomanic episode may be able to continue functioning normally, although other people may notice changes in their mood and behavior.

Major Depressive Episodes Explained

Acute bipolar depression resembles major depression. It is characterized by:

A low mood (sadness, hopelessness, worthlessness)
Loss of interest in previously enjoyed activities
Low self-esteem
Lack of energy
Changes in sleeping patterns (increased or decreased sleep)
Fatigue
Weight changes
Suicidal ideation

Comparing Mood Episodes: Hypomania, Mania, and Depression

Hypomania, mania, and depression are baseline characteristics in people with bipolar disorder. Mania is feeling elated, active, and full of energy. Severe mania can be dangerous without proper treatment. People who experience hypomanic episodes have a milder form of these “up” symptoms and elevated mood. Depressive episodes are feelings of sadness with reduced energy and activity. What are the 10 types of depression?

Bipolar I versus Bipolar II: Additional Differences

Some studies have found the following differences between bipolar I and II disorders:

Bipolar II patients are more commonly women and older.
Bipolar II disorder is typically diagnosed at a later age compared to bipolar I.
People with bipolar II are less likely to seek evaluation after a single episode.
Lithium treatment is usually started after more episodes in bipolar II patients.
Mood stabilizers and antipsychotics are prescribed less frequently to people with early bipolar II disorder, and antidepressants are more common.
More close family members of bipolar II patients have major depression and anxiety disorders.
The usual course of bipolar II disorder is an initial depressive episode followed by multiple depressive episodes and predominantly depressive polarity.
There are fewer hypomania-depression cycles early in the course of the illness in bipolar II patients.
More patients with bipolar II have rapid cycling and/or a high number of episodes.
There is no difference in age at onset of mood disorders, ability to function, number of suicide attempts, family history of suicide, or treatment response to lithium between bipolar I and bipolar II. (Learn: Signs of Lithium Toxicity and What to Do Next)

Key Symptoms and Diagnostic Criteria

Identifying Bipolar I Disorder

Mental health professionals make a diagnosis of bipolar I disorder based on guidelines in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V).

Bipolar I is diagnosed if there is at least one episode of mania with a distinct period of mood disturbance lasting at least 7 days that cannot be attributed to any other medical condition or substance.

Recognizing Bipolar II Disorder:

Bipolar II disorder is also diagnosed by mental health professionals based on guidelines in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V).

Bipolar II is diagnosed if there is at least one episode of hypomania and at least one episode of depression with a distinct period of mood disturbance that cannot be attributed to any other medical condition or substance. People with bipolar II disorder have never had a manic episode.

The Significance of Depressive Episodes in Bipolar Disorders

A depressive episode in people with bipolar disorder is associated with a high suicide risk, up to 20 times higher than the general population. Moreover, depressive symptoms caused by bipolar disorder can be challenging to differentiate from major depression.

Treatment of depressive symptoms caused by bipolar with an antidepressant drug can trigger mania or rapid cycling. Therefore, an accurate diagnosis is vital to ensure proper treatment of depressive episodes in bipolar disorders.

Treatment Options and Managing Bipolar Disorder

Treatment for bipolar disorder includes medications and talk therapies. To achieve the best outcome, treatment for bipolar disorder is typically highly individualized based on the symptoms and a person’s health history.

Mood stabilizers

Mood stabilizers such as lithium (Lithobid) are prescribed to control manic and hypomanic episodes. Example includes lithium (Lithobid)

Anticonvulsants are also used to stabilize mood. Examples include valproic acid/ divalproex sodium/valproate sodium (Depakote, Depakene), lamotrigine (Lamictal), and carbamazepine (Tegretol, Equetro, Epitol).

Learn more about 5 Mood Stabilizers for Treating Bipolar Disorder.

Find out the antipsychotic medications with the least side effects.

Antipsychotics

Antipsychotics are prescribed alone or with mood stabilizers to people with bipolar disorders. Examples include olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), lurasidone (Latuda), ziprasidone (Geodon), asenapine (Saphris), and cariprazine (Vraylar).

Learn about Aripiprazole (Abilify) Side Effects to Look For.

Antidepressants

In many cases, antidepressants have been found to be beneficial in addition to mood stabilizers for the treatment of bipolar disorder. SSRIs (selective serotonin reuptake inhibitors) like citalopram (Celexa), fluoxetine (Prozac), and sertraline (Zoloft) are often used to treat bipolar disorder.

While antidepressants are helpful to manage depressive symptoms, they can sometimes trigger a manic episode in people with bipolar disorder. That’s why antidepressants are always used in combination with a mood stabilizer or antipsychotic.

The U.S. Food and Drug Administration (FDA) has approved a combination antidepressant-antipsychotic called Symbyax (olanzapine/fluoxetine) for the treatment of depressive episodes in people with bipolar I disorder.

Check out: “What You Need To Know About Depression Medication.”

Psychotherapy: Cognitive Behavioral Therapy and Family-Focused Therapy

Psychotherapy is used for the treatment of bipolar I and bipolar II disorders in addition to medications. It may include cognitive behavioral therapy, which helps to identify triggers and replace negative, unhealthy thinking patterns and behaviors with positive, healthy ones. Social rhythm therapy can help people with bipolar disorder establish a consistent routine to better manage mood swings.

In addition, mental health professionals recommend dual diagnosis and treatment for substance use disorders (alcohol and drug abuse), which can trigger, worsen, or prolong bipolar symptoms.

What Medications Are Prescribed In Cognitive Behavioral Therapy (CBT)?

Lifestyle Changes and Self-Care for Managing Bipolar Disorder

A mental health professional can prescribe medications and psychotherapy to manage a mood disorder such as bipolar. However, healthy lifestyle changes also play a major role in managing mood disorders. These include:

Common Questions About Bipolar Disorder

Which is more serious: bipolar 1 or bipolar 2?

Both bipolar I and bipolar II can be serious. They are separate diagnoses. One is not a milder form of the other. A severe full manic episode in bipolar I can be dangerous. A major depressive episode in bipolar II can likewise have serious consequences.

Which is harder to treat: bipolar 1 or 2?

Bipolar I can be harder to treat than bipolar II. However, both bipolar I and II require treatment with medications, therapy, and lifestyle changes.

People with bipolar I have at least one episode of mania. A manic episode may be associated with severe symptoms that are disruptive to daily life. Manic episodes can also trigger psychosis, which can lead to severe psychiatric symptoms such as delusions, paranoia, and hallucinations.

What are 3 signs of bipolar type 2 disorder?

Signs of bipolar II disorder include:

A fluctuation between hypomanic symptoms and depressive symptoms.
Never had a full manic episode.
Rare mood swings that occur multiple times a year.

What is bipolar disorder level 3?

Bipolar disorder level 3 is called cyclothymic disorder.

People with bipolar III disorder (cyclothymia) experience milder hypomanic and depressive symptoms that do not meet the criteria for bipolar I and II disorders.

What is a bipolar 2 person like?

A person with bipolar II experiences hypomanic and depressive episodes. The hypomania is milder than the mania seen in people with bipolar I.

Does bipolar 2 have manic episodes?

No, a person with bipolar II disorder never has manic episodes. Bipolar II disorder is characterized by hypomanic and depressive episodes. The hypomania is less extreme than the mania seen in bipolar I. The depressive episodes of bipolar II tend to be longer and more frequent than those in bipolar I disorder.

Challenges in Treating Bipolar 1 and Bipolar 2

Bipolar disorder is a complex mental health condition. It is influenced by several biological and psychological factors, including genetics, environment, hormones, nutrition, and lifestyle. (Is depression genetic?)

In addition, bipolar disorders affect almost all areas of life, including relationships, work, finances, and significant life events. Therefore, people diagnosed with bipolar disorder need comprehensive treatment and support.

Finding the right combination of treatments can be challenging. It can take some trial and error to find the right medication and dose that has a positive treatment response without causing side effects.

It’s important for people with bipolar disorder to regularly meet with their mental health professional. Periodic adjustments in medications and doses may be required to ensure a positive treatment response.

Understanding Bipolar Disorder Level 3

Bipolar disorder level 3 is known as cyclothymia or cyclothymic disorder. It is characterized by recurrent depressive and hypomanic symptoms. However, these are less severe symptoms that do not qualify as manic depression seen in bipolar I and bipolar II disorders.

Note: A mental health professional may diagnose unspecified bipolar disorder if the symptoms cause significant distress but do not meet the criteria for bipolar I, II, or III.

How Can I Support a Loved One with Bipolar Disorder?

Recognize and Understand Mood Episodes

Bipolar disorder causes extreme mood episodes, including highs (mania or hypomania) and lows (depression). Dealing with these mood swings can be difficult for family members and friends. They can put a strain on relationships and disrupt family life.

Fortunately, most people with bipolar disorder can live active, healthy lives with proper treatment, including medication, psychotherapy, and support.

The important thing is to seek care from a mental health professional if you suspect bipolar disorder in a loved one. They can make a proper diagnosis and recommend appropriate treatment.

Provide Support and Understanding

It’s important for you to be patient, show love and understanding, and provide support and motivation if your loved one is receiving treatment for bipolar disorder. You can help by:

Learning about bipolar disorder and treatment options.
Encouraging the person to see their mental health professionals regularly.
Being understanding, encouraging, and supportive.
Having patience (bipolar disorder treatment takes time, and there is no cure for this lifelong condition).

Resources for Families and Caregivers

For further information about bipolar I versus bipolar II disorder and other helpful resources, visit:

American Psychiatric Association (APA)
National Institute of Mental Health
National Alliance on Mental Health (NAMI)
International Society for Bipolar Disorders
Brain and Behavior Research Foundation

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