Bipolar disorder is a condition that leads to extreme mood swings causing mania (a euphoric high) or severe depression, and it is believed an estimated 40 million people live with the disorder worldwide. However, there are two different types; bipolar I, and bipolar II. 

Here, we are exploring bipolar I and bipolar II as separate conditions, the key differences between them, how both conditions impact daily life, the challenges in diagnosing one or the other, how each condition is best treated, and where to seek professional help if you think you or a loved one may have bipolar I or II. 

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about bipolar disorder, we can help. 

What is bipolar I?

Bipolar I is a condition causing extreme mood swings of either mania (a euphoric high) or bouts of depression. For many people, these mood swings could last several days at a time, and between times there may be long stretches of emotional stability. For others, they may fluctuate between mania and depression with no periods of emotional stability in between. 

Symptoms of a bipolar I manic episode might include: 

• Feeling extremely elevated, or high
• Feeling very irritable
• Feeling wired or jittery, and more active than usual
• Having racing thoughts  
• A decreased need for sleep
• Talking rapidly about many different subjects 
• Having an excessive desire for enjoyable activities like eating, drinking, sex and more
• Believing they can achieve many things at once without tiring 
• Feeling uncharacteristically powerful or talented 
• Engaging in risky behaviours 
• Experiencing delusions or hallucinations 

In order for the disorder to be categorised as bipolar I, a person will have had at least one manic episode lasting 7 days or more. 

Symptoms of a bipolar I depressive episode might include:  

• Feeling extremely low or sad 
• Feeling anxious or restless 
• Having trouble focusing 
• Finding it difficult to make decisions
• Finding it difficult to fall asleep, waking too early or sleeping excessively 
• Talking slowly and forgetting things 
• Having a lack of interest in activities they once enjoyed 
• Finding it hard to do simple tasks 
• Feelings of hopelessness, worthlessness, or suicidal thoughts 

In order for the disorder to be categorised as bipolar I, a person will usually experience periods of depression lasting at least 2 weeks. In all cases, if someone requires hospitalisation, they may be categorised as having bipolar I. 

The condition can also make it difficult for people to maintain relationships, remain employed, continue with regular interests, and more. 

What is bipolar II?

Bipolar II is difficult to distinguish from bipolar I, as it causes many of the same symptoms, including extreme mood swings of depression. One of the main differentiating factors when it comes to bipolar II is that instead of experiencing mania, a person will usually experience hypomania, which is a less intense form of mania. Hypomanic episodes may cause a person to feel unusually excited, happy or creative, but they will not be at risk of delusions or hallucinations in the same way people with bipolar I are. They may engage in some risky behaviours, like spending sprees or hasty business decisions, but not in the same potentially damaging or dangerous way those with bipolar I might do. 

For a person to be categorised as having bipolar II, they will usually have experienced major depressive episodes lasting at least 2 weeks (similarly to bipolar I), along with at least one episode of hypomania. Research suggests the depressive episodes in bipolar II are often more frequent and last longer than those experienced by people with bipolar I, and they may also persist for longer throughout life. 

Bipolar II was first differentiated from bipolar I in 1994 in order to separate the two sets of symptoms and give both types of bipolar disorder the appropriate treatment. Similarly to bipolar I, people with bipolar II may or may not return to a state of emotional stability between depression and hypomania. Those with bipolar II are generally more likely to be able to keep steady employment and maintain healthy relationships with others.

Doctors may easily misdiagnose bipolar II as depression due to the lack of mania symptoms, and depression being the primary symptom. 

What differences are there between bipolar I and II?

There are several different types of bipolar disorder, including cyclothymia, rapid cycling bipolar, bipolar with mixed features, or bipolar with seasonal pattern. Often, bipolar will be categorised as either bipolar I or II , and the main differences between them are typically the severity and duration of symptoms, as well as how they impact the person’s daily activities and quality of life. 

The two can be differentiated by a few key factors: 

• Bipolar I tends to cause severe mood elevations called mania that last at least one week or require hospitalisation, while bipolar II causes less severe mood elevations called hypomania. For clarity, those with bipolar I can experience hypomania too, but this will usually be alongside mania. 
• Bipolar I may not lead to a depressive episode, while bipolar II will almost certainly include depressive episodes which define the condition, and can be longer lasting than those found in bipolar I. 
• Bipolar I may cause psychosis symptoms such as delusions or hallucinations, but bipolar II will not. 
• Bipolar I may lead to hospitalisation, but this is unlikely for those with bipolar II.
• Bipolar I is likely to significantly impact people’s daily functions, while those with bipolar II may not experience the same significant impacts on their ability to manage daily life and relationships. 
• Both those with bipolar I and bipolar II may be recommended treatments that include a combination of medication and therapy, but those with bipolar I may be prescribed medications to treat symptoms of psychosis if needed. 

What are the challenges in diagnosing bipolar I vs bipolar II? 

As mentioned, there are often challenges when diagnosing bipolar disorder due to overlapping symptoms of other mental health conditions. It can also be difficult to categorise either bipolar I or II due to overlapping symptoms. 

Often, bipolar II is misdiagnosed as depression due to bouts of depression being a primary symptom, while bipolar I can be misdiagnosed as another disorder with symptoms of psychosis. One study suggested 31% of patients with bipolar I were mistakenly diagnosed as having another disorder with obvious psychotic symptoms, such as schizophrenia. 

In order to ensure patients receive the correct diagnosis, a detailed assessment must be done while looking at the person’s medical and mental health history. Symptom tracking can also help to achieve an accurate diagnosis.

How are bipolar I and bipolar II treated? 

Treatment for bipolar disorder, no matter which kind, is always unique for each individual depending on their specific type of bipolar disorder and their symptoms, which can differ from case to case. Both bipolar I and bipolar II are typically treated with a combination of medications and therapy, however certain lifestyle changes may be recommended by doctors or therapists in order to improve general health, which can in turn have a positive effect on the severity of symptoms. 

Medications 

Treatments for bipolar I and bipolar II usually consist of mood stabilising medications, antipsychotics or antidepressants. For example:

• Mood stabilisers to control episodes of mania or hypomania, such as lithium, or anticonvulsant medicines such as carbamazepine, lamotrigine or valproate. Mood stabilisers are usually used for both bipolar I and II.
• Antipsychotics to control symptoms like hallucinations or delusions, such as haloperidol, olanzapine, quetiapine or risperidone. These will usually be prescribed to those with bipolar I, and can be prescribed alongside mood stabilising medications.
• Antidepressants to help with the depressive symptoms of both bipolar I and II, but primarily bipolar II, which tends to cause more severe depressive symptoms. These must be carefully prescribed and monitored, as sometimes antidepressant medications can trigger manic episodes in those with bipolar I. 

Keep in mind that when taking medications for bipolar disorder, several different medications or combinations may need to be tried out to find what works best and to find a balance. It is important to speak to a therapist or doctor on a regular basis to discuss how medications are going, adjust doses if needed, or switch to something else that may better manage symptoms and side effects.

Therapy

Several types of therapy can be recommended for those with bipolar disorder, depending on what they struggle with. These may include: 

• Cognitive behavioural therapy (CBT) to identify unhealthy belief systems and behaviours, and replace them with more healthy and positive ones. This is more likely to be recommended during depressive episodes rather than manic or hypomanic episodes. 
• Interpersonal and social rhythm therapy (IPSRT) can help to establish a consistent routine in order to better manage mood in daily life. 
• Family therapy is sometimes recommended for those with bipolar disorder to help family members understand the needs of a loved one with this condition.  
• Substance abuse treatments (if necessary), as many people with bipolar disorder suffer from accompanying alcohol or drug addictions in a misguided effort to control symptoms. One study found that increased alcohol use was associated with increased depression and manic/hypomanic symptoms, and this association was more pronounced in bipolar II than bipolar I. While substances can alleviate symptoms for a short time, they can also trigger or worsen symptoms like depression or mania, so getting treatment for this is important. 
• Group psychoeducation or support groups can provide a safe space to discuss symptoms and helpful coping mechanisms with others who understand the emotional difficulties of living with bipolar disorder. 

Lifestyle Changes 

Lifestyle changes can make a big difference to the experience of someone living with bipolar I or bipolar II. The changes that may be recommended to a person with bipolar I or II include:

• Get more sleep – Sleep issues are a regular occurrence in those with bipolar disorder, but there is a bidirectional relationship, meaning treating insomnia symptoms can lessen the impact of the disorder. Adequate sleep has been found to help improve bipolar disorder symptoms. 
• Manage stress levels – Studies have found people with bipolar disorder reported more life events before acute mood episodes, suggesting stress can impact the symptoms of bipolar disorder. For this reason, working to reduce stress levels can help to keep the symptoms of bipolar disorder under control. 
• Eat a healthy, balanced diet – For those with bipolar disorder, a diet with plenty of wholegrains, omega-3 fatty acids and magnesium is recommended to improve overall health and minimise symptoms. 
• Get regular exercise – Getting exercise on a regular basis can help with both stress management and improving overall health, so there are many potential benefits of both acute and long-term exercise routines for those with bipolar disorder. 
• Create a more structured and stable routine – By focusing on doing things at the same time each day, and keeping routines manageable, people with bipolar disorder can avoid unnecessary stress and be more efficient in managing symptoms when they do arise.  

Where can someone with bipolar I or II seek support? 

If you live with bipolar disorder, or you suspect you may have bipolar I or II, it is extremely important to seek professional support for an accurate diagnosis and appropriate, tailored treatment plan. Doing so can not only confirm your symptoms do in fact indicate a variation of bipolar disorder, but it can identify whether you have bipolar I or bipolar II, provide better understanding of the condition, and advise the best ways to manage this. 

If you would like to explore therapy treatment options for bipolar disorder, you can speak to your GP about this during your discussions about medication, or if you would like to access support without being stuck on a long NHS waiting list, you can speak to a private provider like Augmentive. We can help you to manage your bipolar disorder diagnosis and support you on your treatment journey. You can find further helpful resources and advice on bipolar disorder through the NHS, as well as through Mind.org.uk. 

You can also learn more in our articles:

• Understanding how a person with bipolar disorder thinks
• The Overlaps In ADHD And Bipolar Disorder
• Can You Have Both Autism And Bipolar Disorder?

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from a private bipolar assessment, to help finding a psychiatrist near you for support.

We believe all advice and support for those with bipolar disorder should be personalised to each person’s individual situation, and our free 15 minute consultation can help match you with an appropriate professional who can help you.