From Becca Trabin: Bipolar Disorder for Dummies
Question No. 1 in our series: What’s the difference between Bipolar I and Bipolar II?
According to the Depression and Bipolar Support Alliance:
Bipolar I is “characterized by one or more manic episodes or mixed episodes (symptoms of both a mania and a depression occurring nearly every day for at least one week) and one or more major depressive episodes.”
Bipolar II “is diagnosed after one or more major depressive episodes and at least one episode of hypomania, with possible periods of level mood between episodes.” Bipolar II is further characterized by more rapid cycling between depression and hypomania.
In short, Bipolar I patients are more manic, and Bipolar II patients are more depressed. Bipolar I is more severe in terms of frequency of psychotic displays, while Bipolar II is more severe in terms of frequency of suicides.
-For all intents and purposes, why distinguish between the two?
A misdiagnosis can lead to improper treatment, as people with Bipolar I benefit from higher doses of mood stabilizers and antipsychotics, and people with Bipolar II benefit from higher doses of antidepressants. Those with Bipolar I who are not treated for manic episodes will continue to get worse, as will those with Bipolar II who are not treated for depression.
However, it’s important to keep in mind that all of the taxonomical distinctions in the DSM IV are fluid and subject to revision (i.e. homosexuality is no longer a mental illness). The human brain is highly complex and capable of many feats, especially with the aid of Cognitive Behavioral Therapy. Diagnoses of mental disorders are best viewed as stepping stones leading to effective treatment, not life-long labels under which to suffer.
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liz | 12:33 PM | Uncategorized
What’s more, the issue of Type I vs. Type II is complicated by the fact that some people, myself among them, carry a diagnosis of BPD, yet don’t slot neatly into either type, instead yanking symptoms from each in an a la carte manner. I’ve never had a major depressive episode (that I know of), so II should be ruled out. But I’ve never had a full-blown manic one, either, so there goes I. I have periodic episodes of easily identified hypomania interspersed with periods of comparative euthymia or mild dysthymia. So I could be labeled either a watered-down Type I or a cyclothymic-leaning version of Type II.
The take-home message is that it’s going to take a while to figure out what the best drug regimen for me is (not that it wouldn’t in any case). I was diagnosed in April but probably could have been diagnosed a decade earlier, but my BPD was neatly masked by violent binge-drinking-style alcoholism.
Anyway, great points.
Haven’t read here for awhile, for which I’m sorry. BP I & II. I just thought that people with II (like me) aren’t quite as far as people with I. Poets like Robert Lowell, who would fight four cops at the same time, definitely fit as BP I. Me? Well, what forced me to get diagnosed was a Level I case of hypomania. No surprise, I worked itself out as sexualized behavior that was less pleasurable than totally exploitive. Nasty.
Now, if antipsychotics are given to BP I rather than II, why did a psychiatrist react to my insomnia in June by giving me Seroquel, a deck gun aimed at a balsa wood house. I flipped out: which is to say I exhibited all the symptoms of someone with a stroke. Unsteady walk, almost no speech, disorientation. I was afraid I was losing my mind entirely. The hospital e-room threw me into a CAT scan: no brain damage. I did in fact come back from the medication poisoning to about 3 weeks more of insomnia that was almost unbearable. The med was horrible. Needless to say I don’t go to that shrink anymore….
I fit clearly into the BP1 category, but 4 years after diagnosis my psychiatrist and I have yet to hit on the “perfect” med cocktail. It’s been a long and painful road.
With regard to the comment from ambibextrous: in a lot of the reading I’ve done I’ve noticed a trend towards speaking of a bipolar *spectrum*, rather than a clear delineation between types 1 and 2. Perhaps looking at it in those terms might be helpful in the struggle you’re having with not feeling that you fit anywhere. I do think that categories can be helpful (in my case, because I feel it gives me something to hold on to), but I agree with Becca that at the end of the day it should be about finding the treatment appropriate to one’s unique set of symptoms. If you’re working with a psychiatrist who has that perspective, then I think you’re on the right track – however frustrating the merry-go-round of trying to find the right med combo is.
To echo ambidextrous . . . I too have a hard time placing my sypmtoms precisely in either category.
I’m presently “Bipolar 2 vs. Other.” My shrink tells me she adds the “vs. Other” b/c she suspects I’m really Type 1.
No question I’ve gone through pretty severe depressions, but the manic side is harder to pin down. I’ve had several stretches that I think were hypomania, but only one episode that seems likely to qualify as mania. And that one (a) was brief, (b) was so booze-fueled that I can’t remember much of it, & (c) was also probably a suicide attempt.
I’ve also only taken one drug specifically for BP (Lamictal), & haven’t been able to tell for sure what effect it’s been having. I’ve taken SSRIs for several years, & they never sparked mania.
So am I 1 or am I 2? Personally, I think the whole BP spectrum concept makes more sense, esp. when you toss in cyclothymia, mixed states, etc.
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