Bipolar Disorder Q&A: Do I have Bipolar I or II?

By Candida Fink MD

OuchOuch Asks…

I did not experience hypomanic symptoms until I started taking anti-depressants. Anti-depressants didn’t work for me – they either didn’t work or they revved me up. Mood stabilizers helped my depression. I was therefore diagnosed as Bipolar II – is it really Bipolar II?

Dr. Fink Answers…

Bipolar disorder usually fits into one of the following five categories:

• Bipolar I: Characterized by at least one full-blown manic episode that doctors can’t attribute to another cause, such as a medication or substance abuse. A Bipolar I diagnosis doesn’t require an episode of major depression.
• Bipolar II: A type of bipolar disorder characterized by at least one major depressive episode that doctors can’t attribute to another cause, along with experiencing one or more hypomanic episodes.
• Cyclothymia: Sometimes referred to as “bipolar lite,” cyclothymia is a muted form of bipolar disorder that nevertheless interferes with your life. It involves multiple episodes of hypomania and depressive symptoms, which don’t meet the criteria for mania or major depression. Symptoms must last for at least two years, during which you have no more than two months without symptoms.
• Bipolar NOS: A type of bipolar disorder characterized by hypomanic, manic, or depressive episodes that don’t fit in any of the other bipolar categories and can’t be ascribed to unipolar depression.
• Rapid cycling: A state in which mood alternates between depression and mania more than four times in a year.

Based solely on what you describe in your question, you may or may not actually have bipolar disorder. This is what my co-author and I have referred to as “diagnosis by prescription.” Antidepressants can cause hypomania or mania and it is simply a side effect – not an indication of another disease. Not responding to antidepressants but responding to mood stabilizers suggests bipolar disorder, but not necessarily. Since both of these factors exist for you, the possibility that it is Bipolar II is certainly elevated, but you might consider a second opinion or simply bring this question to your prescriber for a full discussion.

You should be aware, however, that if you do, in fact, have Bipolar II, your diagnosis could change to Bipolar I if you were to experience a full-blown manic episode that cannot be attributed to something else, such as an antidepressant or some other illness.

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