Management of Bipolar II Disorder

Abstract

Bipolar II disorder (BP II) disorder was recognized as a distinct subtype in the DSM-IV classification. DSM-IV criteria for BP II require the presence or history of one or more major depressive episode, plus at least one hypomanic episode, which, by definition, must last for at least 4 days. Various studies found distinct patterns of symptoms and familial inheritance for BP II disorder. BP II is commonly underdiagnosed or misdiagnosed. Making an early and accurate diagnosis of BP II is utmost importance in the management of BP II disorder. The clinician should have this diagnosis in mind when he is facing a patient presenting with mood problems, particularly unipolar depression. Quetiapine and lamotrigine are the only agents with demonstrated efficacy in double-blind RCT. Although the evidence for the use of lithium in long-term therapy is largely based on observational studies, the many years of close follow-up, comparatively larger subject numbers, and ‘harder’ clinically meaningful with bipolar disorder outcomes measures, enhance our confidence in its role in treating BP II. With respect to short-term treatment, there is some limited support for the use of risperidone and olanzepine in hypomania and for fluoxetine, venlafaxine and valproate in treating depression. The current clinical debate over whether one should use antidepressants as monotherapy or in combination with a mood stabilizer when treating BP II depression is not yet settled. There is a need for large, well-designed RCTs to cast more definitive light on how best to manage patients with BP II disorder.

Bordering on the bipolar: a review of criteria for ICD-11 and DSM-5 persistent mood disorders

“…Although research will continue to determine the prevalence and aetiology of these disorders, there are some other relevant factors that may have led to the increasing popularity of the diagnosis of ‘bipolar II disorder’ rather than ‘borderline personality disorder’. The idea that prevailing fashion may determine a psychiatric diagnosis is rather disconcerting, especially as the treatment of these disorders is radically different: personality disorders are treated with psychotherapy, whereas bipolar I disorder is treated with medication (Benazzi 2007; Wong 2011). However, there is increasing evidence that bipolar II disorder may be a separate entity from bipolar I disorder (the majority of published research has focused on bipolar I disorder) (American Psychiatric Association 2013; Hall-Flavin 2019).…”

“…For example, bipolar II disorder is often associated with chronic low mood over years, rather than intermittent discrete depressive episodes. The majority of treatments have been devised and tested in bipolar I disorder, rather than bipolar II disorder, although the two conditions are often treated in the same way (Benazzi 2007; Wong 2011; Hall-Flavin 2019).…”

Unusual Distress 5 Months After Delivery

“…15 The medical and personal context of a psychiatric disorder that develops during pregnancy or postpartum plays a critical role in treatment and outcome. Evaluating and mobilizing appropriate social and material support is critical.…”

Mood-Stabilizing Agents

“…In maintenance treatment, lithium and probably also other mood-stabilizers except lamotrigine appear to be more effective against hypomanic > manic > mixed > depressive phases in type I bipolar disorder [ 125,332 ] , and is at least as effective as alternative treatments in rapid-cycling bipolar disorder [ 248,335 ] . Lithium also appears to be effective in type II bipolar disorder in protecting against recurrences of major depression, and especially of hypomania, although controlled, long-term treatment trials in bipolar disorders other than type I are uncommon [ 249,322,332,382 ] . Lithium also may have bene fi cial effects when used adjunctively in nonbipolar depression, although the place of routine lithium treatment in unipolar major depression without even suggestive evidence of bipolarity is neither secure nor FDA approved [ 80,140,213,234 ] .…”