A mood disorder characterized by depressive and hypomanic episodes, without full mania
1. Definition & Diagnostic Criteria (DSM-5)
Bipolar II requires:
✅ At least one major depressive episode
✅ At least one hypomanic episode (lasting ≥4 days)
✅ No history of full mania (distinguishes from Bipolar I)
Key Features:
- Hypomania is less severe than mania (no hospitalization/psychosis required)
- Depressive episodes are often more frequent and prolonged than hypomanic episodes
2. Hypomania vs. Mania Comparison
| Feature | Hypomania | Mania |
|---|---|---|
| Duration | ≥4 days | ≥7 days |
| Functioning | No marked impairment | Severe impairment |
| Psychosis | Never present | May occur |
| Hospitalization | Not required | Often required |
Depressive Episode Criteria:
Same as Major Depressive Disorder (MDD), but often more treatment-resistant
3. Clinical Presentations
| Episode Type | Duration | Key Features |
|---|---|---|
| Hypomanic | 4+ days | Increased energy, decreased sleep need |
| Depressive | 2+ weeks | Hopelessness, fatigue, anhedonia |
| Mixed Features | Variable | Dysphoric hypomania (agitation + depression) |
High-Risk Signs:
• Suicide attempts (higher risk than Bipolar I during depressive phases)
• Misdiagnosis as MDD (especially if hypomania goes unreported)
4. Causes & Risk Factors
| Category | Contributors |
|---|---|
| Genetic | 70% heritability (strong family history) |
| Neurobiological | Altered amygdala reactivity, circadian disruptions |
| Environmental | Sleep deprivation, antidepressant use (may trigger hypomania) |
Myth Buster:
❌ “Hypomania is harmless” → Often precedes devastating depressive crashes
5. Diagnosis Challenges
Common Pitfalls:
• Patients often don’t report hypomania (feels “normal” or productive)
• Misdiagnosed as:
- MDD (if hypomania unrecognized)
- Borderline Personality Disorder (due to mood swings)
Assessment Tools:
• Hypomania Checklist (HCL-32)
• Mood Disorder Questionnaire (MDQ)
6. Treatment Approach
A. Medication Management
| Class | Examples | Notes |
|---|---|---|
| Mood Stabilizers | Lamotrigine, Lithium | First-line for depression prevention |
| Atypical Antipsychotics | Quetiapine, Lurasidone | FDA-approved for bipolar depression |
| Avoid | Antidepressants alone | High risk of switching to hypomania |
B. Psychotherapy
• CBT (identify early mood shifts)
• Interpersonal Social Rhythm Therapy (IPSRT) (stabilize daily routines)
C. Lifestyle Management
• Strict sleep schedule (critical for mood stability)
• Mood tracking (apps like eMoods)
7. Prognosis & Course
• Chronic condition requiring lifelong management
• 15-20% progress to Bipolar I (usually after antidepressant-induced mania)
• Better outcomes with:
- Early diagnosis
- Sleep hygiene
- Stress reduction
8. Special Populations
| Group | Clinical Pearls |
|---|---|
| Women | Higher antidepressant-triggered switching risk |
| Elderly | Often misattributed to “age-related” mood changes |
| Students | Hypomania may boost academic performance temporarily |