Bipolar 1 vs. Bipolar 2: Understanding the Difference Between These Mental Health Conditions

Bipolar disorder is a mental health condition where people have different mood episodes over time - ranging from low-energy depression to high-energy mania. There are different types of bipolar disorder, including:

• Bipolar 1

• Bipolar 2

• Cyclothymic disorder

• Other types of bipolar disorders

Bipolar 1 and bipolar 2 are the most common. And they share a lot of similarities, especially since both can cause episodes of hypomania and depression. But there's one key difference: People with bipolar 1 can also have mania, but people with bipolar 2 do not. This matters because manic episodes can be much more disruptive to your life, and can even result in hospitalization.

What is bipolar 1?

Bipolar type 1 is a mental health condition that causes mood episodes. These episodes typically come and go over time.

Mood episodes in bipolar 1 include:

• Manic episodes

• Depressive episodes

• Hypomanic episodes

To be diagnosed with bipolar 1 disorder:

• You must have had at least one manic episode in your lifetime.

• You may or may not have had depressive or hypomanic episodes.

What is bipolar 2?

Bipolar type 2 is also a mental health condition that causes mood episodes. Just like with bipolar type 1, when you have bipolar 2 your mood episodes can come and go.

Mood episodes in bipolar 2 include:

• Depressive episodes

• Hypomanic episodes

To be diagnosed with bipolar 2 disorder:

• You need to have experienced at least one depressive episode.

• You've never had a manic episode.

Symptoms of bipolar disorder: Depressive, manic, and hypomanic episodes

Bipolar 1 and bipolar 2 share many of the same symptoms - with one key difference. People with bipolar 2 don't have episodes of mania.

Let's take a closer look at the three different types of mood episodes that people with bipolar disorder experience.

Depressive episodes

Depressive episodes (or "bipolar depression") can happen in both bipolar 1 and bipolar 2. These episodes have the same symptoms as major depression.

Symptoms of a depressive episode in bipolar disorder include:

• Feeling sad, depressed, or hopeless nearly every day

• Not feeling interested in your normal activities

• Changes in appetite, significant weight gain, or significant weight loss

• Trouble sleeping at night, or sleeping a lot during the day

• Feeling very physically restless, or feeling heavy and weighed down

• Feeling guilty or worthless

• Problems concentrating or making decisions

• Thoughts about death or suicide

To be classified as a depressive episode, at least 5 of these symptoms (including low mood or loss of pleasure) have to be present for 2 weeks or longer.

Manic episodes

According to the DSM-5 - a clinical guidebook - mania and hypomania have the same basic symptoms.

These symptoms include:

• Experiencing an elevated, energetic, or irritable mood

• Feeling like you're special, powerful, or important

• Having a decreased need for sleep

• Talking more than usual or talking very quickly

• Jumping from topic to topic

• Experiencing racing thoughts

• Being easily distracted

• Working with unusual intensity on projects at home, work, or school

• Feeling restless or having a hard time sitting still

• Engaging in risky behaviors, like excess spending, substance abuse, or sexual activities

During a manic episode, your symptoms can cause serious problems at home, work, or school. Many people with mania also experience psychosis (a break with reality). And during a manic episode, it can even become hard to take care of your basic needs, like eating, getting dressed, getting adequate sleep, and maintaining a place to live.

Hypomanic episodes

During a hypomanic episode, symptoms are the same as in a manic episode. The difference? The symptoms are less severe.

Friends and family may notice that you're acting differently than usual. But you can still keep up your daily activities. People with hypomania don't have psychosis and usually don't need to be hospitalized.

Is it mania or hypomania?

It can sometimes be hard to tell a manic and hypomanic episode apart. After all, as we mentioned above, the basic symptoms of mania and hypomania are technically the same.

But there are some differences between a manic episode and a hypomanic episode. Let's take a look at a side-by-side comparison.

Quiz: Am I Bipolar?

Diagnosing bipolar disorders 1 and 2

Just like most other mental health conditions, bipolar disorder is a clinical diagnosis. This means a mental health professional - usually a psychiatrist - can diagnose bipolar disorder by talking to you and observing your symptoms. They may also want to talk to your friends and family (with your permission).

When talking with you, your mental health professional will want to learn more about your current and past symptoms. They may also want to hear more about your family members, since bipolar disorder can run in families.

If your mental health professional suspects bipolar disorder, they'll also look for clues about whether or not you've had a manic episode in the past. This will help them to decide if you have bipolar 1 or bipolar 2.

How do treatments vary for bipolar 1 vs. 2?

Treatment for bipolar 1 and bipolar 2 usually includes medication and therapy. Many of the same medications are used to treat manic, hypomanic, and depressive episodes.

Medications

Common medications for both bipolar 1 and bipolar 2 include:

• Lithium

• Valproic acid

• Aripiprazole

• Haloperidol

• Olanzapine

• Quetiapine

• Risperidone

• Lurasidone

Medications can stop a mood episode in progress. Many people with bipolar disorder also take medication long term to stabilize their mood and prevent future episodes.

Therapy

Most of the time, bipolar disorder is treated with medication. But, for some people, therapy can help, too. Types of therapy that can work for bipolar disorder include:

• Cognitive behavioral therapy (CBT)

• Interpersonal and social rhythm therapy (IPSRT)

• Family-focused therapy (FFT)

• Dialectical behavior therapy (DBT)

Therapy is a great place to get support. It can also help with mood symptoms, like depression and irritability. It's also a good way to understand your disorder and learn how to manage it.

What causes bipolar disorder?

It's not clear what causes bipolar disorder. Like other mood disorders, the cause of bipolar disorder is probably a combination of genetics, environment, and life experiences. It may also be related to how your brain functions and how it uses certain chemicals, like serotonin and dopamine.

What triggers a manic episode?

It's hard to say. There's some evidence that positive life events may trigger mania when you have bipolar disorder, especially if these events disrupt your daily routine.

Examples of triggers include:

• Falling in love

• Starting a new project

• Frequently going to late-night parties

• Going on vacation

• Listening to loud music

• Doing activities that disrupt your sleep

Caffeine, alcohol, and drug use may also make some people with bipolar disorder more likely to have a manic episode. And some people find that seasonal changes or changes in the weather can also affect their mood episodes.

When to seek help

If you're concerned about bipolar disorder, talk to your medical care team. They can help you understand whether you're dealing with bipolar disorder type 1 or type 2, or something else altogether.

You should reach out for help as soon as possible if you (or a loved one) is:

• Having a hard time caring for your basic daily needs

• Engaging in risky, dangerous, or extreme behavior

• Putting other people at risk

• Having difficulty managing your medications or medical appointments on your own

Most of the time, people with hypomania don't need to stay in the hospital. But manic and depressive episodes sometimes need to be treated in a hospital setting, especially if your symptoms are severe.

Tips on supporting a loved one with bipolar disorder

If you have a friend or family member with bipolar disorder, it can be tough to know where to begin, especially since 1 in 5 people with bipolar disorder may not be aware that they need help.

Educating yourself about bipolar disorder is a great place to start. You can also consider joining a support group for friends and family of people with mood disorders. You may also want to find a therapist to talk to about your challenges. Since mood episodes tend to recur in bipolar disorder, it can also be helpful to put together a crisis plan to prepare for future episodes.