Transcript

Clinical differences between bipolar I and bipolar II depression

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What Are Some of the Clinical Differences Between Bipolar I and Bipolar II?

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Rakesh Jain, MD, MPH
Clinical Professor
Department of Psychiatry
Texas Tech University School of Medicine
Midland, Texas
Private Practice
Austin, Texas
(Dr. Rakesh Jain)
What are some of the clinical differences between bipolar I and bipolar II? Depressive episodes—predominant in both bipolar I and bipolar II disorder—may include hospitalization, psychotic symptoms, and functional impairment.
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Depressive episodes may include:

Hospitalization
Psychotic symptoms
Functional impairment

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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed Text Revision. American Psychiatric Association; 2022.

(Dr. Rakesh Jain)
This time spent in depression across both subtypes is greater, on average, than the time spent in mania or hypomania. Furthermore, patients with bipolar II typically experience a higher frequency of depressive episodes that last longer, with 81% of their time ill due to depressive episodes versus 70% for patients with bipolar I.
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Time ill due to depressive episodes
Bipolar II is associated with a higher frequency of depressive episodes that last longer than those of bipolar I^2,3
Two pie graphs are shown with the figures 81% and 70%, with the headers Bipolar II¹ and Bipolar I, respectively.

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1. Forte A et al. J Affect Disord. 2015;178:71-78.
2. Karanti A et al. Bipolar Disord. 2020;22(4):392-400. 3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed Text Revision. American Psychiatric Association; 2022.

(Dr. Rakesh Jain)
Additional differentiators between bipolar I and II include the fact that patients with bipolar II are more likely to have comorbid psychiatric disorders, may have a higher risk of death by suicide, and frequently experience a diagnostic delay of approximately 10 years versus approximately 5 years for bipolar I. The reason for this delay in diagnosis could be that depressive episodes in bipolar disorder are clinically identical to those in unipolar depression; as such, many patients with bipolar disorder can be misdiagnosed with unipolar depression.
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Compared with bipolar I depression, patients with bipolar II...^1-4

Are more likely to have comorbid psychiatric disorders
May have a higher risk of death by suicide
Frequently experience a diagnostic delay of ~10 years (vs ~5 years for bipolar I)⁵

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1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed Text Revision. American Psychiatric Association; 2022.
2. McIntyre RS et al. Lancet. 2020;396(10265):1841-1856. 1841-1856. 3. Dell'Osso B et al. Int J Bipolar Disord. 2021;9(1):3. 4. Karanti A et al. Bipolar Disord. 2020;22(4):392-400.

(Dr. Rakesh Jain)
While depression is predominant, the identification of mania or hypomania is the key factor that distinguishes a diagnosis of bipolar I or II disorder from unipolar depression. Bipolar I disorder is characterized by the presence of at least 1 manic episode that lasts 1 week or more. Bipolar II, on the other hand, is characterized by episodes of depression that alternate with hypomania rather than mania, with hypomanic events that last at least 4 days.
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Bipolar I is characterized by

At least 1 manic episode
Lasting ≥1 week
Hospitalization
Psychotic symptoms (up to 75%)
Functional impairment

Bipolar II is characterized by

Hypomania, not mania
Lasting ≥4 days
No hospitalization
Psychotic symptoms
No marked functional impairment

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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed Text Revision. American Psychiatric Association; 2022.

(Dr. Rakesh Jain)
Hypomania can be difficult to detect because episodes may not be severe enough to affect functioning; examples of hypomanic behavior involve having higher energy levels than usual, with behaviors such as not going to bed, talking fast, or quickly jumping from subject to subject.
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Hypomania can be difficult to detect because episodes may not be severe enough to affect functioning
Examples include¹:

Higher energy levels than usual
Not going to bed
Talking more than usual
Quickly jumping from subject to subject

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1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed Text Revision. American Psychiatric Association; 2022.

(Dr. Rakesh Jain)
In conclusion, depressive episodes are predominant in both bipolar I and II disorder. In particular, bipolar II is often characterized by hypomania versus mania and by a higher frequency of depressive episodes that last longer and have greater severity than those in bipolar I.
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Depressive episodes are predominant in both bipolar I and bipolar II disorder
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Forte A et al. J Affect Disord. 2015;178:71-78.
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