Michael W. Otto, PhD
Michael W. Otto, PhD, a professor of psychology at Boston University. He is coauthor, with Jasper A.J. Smits, PhD, of Exercise for Mood and Anxiety: Proven Strategies for Overcoming Depression and Enhancing Well-Being.
It’s widely known that bipolar disorder causes violent mood swings—from deep depressions to wildly manic episodes that may require hospitalization. But sometimes, the mood swings are less extreme.
With bipolar II disorder, a milder form of bipolar disorder, sufferers are subjected not only to depression but also to periods of extra energy (sometimes accompanied by outbursts of anger and irritability), heightened activity and reduced need for sleep. The difference, however, is that the “highs” that occur with bipolar II disorder are less severe (and typically less frequent) than the uncontrolled excesses of mania that characterize bipolar disorder. In the roughly two million Americans who have bipolar II, these highs (“hypomanic” episodes) last at least four days.
Problem: Because depression is usually more prominent than the hypomanic episodes, bipolar II is often mistaken—sometimes for years—for simple (“unipolar”) depression.
When bipolar II is misdiagnosed as simple depression, it is often treated with an antidepressant, such as fluoxetine (Prozac) or escitalopram (Lexapro). However, for unknown reasons, these drugs, when used alone, are unlikely to help the depression of bipolar II—and may, in fact, trigger hypomanic episodes or even bouts of full-blown mania.
That’s why it’s crucial to fully describe your symptoms to your doctor if you are diagnosed with depression. Be sure to tell him/her about any hypomanic symptoms, such as periods of excessive energy and self-esteem, diminished need for sleep, racing thoughts, distractability, irritability or other symptoms that characterize bipolar II.
Because bipolar II causes both hypomanic episodes and depression, proper drug therapy includes a mood stabilizer, such as lithium, valproic acid (Depakote), olanzapine (Zyprexa) or aripiprazole (Abilify)—along with other drugs, including antidepressants, added when necessary.
Although mood-stabilizing medication is considered a core treatment for bipolar II, psychotherapy is used to further stabilize mood and improve day-to-day functioning—with benefits usually occurring with 12 to 20 sessions. Shown to help…
Cognitive behavior therapy aims to change self-defeating actions and negative thinking patterns that foster and exacerbate mood episodes. The negative patterns are replaced with ways of thinking and behaving that help keep one’s mood even and prevent relapses.
Interpersonal therapy focuses on resolving personal conflicts that can cause or result from disturbed moods. It also teaches problem-solving skills to build strong, supportive relationships.
Focused family therapy promotes understanding and communication among family members to ease the strains of living brought by bipolar II disorder.
It’s wise for people with bipolar II to learn all they can about their condition—and encourage their family members to do so as well. Web sites that provide useful information on bipolar II: Depression and Bipolar Support Alliance, DBSAlliance.org…and Mental Health America, nmha.org.
Knowing what to expect—and seeing problems, such as irritability and anger, as symptoms of the disorder rather than personal shortcomings—will help ease friction and maintain the strong family support that promotes emotional well-being.
It’s hard to tell on your own when your mood is darkening or getting unrealistically upbeat. Educate your family about warning signs (such as those described earlier) so they can guide you to seek help from a doctor, who may adjust your medication or suggest a change in treatment before things get out of hand. Regular family meetings also help keep lines of communication open. In addition…
A predictable routine in which activity patterns remain constant will help keep your moods stable.
Because disrupted sleep has been shown to increase the risk for both hypomanic and depressive episodes, people with bipolar II should plan to go to sleep and wake up at around the same time every day—on weekdays and the weekend. This is particularly important in times of stress.
If you have trouble sleeping, seek professional help. It could be an early warning of a mood episode.
Tension at work and/or at home or even positive life changes, such as a job promotion or marriage, can undermine mood stability.
There are lots of stress-relief remedies—the key is finding what works for you. Listening to music…going to the movies…gardening…reading…spending time with friends. What do you find pleasurable, relaxing and a real break from everyday cares? Also consider trying relaxation exercises and/or meditation to help you unwind.
Set aside 30 to 60 minutes for stress relief daily. If you anticipate a period of high demand or turmoil, consider scheduling a little extra time for stress-relieving activities.
For people with bipolar II, exercise is especially important. That’s because it improves sleep and has a beneficial effect on mood. In fact, studies have repeatedly shown that exercise can be as effective as an antidepressant in treating depression and is a helpful addition when medication isn’t working as well as it should.
A reasonable goal is 150 minutes per week of moderate exercise (brisk walking, leisurely swimming or biking, for example). That’s the equivalent of a half hour a day, five days a week.
Important: If you’ve been sedentary, start with brief bouts of exercise (a 10-minute walk at a comfortable pace, for example) and gradually work up to the goal.
Unwise use of alcohol can trigger or worsen mood episodes in people with bipolar II. For this reason, it’s usually best for those with the disorder to avoid alcohol and potentially addictive medications such as opiate painkillers.