Diagnostic Criteria and Treatment Approaches for Bipolar II Disorder

Diagnostic Criteria

• The American Academy of Child and Adolescent Psychiatry states that Bipolar II Disorder requires periods of major depression and at least one hypomanic episode (lasting at least 4 days) with no history of full manic or mixed manic episodes 1
• The American Academy of Child and Adolescent Psychiatry also states that Bipolar I Disorder, current episode depressed, requires a history of at least one manic episode (lasting at least 7 days unless hospitalization is required) plus a current depressive episode 1
• Hypomanic episodes in Bipolar II are less severe than manic episodes and do not cause marked impairment in social or occupational functioning or require hospitalization 1

Treatment Approaches

• The treatment guidelines recommend lithium or valproate as the foundation of maintenance treatment for Bipolar II, with antidepressants added only in combination with mood stabilizers for depressive episodes 2
• Antidepressants should always be combined with mood stabilizers in Bipolar II depression to prevent triggering hypomania 2
• SSRIs are preferred over tricyclic antidepressants for bipolar depression in both conditions 2
• Both conditions require psychoeducation about symptoms, course of disorder, treatment options, and impact on functioning 2
• Both benefit from cognitive behavioral therapy and family interventions when trained professionals are available 2
• Establishing stable social and sleep routines is particularly important in both conditions 2