Treatment for Bipolar 2 Disorder

Pharmacological Treatment

The American Academy of Psychiatry recommends lithium or valproate as the foundation of maintenance treatment for bipolar 2 disorder, with antidepressants added only in combination with mood stabilizers for depressive episodes 1
Maintenance treatment with mood stabilizers should continue for at least 2 years after the last episode of bipolar disorder 1
Decisions to continue maintenance treatment beyond 2 years should preferably be made by a mental health specialist 1
Lithium requires close clinical and laboratory monitoring, and should only be initiated in settings where these monitoring capabilities are available 1
Second-generation antipsychotics may be considered for acute hypomanic episodes if availability and cost are not constraints 1
Antipsychotic medications should generally be prescribed one at a time 2
For moderate to severe depressive episodes, antidepressants may be used but ALWAYS in combination with a mood stabilizer (lithium or valproate) 1
SSRIs (such as fluoxetine) are preferred over tricyclic antidepressants for bipolar depression 1

Psychoeducation should be routinely offered to all individuals with bipolar 2 disorder and their family members/caregivers 1
Information should cover symptoms, course of the disorder, treatment options, impact on psychosocial functioning, and heritability 3
Cognitive behavioral therapy and family interventions should be considered when adequately trained professionals are available 1
Family-focused therapy emphasizes treatment compliance, positive family relationships, and enhances problem-solving and communication skills 3
Interpersonal and social rhythm therapy focuses on reducing stress and vulnerability by stabilizing social and sleep routines 3
Education about medication compliance, recognition of early relapse symptoms, and factors that may precipitate relapse (e.g., sleep deprivation, substance abuse) is crucial 3
Stress reduction and promotion of stable social and sleep habits are particularly important targets 3
Establishing a strong therapeutic relationship and regular follow-up assessments improve treatment adherence 3

Interventions to enhance independent living and social skills should be considered 1
Support for inclusion in economic activities appropriate to the patient's social and cultural environment should be facilitated 1
Supported employment may be considered for those who have difficulty obtaining or retaining employment 1