Bipolar 2 Disorder
The essential feature of Bipolar II Disorder is a clinical course that is characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode.
Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2 week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
For adults depressed mood most of the day occurring nearly every day, whilst for children and adolescents it can be irritable mood.
Loss of interest or pleasure in all, or almost all, activities most of the day occurring most days.
Significant weight loss when not dieting or weight gain, a change of more than 5% of body weight in a month, or a decrease or increase in appetite nearly every day. In children, failure to make age expected weight gains can be taken into account.
Unable to sleep or sleeping too much which occurs most days. People when depressed often have problems falling asleep and will frequently awake very early in the morning. This is called insomnia. Hypersomnia occurs when a person sleeps too much. They may have a problem staying awake throughout the day.
A person with depression may feel or appear to others that their thinking and movement has been significantly slowed down. In some cases the opposite can occur and a person may be very agitated, restless with a heightened state of anxiety.
Fatigue or loss of energy nearly every day. A person may become unmotivated to undertake everyday chores such as washing up or attending to their personal care.
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). A person may dwell on past events and feel guilty for things that have happened that they had no control over.
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). A person may simply be unable to make a decision, even everyday decisions which we make such as should I walk to work or take the car can be challenging.
Recurrent thoughts of death (not just fear of dying), recurrent suicidal thoughts without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a substance (e.g. drug abuse, medication) or a general medical condition (e.g. thyroid problems).
E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Hypomania
Hypomania is similar what a person may experience in a Manic State however the severity on their life is not usually as significant as that of Mania.
A. A period of persistently elevated, expansive, or irritable mood, lasting at least 4 days, that is clearly different from the usual non depressed mood. Some people are more excitable than others and this behaviour pattern must be out of character to a person's normal mood state.
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g. feeling rested after only 3 hours of sleep)
More talkative than usual or pressure to keep talking. I know myself that I hate that quiet room when everyone is siting there and not talking. On countless occasions I have irritated people with my constant talking, especially strangers in doctor's waiting rooms etc.
Flight of ideas or subjective experience that thoughts are racing. I personally have found hypomania to be my most productive state both on a work and social level. A business idea can blossom but it can be difficult to distinguish the good ideas from the bad ones when in this state.
Distractibility (i.e. attention too easily drawn to unimportant or irrelevant external stimuli) I have lost countless days reading irrelevant information on the internet and starting new hobbies which I did not have the knowledge or skills to start with!
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic. The behaviour is out of character to a person's normal mood.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
F. The symptoms are not due to the direct physiological effects of a substance (e.g.drug abuse, medication, or other treatment) or a general medical condition (e.g. thyroid problems).
Please be aware that antidepressants can cause someone to appear to be in a manic or hypomanic state. This would come under section F ruling out a diagnosis of Bipolar 1 or Bipolar 2 Disorder.
