By Clare Dolman, researcher and Bipolar UK ambassador

Many people, including many clinicians, don’t pay much attention to the bipolar spectrum. They often don’t appreciate that there are a lot of significant differences between bipolar types 1 and 2. The obvious one is that people with bipolar type 2 don’t experience full-blown mania.

The ‘milder’ myth

The view that bipolar type 2 is a much milder version of bipolar 2 is not borne out by the research – or people’s experiences.

For example, a study by Vieta and colleagues¹ found that people with bipolar type 2 have significantly more episodes of both depressive and hypomanic switches, though they are likely to be hospitalised less frequently.

They suggest that bipolar type 2 is less severe than bipolar type 1 in terms of symptom intensity but more severe with regard to episode frequency.

Other differences

There are other important differences too: women with bipolar type 2 are less likely to suffer an episode of perinatal illness, depressive or psychotic, than women with bipolar type 1 (approximately a 40% risk versus a 50% one), and an episode is less likely to be triggered specifically by the birth.²

Both sub-types experience suicidality to a similar degree but people with bipolar type 2 are more highly associated with seasonal affective disorder (SAD),³ and more likely to also experience anxiety disorders.⁴

Recognising the differences

As most research identifies bipolar type 2 as accounting for at least 40% of the bipolar spectrum, it’s obviously important than the differences between the two conditions are recognised, both by clinicians and by people with bipolar themselves.

Professional training programmes should include more on the differences and the necessarily different approaches to treatment.

People with bipolar themselves need to know more about these differences too – and we need more accounts of people with lived experience of bipolar type 2 to help raise awareness and improve understanding.

A moving account

In the book ‘BrainStorm: From Broken to Blessed on the Bipolar Spectrum’, published in 2022, author Sara Schley gives a moving account of her struggles to cope with bipolar type 2 – and the obstacles to getting a correct diagnosis.

Sara chronicles how the condition has affected her life over 40 years; the deep depressions and the frightening brain freeze. But it’s not a depressing read. On the contrary, it’s a very hopeful and positive book.

We learn that, at 21, as an Ivy League student heading to medical school, Sara experienced her first major ‘brain breakdown’. She did not know that she had a ‘bipolar type 2’ brain on the bipolar spectrum until she was correctly diagnosed 25 years and five psychiatrists later.

‘BrainStorm’ is Sara’s story of this journey, offering an intimate and riveting first-person narrative of surviving and ultimately thriving with bipolar type 2.

A story to save lives

It won’t be a major surprise to most visitors to the Bipolar UK site that Sara’s diagnosis took so long, especially as she was barely aware of periods of hypomania, mainly suffering frequent bouts of debilitating depression.

The antidepressants Sara was given often made her worse and it wasn’t until her mid-40s that she found a psychiatrist who knew enough about the bipolar spectrum to diagnose her correctly and prescribe a mood stabiliser.

Shockingly, the previous four psychiatrists she’d seen didn’t even ask her about her family history. Both her mother and grandfather experienced mood swings.

This is partly why she passionately felt that this book needed to be written. As she says: 'I’m telling my story to save lives, end the stigma, and maximise healing for millions living with bipolar spectrum brains and those they touch.'

In addition to a beautifully written and compelling narrative, ‘BrainStorm’ offers practical suggestions on how to keep mentally as well as physically well. These are strategies that Sara has refined over four decades that she says have really helped her to maintain her equilibrium and live a full and happy life.

If you have bipolar type 2, think you might have it, or know someone who has, I highly recommend Sara’s book.

Find out more

Lots of helpful info can be found on Sara’s website 

Watch Sara’s inspiring TedX Talk, already seen by over 30,000 people, here

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References

1. Vieta E, Gasto C, Otero A, Nieto E, Vallejo J. Differential features between bipolar I and bipolar II disorder. Comprehensive psychiatry. 1997 Mar 1;38(2):98-101.

2. Di Florio, A., 2012. Bipolar disorder in pregnancy and the postpartum (Doctoral dissertation, Cardiff University).

3. Yeom, J.W., Cho, C.H., Jeon, S., Seo, J.Y., Son, S., Ahn, Y.M., Kim, S.J., Ha, T.H., Cha, B., Moon, E. and Park, D.Y., 2021. Bipolar II disorder has the highest prevalence of seasonal affective disorder in early‐onset mood disorders: Results from a prospective observational cohort study. Depression and Anxiety, 38(6), pp.661-670.

4. Karanti, A., Kardell, M., Joas, E., Runeson, B., Pålsson, E. and Landén, M., 2020. Characteristics of bipolar I and II disorder: a study of 8766 individuals. Bipolar disorders, 22(4), pp.392-400. 

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Last updated: 26 March 2024