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Bipolar II Disorder Treatment

Bipolar disorder is a psychiatric disorder characterized by mood swings between mania and depression. Bipolar II is one subtype characterized by at least one depressive episode and one hypomanic episode, which is similar to a manic episode, but usually less severe with a duration of only a few days or weeks. Periods of depression predominate and last longer than periods of hypomania. Hypomania includes a period of increased activity and productivity that often does not interfere with functioning.

  1. Mood Stabilizer (Lithium)

    • The National Institute of Mental Health stresses that bipolar disorder is a chronic disease that requires treatment over the course of your life to maintain emotional stability. The first-line treatment for bipolar II disorder is the mood stabilizer lithium (Eskalith, Lithobid). Even though lithium is used primarily to control mania, it stabilizes moods in those with bipolar II and often helps to control depression. Lithium levels must be carefully monitored by blood testing to prevent toxicity, and lithium can affect thyroid hormone levels.

    Anticonvulsants

    • According to "Lippincott's Nursing Drug Guide," divalproex sodium (Depakote) is used as an alternative to lithium, although it can increase the male hormone testosterone in young women, so it must be monitored carefully. Treatment with Depakote stabilizes moods similarly to lithium, but is faster-acting. If lithium or Depakote are ineffective, the physician may prescribe carbamazepine (Tegretol), lamotrigine (Lamictal) or gabapentin (Neurontin).

    Antidepressants

    • While bipolar II often causes severe depression, antidepressants, such as SSRIs (Prozac, Zoloft), may trigger severe episodes of mania; so antidepressants are only used as a last resort if lithium or anticonvulsants are ineffective in controlling depression. Additionally, you must be monitored carefully for changes in mood and/or suicidal thoughts. According to the NIMH, antidepressants should be taken along with mood stabilizers to reduce incidence of mania, but there is little evidence that antidepressants are more effective than mood stabilizers alone.

    Atypical Antipsychotics

    • Newer antipsychotic drugs, such as olanzapine (Zyprexa), aripiprazole (Abilify) or quetiapine (Seroquel), are used less frequently than other medications, but may be indicated as treatment for depressive episodes non-responsive to other treatments.

    Therapy

    • According to the National Alliance on Mental Illness, cognitive behavior therapy is particularly useful once you are stabilized by medications because it can help you to identify triggers for mood changes and recognize patterns in your disorder. You can learn strategies for managing stress and coping with bipolar disorder. Interpersonal social and rhythm therapy teaches you to monitor your daily activities and patterns (including sleep schedule) so you can establish a consistent schedule as this reduces mood swings. Family therapy can help family members learn coping skills and help them to resolve conflicts. Group therapy may help you to feel less socially isolated.

    Electroconvulsive Therapy

    • According to NIMH, electroconvulsive therapy can reduce symptoms when other medications are ineffective or cannot be used, such as during pregnancy. ECT is given with anesthesia, so you don't feel the electric shock to your brain, but you may experience some confusion for a few days after treatment.

    Warning

    • Most medical treatments for bipolar II disorder can cause birth defects, so women should use birth control and discuss with a physician management of the disorder during pregnancy before becoming pregnant.

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