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One of the more relevant characteristics of bipolar II is anxiety, encompassing a range of forms from panic attacks to social anxiety and obsessive-compulsive symptoms.
Many of my patients worry about imaginary crimes and are persistently anxious about something they did or said that has no bearing on the actual reality. They often “read” facial expressions wrong, seeing something negative in people where it doesn’t exist. This anxiety builds up . . . until, usually within a week or so, the patient plummets into a depression. The anxiety is still there, combined now with feelings of hopelessness and helplessness.
the quetiapine (brand name: Seroqeul)
I take this.
People with bipolar II tend to experience anxiety to a greater extent than those with bipolar I (38 percent vs. 23.7 percent). In addition, people with bipolar II have more phobias (22.5 percent vs. 11.8 percent) and more depressive episodes, which is one of the reasons why it is often misdiagnosed as unipolar depression.1
THE BIPOLAR SPECTRUM Type ½, schizobipolar: a combination of schizophrenia and bipolar disease Type I, mania without depression Type I½, a preponderance of mild mania (hypomania) combined with depression Type II, a more balanced combination of hypomania and depression Type II½, depression paired with marked mood swings within the normal range (cyclothymia) Type III, bipolar disorder created by antidepressants Type III½, bipolar disorder created by stimulants Type IV, bipolar disorder born from a highly emotional temperament (hypothymic)2
The problem with bipolar II lies in its subtlety. People with the condition usually only seek help when they are in a depressive cycle. After all, why would anyone seek help when he or she feels confident, needs little sleep, has tremendous creative energy, and stands out in a crowd? Unfortunately, this initial manic “high on life” attitude sooner or later becomes anxiety, irritability, anger, and irrationality—symptoms seldom associated with mania but very much considered signs of depression.
Ironically, when a person with bipolar II actually does go into a depressive cycle, the symptoms are usually atypical, the very opposite of what one assumes depression is. Instead of a loss of appetite, there’s compulsive and binge eating. Instead of insomnia, there’s sleeping too much (hypersomnia). Instead of detachment from emotion, there is exaggerated vulnerability to feeling hurt when faced with rejection and criticism (interpersonal sensitivity). Instead of feeling better as the day goes on, as in most depressions, the individual feels progressively worse throughout the day.
GENDER BIAS Research shows that more women suffer from bipolar II than from bipolar I. They won’t get severe mania, but they get depressed. They are also at higher risk for rapid cycling (more than four highs and lows in a year) and are harder to treat with standard regimens. Why? Possibly because of hormonal differences and psychosocial factors.10
I would spend days in bed, looking at the ceiling, my mind racing: I had to work. The deadline was approaching. “I have to work. But I’m not.” I would cancel plans and stay at home with my dog, watching TV and getting fat. I couldn’t go outside, let alone on a date.
This is me. I’m always backing out of stuff.
If you have bipolar II, you may become even more manic (read: anxious) and feel your head will burst with the worry upon worry upon worry settling in like the guest who wouldn’t leave. Or you’ll crash, becoming so depressed that you hate yourself, you can’t do anything, and, by the way, who were you to think you could?
And unlike normal feelings of joy, hypomania doesn’t just go away, leaving behind happy memories. Instead of afterglow, there is a crash—of shame, of self-loathing, of sadness that shatters like broken glass.
Type 1: Active/elevated hypomania: You are full of energy and can multitask without a problem. Your mood is elevated and your thinking is crystal clear. Type 2: Risk-taking/irritable hypomania: You get angry easily; you are impatient and stubborn. But you’ll also take a lot of risks, and your creativity feels as if it has no bounds.
