Bipolar II disorder

I did see a psychiatrist a few years ago.

He said, "Bipolar II is what I think you have." I was very thrown.

I tried medication.

It did not gel with me, and I was like, "Nup, I don't have it," because it didn't gel with me.

Well, it's bipolar-

The Hollywood-

... and bipolar II, they're different.

But, but both of them, the Hollywood portrayal of both of them.

Understanding what the system can and cannot do, having reasonable expectations, because I really do believe that many people just, they don't understand the limitations of the system.

You're listening to Inside Bipolar, a Healthline Media podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Hello, everybody, and welcome to the podcast.

My name is Gabe Howard, and back in 2003, I was diagnosed with bipolar disorder.

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Not every SSRI is going to react the same with every patient.

Not everyone with bipolar II is going to react to Seroquel in a certain way.

But it's, I think the fact the conversation is like, "Did we know that she had an underlying diagnosis or not?" Right? Is more so the conversation.

But Gelada is asked by the Commonwealth, "What did Lindsay Clancy express to you as far as Seroquel? Did she want to continue with that?" "No." "Did she explain why?" "So she felt like when she took Remeron and Seroquel together, she felt weighed down and exhausted, but her mind was still awake and alert, and she didn't seem to think that there was a benefit of being on it." "And did she express to you a desire to wanna get back to trialing Prozac?" "Both Lindsay and her husband expressed that that was their preference." Which, okay, this is where Patrick- Oh ...

It's unusual for somebody to describe taking Zoloft and then going 48 hours without sleep and not being tired.

So that raised my clinical suspicion a bit, and she had been, I would say, having difficulty tolerating other antidepressant medications that we had been trying to have her take since then.

So again, I'm wondering if it's because potentially there might be an underlying what we call a mood disorder, bipolar disorder." There's bipolar I and bipolar II.

Both have mania symptoms as part of the diagnosis.

like, delusion, psychosis.

Bipolar II is where you have the extremes of, you know, like, mania and then the lows.

Well,

no, so sometimes, so bipolar I is the delusions, but also the manias are bipolar I. Bipolar II, you have the lows.

So they're getting rid of bipolar 2 in the book.

Really? Because it's kind of a nothing.

And that's sort of the international standard for patients who come in manic is to use lithium and neuroleptics.

Second question from Ruby is, once patients report mania, is it bipolar I or bipolar II, and what's the key difference? So I'm going to tell you my personal view of this because this is a somewhat controversial area.

Bipolar I patients, they're pretty easy to figure out.

Usually sooner or later, you catch the manic and you know they've got it.

Bipolar II patients, instead of getting manic, they can get in horrible mixed states where they have energy, but they're depressed at the same time.

Those mixed states are highly dangerous for suicide.

And so you'll have patients who will come in who will be speaking fast and energized, but say they're depressed and miserable.

It's important to recognize that those people may have bipolar type 2, and some bipolar type 2 patients never really are manic.

And so the meds for that, when you come off to drink ayahuasca, they don't tend to spike you into a manic moment or episode.

So we've had a lot of bipolar II, no problem.

So

Okay.

So it seems to me that potentially she has five out of the nine components of borderline personality disorder, and that is enough to give her a diagnosis.

And it often does cross over with bipolar II.

Bipolar II, which involves mood swings, dramatic mood swings, from being manic and thinking everything's amazing and so forth, to absolutely collapsing and thinking life is hell.

That is something that is associated with borderline personality disorder, and they can become morbid.

So...

Because, so first of all, at the genetic level, Personality disorders are correlated with mutational load.

People that have personality disorders are more likely, such as big borderline personality or psychopathy or narcissism, are more likely to have physical abnormalities.

For example, with bipolar II, the face is more likely to have a curvature inside the mouth, essentially, so a weird small mouth.

Exactly.

In bipolar II, women are markedly overrepresented.

They are also overrepresented in rapid cycling, in mixed states, in dysphoric mania, and in atypical bipolar depression.

Meaning women bear the overwhelming brunt of the depressive pole of bipolarity.

However, the epidemiology of bipolar disorder presents a fascinating divergence here.

Really? No way.

While major depression drives downward mobility, patients with bipolar FERS, and particularly bipolar II, are frequently overrepresented in higher socioeconomic classes and among highly educated, highly creative demographics.

Wait, that seems totally counterintuitive.

Well, in the population I see, they're more troubled by depression.

And the type of bipolar we're alluding to is so-called bipolar II, like bipolar, much more common form of it, where the manic part is not a true full-blown mania, it's so-called hypomania.

And that can be very adaptive.

As a matter of fact, I would say maybe over the course of my career, maybe a third of my patient population have been incredibly successful people who've used their hypomanic drive to achieve remarkable things.

alongside major depressive disorder and generalized anxiety disorder.

Now, what we know from the DSM, if that's what Dr. Mack wants us to pay attention to, this guy is diagnosed, this psychologist is diagnosing her with bipolar II as well as major depressive disorder, which then posts or peripartum psychosis or peripartum depression, anxiety, blah, blah, blah.

can fall into as like a classification of major depressive disorder as far as the DSM is concerned internationally they're a little bit smarter and they know that um and and keep in mind the DSM is is like is there as a guidebook for the insurance companies to be able to categorize and you know say how much they're going to pay basically so He diagnosed her as bipolar II alongside major depressive disorder and generalized anxiety disorder.

And he cited her longitudinal treatment records at Tewksbury State Hospital over the past three and a half years.

Keep in mind, these two guys, Mack and Heilbrun, met with Lindsay three years after this event happened.