Bipolar 1 vs. 2: what are the key differences?

Many people have feelings of sadness or happiness that come and go. If you have feelings that are extreme—going abnormally high or low—you might have a condition called bipolar disorder. These high or low feelings can last for a while and can disturb your daily activities. If you think you or a loved one may have this disorder, learn about the causes, symptoms, and treatment for the two main types of bipolar disorder.

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The American Psychiatric Association (APA) describes bipolar disorder as a brain disorder that causes extreme mood changes. These intense mood swings, also called mood episodes, can last days, weeks, or even longer. Mood episodes are manic or depressive. Manic means an abnormally high or irritable mood, while a depressive mood is an unusually low or sad emotional state (APA, 2021). 

These extreme mood swings alter energy levels and daily activities so much that they can cause issues with personal relationships, work, or school (NIMH, 2020).

In the late 19th century, people who had profoundly alternating mood states were called manic-depressives with manic-depression illness. People with this disorder who had an episode of mania were called “maniacs.”

Thankfully, that stigmatizing language was changed. In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-3) changed this diagnosis to bipolar disorder. This was done for two reasons. The first was to remove the stigma and use of the word “maniac.” The second was to clearly define criteria for both the physical and emotional symptoms of bipolar disorder (Mason, 2016).

Scientists and researchers haven’t yet pinpointed the exact cause of all bipolar disorders. However, they’ve identified several factors that can raise your risk of developing bipolar disorder (Jain, 2021). 

Your family history

Bipolar disorders can be hereditary. If one of your parents were diagnosed with bipolar disorder, you have an increased risk of being diagnosed as well. If both parents have bipolar disorder or you have an identical twin diagnosed with it, your risk is even higher. Scientists have even identified two genes that are linked to bipolar disorder (Jain, 2021).

Your brain

Some researchers are studying if the way your brain has developed can affect your moods. Several different chemicals in the brain and hormones in the body affect your behavior and mood. Researchers and scientists have linked dopamine, serotonin, and norepinephrine levels to depression or mania (Jain, 2021).

Your emotional state

Traumatic events, tremendous chronic stress, physical abuse in childhood, the loss of a significant person in your life, alcohol abuse, or substance abuse may increase your risk of exhibiting bipolar disorder (Jain, 2021).

All types of bipolar disorder are defined by episodes of manic (high) and depressive (low) moods. 

Bipolar 1 (bipolar I) disorder is where you or your loved one has had one or more episodes of mania, a period of extremely elevated mood. The manic episode needs to last at least one week or be so severe that you require hospitalization. Many people with bipolar I will have both mania and depression, but for bipolar I, you don’t need to have a depressive episode to be diagnosed (Guzman-Parra, 2021).  

Bipolar 2 (bipolar II) disorder is where you or your loved one have hypomanic episodes, alternating with depressive episodes for at least two weeks. Hypomanic episodes are where you have high mood episodes that are not as severe as full manic episodes. You never have a full manic episode extreme enough to need hospitalization. Sometimes, bipolar II is misdiagnosed as major depression (Guzman-Parra, 2021).

Some people with bipolar disorder can have symptoms of psychosis during a manic or depressive episode. They may hallucinate—see, hear, or feel things that are not present—or become paranoid. If you or someone you love has bipolar disorder, it can be very distressing (NIMH, 2020).

There are two other types of bipolar disorder: cyclothymia (also called cyclothymic disorder) and bipolar disorder unspecified. These are milder forms of the disorder (NIMH, 2020).

The main difference between bipolar I and bipolar II is the intensity and severity of the manic episodes you may experience. If you have bipolar I, you will experience a manic episode. The manic episode may be so severe that you may need to be hospitalized for your safety or the safety of others. If you have bipolar II, you will experience a hypomanic episode with a less intense  “high” mood (Guzman-Parra, 2021).

What is mania?

Mania means a highly elevated mood, and in bipolar disorder, manic symptoms are all related to feeling “high.” Mania is not just feeling exhilarated or like you have a lot of energy. When you or your loved one is in a manic state, the mania significantly impacts your life. You won’t be able to just “calm down.”

You will need to have at least three of these symptoms to be diagnosed as having a manic state (Jain, 2021):

• Feeling you are powerful or very influential

• Experiencing sleep disturbances or a decreased need for sleep 

• Feeling irritable, restless, or even aggressive

• Having bizarre or racing thoughts

• Easily distracted and unable to focus or concentrate on anything

• Rapid talking or pressured speech

• Doing risky things like gambling or overspending money, taking drugs you wouldn’t usually take, or having impulsive sex with different people

What is hypomania?

Hypomania means that manic symptoms are still present but less extreme than if you or your loved one had a full manic episode. However, the behavior will still be visibly different than when you are stable (Jain, 2021).

What is a depressive episode?

A person only needs to experience an episode of mania to be diagnosed with bipolar I or episodes of hypomania to be diagnosed with bipolar II. However, people with either condition often experience periods of severe depression, as well. The depressive episodes in bipolar I and II are symptoms of major depression (Jain, 2021). 

You will need to have five of these symptoms for at least two weeks that interfere with your life to be in a depressive state (Jain, 2021):

• Feeling hopeless, sad, or low

• Feeling worthlessness or guilt

• Sleeping too much or too little

• Unable to concentrate or focus

• Weight gain or loss of five percent within a month without actively trying to do either

• Feeling unable to move

• Thinking or planning to harm yourself (suicidal thoughts)

People with bipolar disorder I or II can be at risk of suicide, especially if they don’t have a treatment plan (Jain, 2020). 

It is important to reach out to your mental health professional, healthcare provider, or loved one if you have thoughts of harming yourself. You can always call the suicide hotline 24/7 at 800-273-8255 to talk to someone who can help.

If you or your loved one’s behavior shows any of the symptoms of mania, hypomania, or depression, you should seek medical advice. 

Your healthcare provider will do a complete physical exam and may order laboratory tests. While there aren’t any blood markers or scans that show bipolar disorder in the body, these tests help rule out other issues that may be affecting your mood and behavior. They will also check if you have any other mental health issues that resemble bipolar disorder (Jain, 2021).

Depending on your physical exam, lab tests, and history show, your health care provider may refer you to a mental health professional or psychiatrist.

For a bipolar I diagnosis, you must have had one manic episode (or more) lasting for at least one week. If the episode lasted less than that time, the symptoms had to be so severe that you required hospitalization. Manic episodes can occasionally last as long as three to six months if they are not treated. Some people with bipolar I do not have depressive episodes, although many do. If you have had a depressive episode, it has to last at least two weeks. Depressive episodes can potentially last between six months to a full year without proper treatment (NIMH, 2020).

For a bipolar II diagnosis, you must have had one or more major depressive episodes and one hypomanic episode. Some people with hypomania may be able to do their work or go to school, but their mood is not stable (NIMH, 2020). 

If you or your loved one is in an extreme manic or depressive episode, please go to the nearest emergency room, as these can be considered life-threatening situations.

Bipolar disorder is typically treated with medications and psychotherapy. Some people may require a procedure to help them, especially if their symptoms do not respond well to medications. Many people also benefit from making lifestyle changes to help them get healthier.

Bipolar disorder is a lifelong but treatable condition. If you are prescribed medications, you may need to take them for a very long time. Your mental health care professional may adjust your dose based on your needs. You may also need to take two or more medications to help decrease your symptoms.

You may want to write down any side effects and how well you feel and sleep when taking your medicines. Then, you can bring this information to your appointments to let your healthcare professional know how well your prescribed medications work for you.

You may need more frequent physical exams to monitor your progress. In addition, let your healthcare provider know if you are taking supplements, as some can interact with your prescribed bipolar medications and worsen your symptoms. 

Medications

Medications for bipolar disorder manage levels of chemicals and hormones affecting the brain. The type and dose depend on your previous and current medical and mental health history (Kato, 2019).

Mood stabilizers are usually prescribed right away to help calm down an episode of mania and improve symptoms of depression. A commonly prescribed mood stabilizer is lithium, which has been used for many years and is effective for many people with bipolar disorder. You will need intermittent blood tests while on lithium treatment to make sure you take a therapeutic dose (Nath, 2020). 

If you or your loved one are in an extreme manic episode, you may receive anticonvulsants (anti-seizure medications), like carbamazepine (Tegretol) or valproic acid (Depakote). Once you’re more stable, you may take lamotrigine (Lamictal) for “maintenance” (Nath, 2020).

Some people need additional medications to help manage their symptoms of mania, hypomania, and depression. These include antipsychotics like olanzapine (Zyprexa), quetiapine (Seroquel; see Important Safety Information), risperidone (Risperdal), and ziprasidone (Geodon). Some people may take these by themselves or together with a mood stabilizer (Kato, 2019).

If you have major depressive episodes, you may take different antipsychotics, including quetiapine (Seroquel), cariprazine (Vraylar), olanzapine-fluoxetine (Symbax), and lurasidone (Latuda) (Jain, 2021). 

Other therapies

Some people do not respond well to medications or cannot take them. Electroconvulsive therapy (ECT) is a fast, effective, and safe treatment for bipolar mania and depressive symptoms. If you are pregnant, your mental health professional may recommend this treatment, as many medications commonly used for bipolar disorder are not approved to take during pregnancy (Salik, 2020).

ECT is done under general anesthesia. A small electric current passes from your scalp to your brain for 15 to 70 seconds, causing a tiny seizure. This seizure helps reduce symptoms of bipolar I or bipolar II disorder, and is completely safe (Salik, 2020). 

Your healthcare or mental health professional may refer you to a psychotherapist to help you and your family deal with the symptoms of bipolar disorder (Kato, 2019).

Cognitive-behavioral therapy (CBT) is often used by psychotherapists and helps you identify what triggers your emotional responses to your bipolar disorder symptoms. CBT can give you tools and skills to help you manage your symptoms and may help you keep your mood stable (Kato, 2019).

Some people may choose to add interpersonal therapy to help them work through or repair relationships with other people that their behavior may have damaged during a manic or depressive episode (Kato, 2019).

If you or your loved one has had challenges with a family member with bipolar disorder, you may benefit from family therapy for families dealing with a bipolar diagnosis (Miklowitz, 2016).

Lifestyle changes

Many people with bipolar disorder find that they feel better when they make lifestyle changes to increase their overall wellness. These changes include (NAMI, 2021a):

• Eating more fruits and vegetables

• Decreasing processed foods

• Eating at least three times a day

• Exercising at least 150 minutes a week

• Creating a routine

• Getting enough quality sleep at night

• Practicing meditation or mindfulness

Other changes you can make to improve your symptoms include stopping any alcohol or recreational drugs, as they can interact with any medications you are taking for bipolar disorder (NAMI, 2021a).

If you or your loved one has been diagnosed with bipolar disorder, you may need support. There are in-person and online support groups for you or your family. You can visit the National Alliance on Mental Illness at nami.org to find a group in your area.

Some people may feel that bipolar II is milder than bipolar I, but both types are serious mental health conditions that require treatment. Moreover, it is not just mania that can cause poor quality of life. Prolonged and severe depressive episodes, which can occur in both bipolar I and II, can also affect people’s ability to return to functioning normally (Guzman-Parra, 2021).

Although bipolar I or bipolar II disorders are lifelong and can’t be permanently cured, the symptoms can be well-managed and treated with medications, therapy, and lifestyle changes. The more information you have about bipolar disorder and how you can control the symptoms, the better you may feel.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Editorial Guidelines | Medical Review Process

Current version

June 22, 2021

Written by

Tobi Ash, MBA, RN, BSN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.