Bipolar 1 vs Bipolar 2: What’s the Difference?

By Erika Krull, LMHP

Bipolar disorder is defined by two different mood states: manic and depression. During a manic episode, a person may appear upbeat with endless energy. A depressive episode may cause a person to appear hopeless, socially withdrawn and with low energy. A person with bipolar disorder shifts between these opposing mood states. Manic states get a lot of attention in the media, but a person with bipolar disorder spends more time depressed.

Bipolar disorder develops into two main types: bipolar 1 and bipolar 2. While both types share many traits, each one has distinct symptoms and effects. They’re also disabling in different ways. This overview covers the differences between both disorders, their risk factors, and how they are diagnosed, treated and managed.

Bipolar 1 Symptoms

Bipolar 1 is a mood disorder defined by manic episodes with periods of depression. Episodes can be months or even years apart. Research shows that about 1% of the general population is affected by bipolar 1 disorder during their lifetime. To be diagnosed with bipolar disorder type 1, the following must occur:

• At least one manic episode during their lifetime
• Manic episodes either lasting at least seven days or severe enough to require hospitalization
• Periods of depression lasting two or more weeks

Manic and Depressive Symptoms for Bipolar 1

Symptoms of manic episodes

• Talkative
• Racing thoughts
• Energetic
• Need little sleep
• Irritable
• Overestimating their abilities

Symptoms of depressive episodes

• Feeling down
• Low energy
• Little interest in anything
• Hopelessness
• Thoughts of death or suicide

Bipolar 2 Symptoms

Bipolar 2 is a mood disorder with periods of hypomania and long periods of depression.  Research shows that about 0.4% of the general population is affected by bipolar 2 in their lifetime. To be diagnosed with bipolar disorder type 2, the person must have at least one hypomanic episode and at least one depressive episode during their lifetime.

Manic and Depressive Episodes for Bipolar 2

Hypomanic episodes

• Resemble manic episodes but are less severe
• Cause less disruption
• Do not require hospitalization

Depressive episodes

• Have symptoms similar to depressive episodes in bipolar 1
• Are chronic
• May be more disabling than with bipolar 1

Risk Factors for Bipolar Disorder

Some people are more likely to develop bipolar disorder than others. People are born with some risk factors, and others may develop over time. Current research has not found differences in risk factors for bipolar 1 and bipolar 2 disorders.

Genetic Factors

Studies show that some mental health disorders may share risk factors. There is no single gene that causes bipolar disorder. In other words, a person could be more at risk of having bipolar disorder, but cannot inherit it.

Environmental and Lifestyle Factors

Lifestyle and environmental factors can make a person more vulnerable to bipolar disorder.

• Being a survivor of child abuse and trauma is linked with bipolar later in life.
• 30–50% of people with bipolar disorder develop a substance use disorder. The risk goes in both directions.
• Highly stressful life events are linked to a person’s first hospitalization.

Gender and Racial Prevalence

Several studies show that bipolar disorder occurs equally among all racial groups and both genders. However, people of color are misdiagnosed more often and suffer more from these disorders. Women tend to seek help more often, but this may not paint an accurate picture of who suffers from bipolar disorder.

How Is Bipolar Disorder Diagnosed?

A healthcare provider or mental health therapist can evaluate bipolar disorder. These assessments may include taking a family history, reviewing a checklist of symptoms, and doing a thorough interview. A person may also need a medical exam to rule out other physical conditions. A psychiatrist may also assess for medication.

It can be challenging to diagnose bipolar disorder accurately. Bipolar 2 disorder has long been considered milder than bipolar 1, but this isn’t the case. Symptoms are different in both disorders.

Manic episodes define bipolar 1 disorder, whereas the primary feature of bipolar 2 is prolonged periods of depression. Bipolar 2 can be misdiagnosed as major depression. Treatment is different for each disorder, so it’s vital to get an accurate diagnosis.

Treatment Options for Bipolar Disorders

Bipolar disorder can be a disruptive disorder, but there are many effective treatments. Someone with bipolar 1 has more manic episodes, while someone with bipolar 2 has more depressive episodes. Because of these differences, treatment should be customized for each person.

Medication

Medication is a vital part of managing bipolar disorder, so a  correct diagnosis is critical with this condition. Long periods of depressive episodes can look like major depressive disorder, which is often treated with antidepressants. However, antidepressants can trigger manic episodes in a person with bipolar disorder.

Mood stabilizers are the main medications used to treat bipolar disorder:

• Lithium: Lithium was discovered as a treatment for manic episodes in the 1940s. It’s been used as a first-line treatment for bipolar disorder ever since. A person needs regular blood tests to make sure their dosage is safe and accurate.
• Anticonvulsants: Some anticonvulsant medication helps reduce manic symptoms. Epilepsy and bipolar disorder share some common traits, which is likely why these medications help both conditions.
• Atypical antipsychotics: Atypical antipsychotics can stabilize a person’s mood. These can help people who can’t take lithium.

Talk therapy helps a person understand their condition and manage symptoms. Several types of therapy can be effective.

• Cognitive-behavioral therapy (CBT) focuses on thinking patterns and behavior changes.
• Dialectical behavioral therapy (DBT) targets emotional regulation and mood-related symptoms.
• Family-focused therapy (FFT) treats bipolar disorder as part of a family system.
• Electroconvulsive therapy (ECT) can be effective for people with drug-resistant bipolar disorder.

Living with Bipolar Disorder

Living with bipolar disorder can be challenging. Chronic symptoms can lead to a lower quality of life. Relapse is common and can happen even when a person maintains their treatment. Suicide risk is estimated to be ten to 30 times higher for people with bipolar disorder. However, bipolar disorder is manageable with the right treatment. A stable lifestyle is important for good symptom management. Routines can keep a person focused on regular sleep, exercise, nutrition and treatment.

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