Bipolar II Disorder in a Primary Care Setting: Clinical Vignette

Bipolar II disorders may be common in primary care settings, but most cases remain undiagnosed because hypomania is often difficult to recognize. Eliciting a history of recurrent periods of expanded mood interspersed with periods of major depression is important, since antidepressant monotherapy is often unproductive or even counterproductive. Once the diagnosis is made, appropriate medications to alleviate hypomanic episodes and depression should be initiated. These medications include mood stabilizers such as lithium and valproate, alone or in combination with antidepressants. Close monitoring of medication levels and patient response is essential in the ongoing treatment of this disorder. Psychotherapy is often an integral part of treatment.