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Bipolar II disorder: a state-of-the-art review.

Michael Berk^1,2, Asier Corrales^3,4, Roth Trisno^1,2,5

¹Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia.

World Psychiatry : Official Journal of the World Psychiatric Association (WPA)

|May 15, 2025

Summary

Bipolar II disorder (BD-II) is often misdiagnosed, leading to poor outcomes. This review highlights its unique challenges, risks, and effective treatments for this distinct bipolar disorder subtype.

Keywords:

Bipolar disorder bipolar II disorder borderline personality disorder depression hypomania misdiagnosis mitochondrial dysfunction mixed states mood stabilizers psychoeducation suicidal behavior

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Area of Science:

Psychiatry
Neuroscience

Background:

Bipolar II disorder (BD-II) is a distinct subtype characterized by depressive and hypomanic episodes, yet research remains limited.
It is frequently misdiagnosed as major depressive disorder due to prevalent depressive symptoms.

Purpose of the Study:

To provide a comprehensive overview of current research on BD-II.
To discuss diagnostic criteria, clinical features, comorbidities, risk factors, and treatment strategies.

Main Methods:

Literature review of existing research and clinical debate on BD-II.
Analysis of diagnostic criteria, epidemiological data, and treatment efficacy.

Main Results:

BD-II patients experience frequent depressive episodes, increasing misdiagnosis risk and potential harm from antidepressant monotherapy.
Significant functional impairment, cognitive deficits, and elevated suicide risk are associated with BD-II, comparable to Bipolar I disorder (BD-I).
High rates of psychiatric (anxiety, substance use) and physical (cardiovascular) comorbidities are noted.

Conclusions:

BD-II requires specific diagnostic and treatment approaches, as current guidelines extrapolated from BD-I may be insufficient.
Mood stabilizers, atypical antipsychotics, psychoeducation, and therapy show promise.
Further research is crucial for refining diagnosis, identifying risk factors, and developing targeted interventions for BD-II.