Bipolar I and II: What’s the Difference?

Living with bipolar disorder can feel overwhelming, especially if you’re unsure which type you might have or how to seek the right support. 

Bipolar I and II are distinct conditions that require different approaches to care. Understanding the differences and knowing when to seek help can help you manage your symptoms and improve your quality of life.

Bipolar I vs. bipolar II

Bipolar disorder causes shifts in mood, energy and activity levels that can disrupt your daily life. Both bipolar I and II involve episodes of high and low moods, but the severity and duration of these episodes varies.

“The defining feature of bipolar I is mania, a state of heightened mood and energy that lasts at least seven days or is so severe that hospitalization is required,” said Lauren Willis, EdS., L.P.C., L.C.A.D.C., Primary Therapist at Inspira Medical Center Bridgeton. “During a manic episode, someone may feel euphoric, excessively energetic or irritable.” These episodes can lead to impulsive decisions, such as overspending or risky behaviors, and may interfere with relationships or work. 

Bipolar II involves hypomania, a milder version of mania. While hypomanic episodes still include increased energy and activity, they are less intense and usually don’t cause significant disruptions or require hospitalization. Bipolar II also involves major depressive episodes, which can be severe and long-lasting, overshadowing hypomanic phases.

Bipolar disorder symptoms 

Recognizing the signs of mania, hypomania and depression is the first step toward understanding which type of bipolar disorder might apply to you:

Signs of bipolar I include: 

• Racing thoughts and fast speech
• Risky or impulsive behavior 

• Increased irritability or agitation

• Feeling euphoric, excessively confident or invincible
• A decreased need for sleep with no noticeable fatigue

Bipolar II symptoms include: 

• An elevated mood 

• Increased sociability 

• Feeling unusually energetic or productive
• A decreased need for sleep with minimal impact on overall function

Symptoms of depression may occur alongside other symptoms:

• Fatigue or loss of energy
• Difficulty concentrating or making decisions
• Loss of interest in activities that used to bring joy

• Changes in appetite or sleep patterns

• Persistent sadness, hopelessness or emptiness

If you recognize patterns of extreme highs and lows in your mood, consider tracking your symptoms over time. This information can be valuable when speaking to your doctor.

How are bipolar I and II diagnosed?

Diagnosis requires a comprehensive evaluation that includes several key steps. Your doctor will ask you about your mood patterns, energy levels and behaviors over time to identify recurring symptoms. They will also review your medical history and family background. Your doctor will also rule out other conditions, such as anxiety disorders, substance use or medical issues that might mimic bipolar symptoms, ensuring an accurate diagnosis.

“Many people live with undiagnosed bipolar disorder for years, attributing their symptoms to stress or other life events,” said Willis. “Proper diagnosis is key to developing an effective treatment plan tailored to your needs.”

Treatment options for bipolar disorder

Treatment for bipolar disorder often includes mood stabilizers like lithium to address both manic and depressive episodes. Antipsychotic medications can help control severe manic episodes in bipolar I, while antidepressants may alleviate depressive symptoms for bipolar II patients.

Psychotherapy can help you better understand and manage your condition. Cognitive behavioral therapy (CBT) can help you identify triggers, improve coping mechanisms and regulate emotions. Interpersonal and social rhythm therapy focuses on maintaining consistent daily routines, which can help reduce the frequency and intensity of mood episodes.

Maintaining a regular sleep schedule is essential, as disruptions can trigger mood episodes. Stress management techniques like mindfulness or physical activity can support your emotional stability. 

When should I see a doctor for bipolar disorder?

“Seek professional help if your mood swings are intense, persistent or disrupting your daily life,” said Willis. “Early diagnosis and treatment can prevent symptoms from escalating and improve long-term outcomes.”

You don’t need to navigate these challenges alone. With the right care and support, you can manage your symptoms effectively and lead a fulfilling life.

Learn more about Inspira’s approach to behavioral and mental health care.