Are There Different Types of Bipolar Disorder?

Bipolar disorder is a complex condition characterized by drastic, unexpected shifts in a person's mood. Contrary to popular belief, there is more than one type of bipolar disorder. In fact, according to the American Psychiatric Association (APA), there are four types, each defined by the presence, frequency, and intensity of your moods.

What Are Mood Episodes?

People with bipolar disorder experience periods of unusually intense emotion, changes in energy and activity levels, and uncharacteristic behaviors. These distinct periods are called “mood episodes.”

There are three main mood episodes:

1. Manic: During a manic episode, you may feel extremely energized and happy, sometimes even unusually angry or irritable. You feel like you have extra energy to burn. This period lasts at least one week.
2. Hypomanic: Less severe manic episodes are called hypomania. In addition to not being as extreme, hypomanic episodes are also shorter—they usually only last a few days. 
3. Depressive: A major depressive episode is a period of at least two weeks during which you experience five or more depressive symptoms nearly every day for most of the day.

Some people can even experience symptoms of depression and mania at the same time (or one right after the other). This is called a mixed episode.

Types of Bipolar Disorder

The APA classifies bipolar disorder according to the duration and severity of these mood episodes. According to APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are four different types of bipolar disorder your doctor may diagnose you with:

1. Bipolar I disorder
2. Bipolar II disorder
3. Cyclothymic disorder
4. Bipolar Not Otherwise Specified (NOS)

Bipolar I Disorder

To be diagnosed with bipolar I disorder, you must have experienced one or more manic episodes. These episodes must last at least seven days or be so severe that you need to be hospitalized immediately.

Although some people also experience depressive or hypomanic episodes, you can be diagnosed without them.

Bipolar II Disorder

Bipolar II disorder is characterized by having both hypomanic and depressive episodes. Also, to be diagnosed with bipolar II, you must never have experienced a full-blown manic episode. 

Cyclothymic Disorder

Also called cyclothymia, this mood disorder is considered a milder and chronic form of bipolar disorder.

Unlike bipolar I and II disorders, the highs and lows of cyclothymia are not severe enough to fit the criteria for manic or major depressive episodes. However, these symptoms must be present for at least 2 years with no symptom-free period for more than 2 months.

Although the mood episodes are less extreme than those of bipolar disorder, it's critical to seek help. Not only can these symptoms interfere with your daily life, but they also increase your risk of developing bipolar I or bipolar II disorder later in life.

Bipolar Not Otherwise Specified (NOS)

This type of bipolar disorder is diagnosed when you have manic or depressive episodes that don't fit into other bipolar categories.

For instance, you may rapidly cycle between manic and depressive episodes. Or maybe you have hypomanic episodes without depressive episodes.

Misdiagnosis

Of all the mental health disorders, bipolar is perhaps one of the most commonly misdiagnosed. Sometimes it's not clear which one of the types of bipolar disorder your symptoms align with.

Bipolar disorders can also be difficult to diagnose because it shares symptoms with so many other conditions. Here are a few mental health conditions that often get mistaken for bipolar disorder and how you can tell the difference.

• Attention-deficit hyperactivity disorder (ADHD): Both disorders come with overlapping symptoms. However, while ADHD is a chronic condition, bipolar disorders are episodic. Additionally, bipolar disorders only affect your mood, whereas ADHD impacts your attention and behavior. 
• Borderline personality disorder (BPD): The main difference between these conditions is the length of the mood swings. Bipolar mood cycles can last for weeks or months, whereas BPD mood swings may last a few hours or days. Additionally, BPD mood swings are often triggered by something. 
• Clinical depression: While bipolar disorders include symptoms of mania, clinical depression is unipolar, meaning there is no “high." Doctors may initially misdiagnose bipolar II disorder as clinical depression because hypomanic episodes often go unnoticed.
• Schizoaffective disorder: When you have schizoaffective disorder, psychotic symptoms appear out of the blue and are unattached to mood changes. With bipolar disorder, psychotic symptoms only crop up during a mood episode.

Being correctly diagnosed is an important step toward getting the right treatment. The most important thing you can do to increase your chances of receiving an accurate diagnosis is to tell your doctor about all the symptoms you’ve been experiencing.

Treatment

Treatment for any bipolar disorder generally involves medications and some form of psychotherapy.

Medications

Medication is the key to stabilizing most bipolar disorders. However, the type of medication your doctor prescribes depends on your symptoms and their severity.

If you experience a manic and hypomanic episode, for example, your doctor may prescribe a mood stabilizer. Examples of mood stabilizers include:

• Lithium
• Depakote (valproic acid)
• Tegretol (carbamazepine)

On the other hand, if you're primarily plagued with depression symptoms, you'll likely be prescribed a selective serotonin reuptake inhibitor (SSRI) such as Zoloft (sertraline), Prozac (fluoxetine), or Lexapro (escitalopram). Because antidepressants can trigger manic episodes, they are generally prescribed along with a mood stabilizer.

If you experience psychotic symptoms during a manic or depressive episode, your doctor will likely prescribe an atypical antipsychotic. If your psychotic symptoms occur during a depressive episode, your doctor may prescribe one of the following four atypical antipsychotics FDA-approved for bipolar depression:

• Vraylar (cariprazine)
• Latuda (lurasidone)
• Symbyax (olanzapine-fluoxetine)
• Seroquel (quetiapine)

Vraylar and Seroquel are the only two that are FDA-approved antipsychotics designed to treat psychotic symptoms that occur during manic episodes.

Psychotherapy

Depending on your situation, psychotherapy might also be necessary. In fact, research shows that psychotherapy combined with medication can be more beneficial than medication alone.

Psychotherapy can help relieve the stress associated with your extreme moods. It can also help you improve your ability to manage relationships with others.

Psychotherapies that are effective for bipolar disorder include:

• Cognitive-behavioral therapy
• Family-focused therapy
• Interpersonal and Social Rhythm Therapy

As with medication, there is no single therapy approach that everyone will find useful.

A Word From Verywell

If you or someone you know is experiencing symptoms of bipolar disorder, it's important to talk to your physician. Your physician may want to rule out any potential physical health issues that may be contributing to your symptoms.

Your physician may also refer you to a psychiatrist or other mental health professional for an evaluation. Be sure to speak openly about your behaviors, moods, and anything else you notice. Open, honest communication is essential to receiving a correct diagnosis and treatment plan.