As I’ve written in the past, I have had a long journey to diagnosis.  My current diagnosis is bipolar 2. In summary (from Epocrates), to be diagnosed with bipolar 2 one must:

• Never have had a manic episode and have had at least 1 depressive and at least 1 hypomanic episode.
• Distinct period of abnormally and persistent elevated, expansive, or irritable mood for at least 4 days and no more than 7 days.
• During hypomanic episode on must have at least 3 of the following symptoms (4 if irritable)
  • Inflated self esteem or grandiosity
  • Decreased need for sleep
  • Pressured speech
  • Racing thoughts or flight of ideas
  • Distractibility
  • Increased activity
  • Excess pleasurable or risky activity
• Episode is unequivocal change in person, uncharacteristic of person, and noticeable by others.
• Not severe enough to cause impairment, cannot be explained by medication or illicit drug use, and does not include psychosis.
• During depressive phase meet the diagnostic criteria of a major depressive episode.

My diagnosis has oscillated between major depressive disorder and bipolar 2.  Even though my doctor has told me that he settled at bipolar 2, the form I submit to insurance still says “mood disorder, not otherwise specified” (or mood disorder NOS).  This is because, for me, along with a lot of people with hypomania, it can be a difficult condition to diagnose. Since doctors don’t follow us around day in an day out, they rely on self-reporting.  What the diagnostic criteria above does not convey is that being hypomanic can mean an increased mood as well as increased productivity and creativity.

For someone who experiences extreme depressions, elevated mood is more than welcome.  Because of this people often don’t see, or don’t want to see, their symptoms as being problematic and therefore are often not quick to report the symptoms to their doctor.  The problem in many cases of hypomania is not the elevated mood, but the high likelihood that it will be followed by a major depressive episode. It’s like falling from a cliff; the hypomania masks the fall until it’s too late.

Treatment for bipolar 2 includes medications (mood stabilizers, antidepressants, and/or atypical antipsychotics), talk therapy, and lifestyle (sleep hygiene, for example, is important).  Compliance with all treatments is important for management, as is good, fast communication with your mental health providers.