Bipolar disorder is a complicated condition that goes beyond an alternating personality. There are four different types of bipolar disorders, each made up of their own unique set of symptoms. ¹ Throughout this article, we’re going to explore the differences between bipolar 1 vs bipolar 2.

The Four Types of Bipolar Disorders

To understand bipolar disorder, you need to understand its varying types. These categorizations are largely determined by differences in symptom severity.

Bipolar 1

Bipolar 1 is marked by a manic episode that lasts seven days or more. You may or may not also experience a depressive episode following manic symptoms. ²

Manic episodes will result in the following symptoms:

• Difficulty concentrating
• Feelings of euphoria (extreme happiness)
• Harmful behaviors (i.e. substance abuse, risky sex)
• High energy
• Poor sleep
• Restlessness

Bipolar 2

If you struggle with bipolar 2, you will experience major depressive episodes and at least one hypomanic episode. On top of that, it’s unlikely you’ll experience a manic episode that requires hospitalization.

It’s common for medical professionals to misdiagnose bipolar 2 as a major depressive disorder since symptoms are so similar. ³

Cyclothymic Disorder

A cyclothymic disorder is a rare mood condition that results in emotional ups and downs. However, these contradictory feelings are not as extreme as those seen in bipolar 1 or 2. ⁴

Mixed Features

Mixed features refer to the coexistence of depressive and manic symptoms. Since these symptoms closely resemble those of manic-depressive disorders, it can complicate a proper diagnosis.

The key difference of mixed features is you will not have just one manic/depressive episode. Instead, you’ll present a mixture of mood states, sometimes experiencing two or more at once. ⁵

You’re more likely to develop mixed features at a younger age. On top of that, you’ll likely face a longer recovery period.

The Differences Between These Diagnoses

The major difference between these diagnoses is the severity and duration of mood shifts. More specifically:

• Bipolar 1 shifts into a manic episode that lasts more than seven days.

• Bipolar 2 shifts into a depressive episode that lasts for more than two weeks.

• Cyclothymic disorder has similar symptoms to bipolar 2 but is less severe in its symptoms.

• Mixed features cause manic and depressive effects within the same episode.

Difficulties in Diagnosis

Since bipolar disorder is marked by shifting moods, it’s already difficult to diagnose. Add to the fact that there are four different types of the condition and it’s like trying to find a needle in a haystack.

Unfortunately, there are no specific tests to diagnose bipolar disorder (i.e. blood tests or brain scans). Therefore, bipolar testing methods are through long-term care and consultation, such as charting and recording the development of symptoms. You may also receive physical and mental exams by medical professionals. ⁶

To distinguish between bipolar 1 and 2, medical professionals will observe if you’re experiencing manic or depressive episodes.

Bipolar 1 vs Bipolar 2: Which is Worse?

Determining whether one form of bipolar disorder is worse than the other comes down to the person. For example, you may experience bipolar 2 but have better control over your depressive symptoms than a friend with bipolar 1.

A 2016 study found that patients with “bipolar I and bipolar II depression were similar in demographics, baseline rating scale scores (depression, anxiety, mania, and quality of life), and mood episode histories.” ⁷ Therefore, it’s largely undeterminable which is worse.

Bipolar 1 and Bipolar 2 Treatment

To treat bipolar disorder, you will be recommended a traditional treatment path of psychotherapy and medication. However, depending on the type of bipolar disorder, there are specific treatment measures geared for your condition.

When it comes to bipolar 1, you may be prescribed: ⁸

• Mood stabilizers
• Antidepressants
• Antipsychotics
• Benzodiazepines.

These can help decrease the severity of manic symptoms. It’s worth noting that electroconvulsive therapy (ECT) may also help in the treatment of bipolar 1. ⁹

Bipolar 2’s treatment path looks similar. However, you’ll likely be given medication to help specifically with depressive episodes. Furthermore, doctors may prescribe antipsychotics to neutralize hypomania. ¹⁰

References

¹ Jain A, Mitra P. Bipolar Disorder. 2023 Feb 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644424.

² Brancati GE, Nunes A, Scott K, O’Donovan C, Cervantes P, Grof P, Alda M. Differential characteristics of bipolar I and II disorders: a retrospective, cross-sectional evaluation of clinical features, illness course, and response to treatment. Int J Bipolar Disord. 2023 Jul 14;11(1):25. doi: 10.1186/s40345-023-00304-9. PMID: 37452256; PMCID: PMC10349025.

³ Shen H, Zhang L, Xu C, Zhu J, Chen M, Fang Y. Analysis of Misdiagnosis of Bipolar Disorder in An Outpatient Setting. Shanghai Arch Psychiatry. 2018 Apr 25;30(2):93-101. doi: 10.11919/j.issn.1002-0829.217080. PMID: 29736129; PMCID: PMC5936046.

⁴ Bielecki JE, Gupta V. Cyclothymic Disorder. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32491800.

⁵ Solé E, Garriga M, Valentí M, Vieta E. Mixed features in bipolar disorder. CNS Spectr. 2017 Apr;22(2):134-140. doi: 10.1017/S1092852916000869. Epub 2016 Dec 29. PMID: 28031070.

⁶ Berk M, Berk L, Moss K, Dodd S, Malhi GS. Diagnosing bipolar disorder: how can we do it better? Med J Aust. 2006 May 1;184(9):459-62. doi: 10.5694/j.1326-5377.2006.tb00319.x. PMID: 16646747.

⁷ Datto C, Pottorf WJ, Feeley L, LaPorte S, Liss C. Bipolar II compared with bipolar I disorder: baseline characteristics and treatment response to quetiapine in a pooled analysis of five placebo-controlled clinical trials of acute bipolar depression. Ann Gen Psychiatry. 2016 Mar 11;15:9. doi: 10.1186/s12991-016-0096-0. PMID: 26973704; PMCID: PMC4788818.

⁸ Baldessarini RJ, Tondo L, Vázquez GH. Pharmacological treatment of adult bipolar disorder. Mol Psychiatry. 2019 Feb;24(2):198-217. doi: 10.1038/s41380-018-0044-2. Epub 2018 Apr 20. PMID: 29679069.

⁹ Perugi G, Medda P, Toni C, Mariani MG, Socci C, Mauri M. The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features. Curr Neuropharmacol. 2017 Apr;15(3):359-371. doi: 10.2174/1570159X14666161017233642. PMID: 28503107; PMCID: PMC5405614.

¹⁰ Ertugrul A, Meltzer HY. Antipsychotic drugs in bipolar disorder. Int J Neuropsychopharmacol. 2003 Sep;6(3):277-84. doi: 10.1017/S1461145703003560. PMID: 12974994.