Which is Worse – Bipolar I or Bipolar II?
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Bipolar blogger Natasha Tracy offers exclusive insight into the world of bipolar disorder.

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Which is Worse – Bipolar I or Bipolar II?

educateMany people, especially those reporting on mental illness, want to know, very simply, what is worse: bipolar I or bipolar II? People want to know which mental illness is more severe. And likely, the answer people propagate is that bipolar I is worse than bipolar II; it is somehow more severe. I’m not quite sure where this conventional thinking comes from, but it’s seen a lot in places like media reports on bipolar disorder.

This could be because people with bipolar I experience full-blown mania, which is, by definition, life-threatening, while people with bipolar II experience only hypomania, which is not. OK, I understand this, but believe me, hypomania can ruin your life just as successfully as mania can.

And what of the depression? Both bipolar I and bipolar II experience the same symptoms of depression, diagnostically, so is one worse than the other?

Length of Illness Period in Bipolar Disorder

When looking at the two disorders, it’s important to consider how much time the average person with bipolar disorder spends ill. (In this case, ill is considered to be in any mood state of depressed, manic, hypomanic, mixed or cycling.)

Numbers do vary, but the longest study looking at this subject followed subjects for about 13 years with weekly ratings follow-ups. In this study:

  • Patients with bipolar I spent 47.3 percent of weeks symptomatic
  • Patients with bipolar II spent 53.9 percent of weeks symptomatic

It was noted that the disease fluctuates greatly even within the same patient over time.

Mood Frequency in Bipolar Disorder

Both bipolar I and bipolar II are characterized by much greater durations of depression than other moods. For example, patients with bipolar I spend:

  • 31.9 percent of their time depressed
  • 8.9 percent of their time manic or hypomanic
  • 5.9 percent of their time with cycling or mixed symptoms

Versus people with bipolar II, who spend:

  • 50.3 percent of their time depressed
  • 1.3 percent of their time hypomanic
  • 2.3 percent of their time with cycling or mixed symptoms

Effectiveness of Treatment in Bipolar Disorder

Now, this is conjecture on my part, but it is my estimation (and the estimation of some doctors I have spoken to) that treatment is somewhat more effective in bipolar I than in bipolar II. This is because of the dominance of depressive symptoms in bipolar II.

Antidepressants do not have the same effectiveness in people with bipolar disorder when compared to people with unipolar disorder, and, in fact, some doctors would argue should not be used at all due to the possibility that they can induce manic or hypomanic episodes.

Thus, depressive symptoms are often harder to deal with than symptoms of mania or hypomania and because people with bipolar II spend so much of their time depressed, treatment is, overall, less effective.

Which is Worse – Bipolar I or Bipolar II?

This is all to say that it depends on how you look at it and it really depends on the individual case. Certainly if someone with bipolar I has 4 week-long episodes of dangerous mania a year, that is a very severe case, but, on the other hand, if a person with bipolar II has 30 weeks of major depression in a row, that is also a severe case. So severity can be present in many forms.

In the end, the media is looking for a shortcut answer—X is worse than Y, but this just isn’t true in the case of mental illness.

In the end, everyone with bipolar disorder is in the same lifeboat; some of us just have bigger paddles than others.

We’re all still struggling to survive.

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About the Author

Natasha Tracy is an award-winning writer who specializes in writing about bipolar disorder.