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Bipolar I vs. Bipolar II — Mania, Hypomania and What a Self-Check Can Tell You
Bipolar I means at least one manic episode; bipolar II means hypomanic episodes plus major depressive episodes. Learn the criteria that separate them (duration, functioning, hospitalization, psychotic symptoms), why bipolar II is often mistaken for depression, what a self-check can and cannot tell you, and how to prepare for an appointment.
Soundary · 6 min read · Updated
Bipolar disorder, once called manic depression, alternates between depressed periods and elevated periods that are clearly different from your usual self. What separates type I from type II is how intense the elevated periods were. The same kinds of symptoms are classed as mania (type I) or hypomania (type II) depending on their intensity, duration and effect on daily life.
Mania and hypomania — same symptoms, different intensity
Both require a period of abnormally elevated or irritable mood with a clear increase in energy and activity, together with at least three of the symptoms below (four if the mood was only irritable).
- Inflated self-esteem or a sense that you can do anything
- Needing much less sleep without feeling tired (e.g. rested after three hours)
- Talking more than usual and finding it hard to stop
- Racing thoughts, one idea leading quickly to the next
- Being easily distracted
- Taking on many projects at once, or being unable to sit still
- Getting involved in things with painful consequences, such as spending sprees, impulsive investments or risky behaviour
| Feature | Mania (type I) | Hypomania (type II) |
|---|---|---|
| Minimum duration | At least 7 days (any length if hospitalization was needed) | At least 4 consecutive days |
| Daily functioning | Marked impairment at work or in relationships | A change others can notice, but no marked impairment |
| Hospitalization | May be needed | Not needed (if it was, it counts as mania) |
| Psychotic symptoms (delusions, hallucinations) | Can occur | None (if present, it counts as mania) |
How the two diagnoses are defined
Bipolar I disorder means there has been at least one manic episode in your life. Depressive episodes are common but not required — one manic episode is enough for the diagnosis. Bipolar II disorder means at least one hypomanic episode and at least one major depressive episode, with no manic episode ever. When milder highs and lows go up and down for two years or more without meeting either set of criteria, it is called cyclothymic disorder.
Bipolar II is not a mild version of bipolar I. Depressive periods tend to be more frequent and longer, so people often spend far more time depressed than elevated, and suicide risk is reported to be as high as in bipolar I. Type II should not be taken lightly.
Why bipolar II is often mistaken for depression
Most people seek help when they are depressed, so depression is what shows up in the clinic. Hypomanic periods are often remembered as times when you felt great or things went well, and people rarely mention them unprompted. As a result, it commonly takes years from first symptoms to an accurate bipolar diagnosis. Treated as depression with an antidepressant alone, some people can be tipped into an elevated state, which is why getting the diagnosis right matters for treatment.
What a self-check can and cannot tell you
Soundary's elevated-mood check (14 questions) looks back over your life for periods that were clearly different from your usual self, rather than asking how you feel today. A high score is a sign that it is worth talking with a professional. A self-check cannot tell type I from type II, though: that requires a clinician to go through the history — how many days the elevated period lasted, how much daily life was disrupted, and whether there was hospitalization or psychotic symptoms.
What to note down before an appointment
- When the elevated period started and how many days it lasted
- How many hours you slept then, and whether you still felt fine
- Changes family or friends noticed (speech, spending, commitments, plans)
- Big decisions made then, or things with painful consequences
- How long and how often depressed periods lasted
- Relatives diagnosed with bipolar disorder or depression
- Medications you have taken and what changed afterwards (especially elevation after an antidepressant)
How it is treated
For both types, treatment centres on medication — mood stabilizers and some atypical antipsychotics — plus day-to-day habits that prevent relapse. Keeping regular sleep and wake times, avoiding heavy drinking and all-nighters, and knowing your early warning signs of highs and lows all help a great deal. Psychoeducation, cognitive behavioural therapy and family education also have evidence for reducing relapse. The right medication depends on the type and course of episodes, so it is decided with a psychiatrist.
FAQ
Are manic depression and bipolar disorder the same thing?
Yes. Manic depression is the older name; the current official term is bipolar disorder, named for moving between the two poles of elevation and depression.
Is bipolar II milder than bipolar I?
No. The elevated periods are less intense, but depressive periods are more frequent and longer, so the overall burden is far from small. Suicide risk is reported to be similar to bipolar I, and it needs treatment just as much.
Can a self-check tell me whether I have type I or type II?
No. A self-check can only point to the possibility that elevated periods occurred. Telling type I from type II requires a clinician to review the course — duration, impact on daily life, and whether there was hospitalization or psychotic symptoms.
How is hypomania different from just being in a good mood?
Good moods come and go with circumstances, whereas hypomania lasts several days and is clearly different from your usual self — enough that others notice. Common signs are needing much less sleep without tiredness, faster speech and thoughts, and impulsive decisions you wouldn't normally make.
Related tests
- Elevated Mood CheckLooking back for periods when you weren't your usual self.Take the test
- Depression (PHQ-9)How low your mood has been over 2 weeks.Take the test
- Sleep Health (SSC-10)A 10-item check of how well you fell asleep, stayed asleep, and functioned by day over the past two weeks.Take the test
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
- Merikangas, K. R., Jin, R., He, J. P., et al. (2011). Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative. Archives of General Psychiatry, 68(3), 241–251.
- Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561–1572.
- Yatham, L. N., Kennedy, S. H., Parikh, S. V., et al. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97–170.
This article is general information written by Soundary from published literature and diagnostic criteria. It is not a medical diagnosis or treatment recommendation for any individual. If you are concerned about symptoms, please consult a mental health professional.