Statistics indicate that approximately 2.6% of U.S. adults experience bipolar disorder each year, with approximately 0.5% developing bipolar 2 disorder. This variant of bipolar disorder, less known but equally impactful, is characterized by alternating periods of depression and hypomania, which can significantly disrupt daily activities and overall quality of life. Despite the challenges that bipolar 2 presents, there are numerous therapeutic approaches to manage its course. This article delves into integrative techniques, combining conventional treatments with lifestyle modifications and complementary therapies, to provide a more holistic approach to managing bipolar 2 disorder.

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What is Bipolar 2 Disorder?

Bipolar 2 disorder, also termed "bipolar two," represents a specific form of mental illness bearing considerable similarities with bipolar 1 disorder, primarily characterized by cyclic swings between high and low mood states over time. The unique feature of bipolar 2, however, lies in the fact that the "up" moods, though present, never achieve the intensity associated with complete mania. These somewhat subdued periods of heightened mood are referred to as hypomanic episodes or, simply, hypomania.

One common feature in individuals living with bipolar 2 disorder is the experience of at least one hypomanic episode in their lifetime. Interestingly, people with bipolar 2 disorder are often seen to encounter depressive episodes more frequently than hypomanic ones. It's from this cyclical pattern of moods that the term "manic depression" has been derived. Despite the frequency of these episodes, it's worth noting that many individuals with bipolar 2 disorder manage to lead ordinary lives in the intervals between hypomania and depression (3).

For bipolar 2 disorder to be diagnosed, at least one major depressive and one hypomanic episode must occur. Following these episodes, individuals tend to revert to their usual functioning. Often, the first depressive episode motivates the individual to seek professional help. Interestingly, hypomanic episodes, though part of the condition, can often result in pleasurable feelings and may even enhance productivity in work or academic contexts. In addition to bipolar 2, individuals often face anxiety and substance abuse issues. The latter, in particular, can amplify the symptoms of depression or hypomania (4).

Bipolar 2 Disorder  Symptoms

Bipolar 2 disorder typically manifests with episodes of hypomania and depression. During hypomanic episodes, individuals may experience feelings of euphoria or heightened irritability, rapid shifts between ideas, inflated self-confidence, quick and loud speech, increased energy, hyperactivity, and reduced sleep needs (3).

While such individuals can appear highly sociable, this state can also lead to erratic behaviors, with occasional progression to full-blown mania. These erratic behaviors might involve impulsive spending or engaging in risky activities, potentially leading to harmful consequences (3).

On the other hand, depressive episodes occur more frequently in bipolar 2 disorder and are similar to those in clinical depression. This can lead to sadness, reduced energy, guilt or worthlessness, and suicidal ideation. The duration of these depressive episodes can range from weeks to months or, though infrequently, even years (3).

What Causes Bipolar 2 Disorder?

Bipolar 2 disorder, similar to other forms of mental illness, can affect anyone. Typically, the symptoms of bipolar disorder first appear during one's teens or early 20s. Almost everyone diagnosed with bipolar 2 disorder experiences its onset before the age of 50. It's worth noting that individuals with an immediate family member diagnosed with bipolar are at a higher risk (3).

The exact causality of bipolar disorder remains unknown. Experts, however, hypothesize that a multitude of factors, including physical, environmental, and social, intertwine to increase an individual's susceptibility to developing bipolar disorder. A genetic linkage is believed to exist, given the disorder's tendency to run in families, although no single gene is the known culprit. Instead, a combination of genetic factors and environmental triggers, such as stressful life events or physical illness, may prompt the onset of the disorder. Furthermore, some evidence suggests that chemical imbalances in the brain, specifically in neurotransmitters like noradrenaline, serotonin, and dopamine, may be associated with bipolar disorder symptoms (5).

What is the Difference Between Bipolar 1 and Bipolar 2?

Bipolar 1 and bipolar 2 are the two predominant forms of bipolar disorder. They are both characterized by significant fluctuations in mood and energy levels. While both forms include episodes of depression, the nature of manic episodes distinguishes them. Bipolar 1 is characterized by severe periods of depression interchanged with episodes of mania, which are intense to the point of necessitating potential hospitalization. Manic episodes are marked by heightened mood, extreme energy, impulsivity, and in certain cases, psychosis, which often lead to risky behaviors. Some individuals experience a return to a normal mood state between these severe episodes.

On the other hand, bipolar 2, identified as a separate condition from bipolar I in 1994, involves depressive episodes as well. However, full-blown mania is replaced with less severe hypomanic episodes. Hypomania, which can often be more subtle and less disruptive than mania, can sometimes result in initial misdiagnosis, commonly as depression. Unlike mania, hypomanic episodes do not typically involve psychosis, and the risks involved during such episodes are generally less severe. It’s worth noting that individuals diagnosed with bipolar 2 disorder are often able to uphold regular employment and maintain healthier relationships with more consistency than those diagnosed with bipolar 1 (6).

How is Bipolar 2 Disorder Diagnosed?

The diagnosis of bipolar 2 disorder typically starts with a consultation with a general practitioner. If bipolar disorder is suspected, the patient is usually referred to a psychiatrist. Immediate arrangements are made if there's a risk of self-harm. During the psychiatrist's appointment, the patient is assessed based on their symptoms, feelings leading up to and during episodes of mania or depression, thoughts of self-harm, medical background, and family history, with an emphasis on any family history of bipolar disorder.

In addition to this, diagnosis and subsequent treatment often hinge on open communication with a healthcare provider. This includes a comprehensive physical examination and necessary medical tests to rule out other potential causes. Then, a mental health evaluation may be conducted, or a referral to a trained mental health care provider could be provided. Accurate diagnosis is particularly important in younger individuals, given the implications on their long-term mental health.

Functional Medicine Labs That Can Help Individualize Treatment Options for Bipolar 2 Disorder

Functional medicine laboratories offer a range of tests designed to personalize patient care and fine-tune therapeutic approaches.

Environmental Toxins Testing for Bipolar II Disorder

The Environmental Toxins test measures exposure to a range of environmental toxins, such as pollutants, chemicals, and toxic metals. Exposure to these toxins can result in oxidative stress, compromising gut function and mental health. As the gut microbiome contributes significantly to the production of mood-related neurotransmitters, and toxins could interfere with brain neurotransmitter balance, the potential link to bipolar episodes is worth noting.

Neurotransmitters & Micronutrients Testing for Bipolar II Disorder

The Neurotransmitters & Micronutrients test is designed to identify any discrepancies in crucial brain chemicals and vital nutrients. It checks levels of neurotransmitters such as serotonin, dopamine, noradrenaline, and micronutrients necessary for their creation and function. Excessive noradrenaline, for instance, may instigate manic episodes, while low levels can result in depressive episodes.

Stool Testing for Bipolar II Disorder

The Gut Zoomer 3.0 Complete stool test offers detailed insights into the health of the gut microbiome. It evaluates the range and amount of microbial species, potential pathogens, and markers of inflammation. The health of the gut microbiome is vital to creating neurotransmitters like serotonin, GABA, and dopamine. Since changes in gut microbiota have been linked to mental health conditions like bipolar disorder, this test could reveal imbalances affecting bipolar symptoms.

Hormone and Stress Testing for Bipolar II Disorder

The DUTCH Complete is a dried urine test offering a comprehensive analysis of stress and sex hormones. It illuminates patterns of cortisol, a key component of stress responses, often serving as a trigger for bipolar disorder. The test also measures levels of estrogen and progesterone, hormones that studies suggest are linked to this disease, particularly in women.

Conventional Treatment for Bipolar 2 Disorder

The conventional management of bipolar 2 disorder primarily involves the long-term use of mood stabilizers like Lithium and Valproate to regulate mood swings. Antipsychotics may also be used to control hypomania and depression, while benzodiazepines provide short-term relief from acute symptoms like insomnia. Seroquel XR is one of the few medications specifically approved for bipolar 2 depression, with antidepressants also being an option. Alongside these pharmaceutical interventions, cognitive-behavioral therapy and ongoing medication are often recommended due to the recurring nature of the condition.

Functional Medicine Treatment for Bipolar 2 Disorder

In treating bipolar 2 disorder, adding integrative medicine to regular treatments can help. Because this mental health issue is complex, it's good to use a mix of medications, therapy, and changes to daily habits and lifestyle. Here are some ways integrative medicine can fit into the regular treatments for bipolar 2 disorder:

Integrative Nutrition for Bipolar 2 Disorder

Optimizing the management of bipolar 2 disorder could potentially benefit from integrative nutritional approaches, highlighting the important link between gut and mental health. Scientific studies have underscored the significant correlation between mental health and diet. Certain nutrients are suggested to play roles not only in the manifestation of bipolar symptoms but also possibly in its manifestation. Nutrients like omega-3 unsaturated fatty acids, typically found in seafood, and micronutrients, including folic acid and zinc, have been linked with a reduction in bipolar disorder symptoms. Additionally, promising outcomes have been found associated with probiotics and Coenzyme Q10 (CoQ10), which further emphasize the potential advantages of focusing on gut health.

The Microbiome Diet, a three-phase plan, could serve as a useful guide to enhancing gut health. This diet promotes the consumption of organic, plant-based 'Microbiome Superfoods.' Such foods include prebiotic options like garlic, onions, and artichokes that nurture beneficial gut bacteria and probiotic-rich foods like sauerkraut and kimchi that support the development of a robust intestinal mucosa layer, contributing to a healthier immune system. By promoting the intake of nutrient-dense superfoods and avoiding foods that may compromise a healthy microbiome, this diet could foster optimal gut health and possibly improve mental health outcomes in individuals with bipolar 2 disorder.

Detoxification Support for Bipolar 2 Disorder

Evidence demonstrates a connection between environmental pollution and an increased risk of psychiatric disorders, including bipolar disorder. Toxins in our surroundings could be minimized by enhancing the body's natural detoxification systems as a strategy to offset these risks.

There is a range of methods that can be implemented to fortify the body's detoxification system. These encompass minimizing exposure to environmental toxins using means like air purifiers, water filters, consumption of organic food, and the usage of personal care products with lesser toxicity. Prioritizing optimal liver performance by supplying it with the requisite vitamins and minerals for detoxification can significantly impact its detoxifying role. A balanced diet rich in certain foods, like cruciferous vegetables, berries, rooibos tea, celery, and grapefruit, can notably augment liver detoxification. Supplements such as Resveratrol, Quercetin, and Lycopene and herbs like Milk Thistle and Turmeric have properties that support liver detoxification. Additionally, lifestyle modifications, like avoiding alcohol and smoking, adding dry brushing and sauna sessions, maintaining adequate hydration, and exercising, can notably contribute to the detoxification process.

Supplements and Herbs for Bipolar 2 Disorder

Supplements can possibly offer symptom relief for those living with Bipolar II Disorder. Some potential evidence-based options include:

Omega-3 Fatty Acids for Bipolar 2 Disorder

Omega-3 fatty acids can influence neuronal pathways similarly to traditional bipolar treatments and may assist in improving the short-term trajectory and prolonging remission periods of bipolar disorder (22).

Dose: Roughly 9.6 grams/day

Duration: Assess efficacy after 4 months

Coenzyme Q10 (CoQ10) for Bipolar 2 Disorder

Coenzyme Q10 (CoQ10) has been linked to mental health improvements when used with mood stabilizers, potentially due to its role in cellular energy creation and protection against oxidative stress (25, 26, 27) .

Dose: 200 mg/day

Duration: Assess effectiveness after 8 weeks

Probiotics for Bipolar 2 Disorder

There's growing evidence that probiotics, sometimes called 'psychobiotics' due to their potential mental health benefits, could help improve the prognosis for those with bipolar 2 disorder. These beneficial bacteria may impact mental health through various means, such as synthesizing neurotransmitters, regulating inflammation, and enhancing stress response mechanisms.

Dose: 10-20 CFU (colony-forming units) per day

Duration: Continuous

Hormonal Balance for Bipolar 2 Disorder

Hormonal factors may play a role in bipolar disorder, especially in women. Studies suggest that female hormones might impact the development and severity of bipolar disorder, with periods such as menopause and premenstrual phase potentially influencing its course. Specifically, pregnant women or those in the postpartum stage with bipolar disorder have an increased risk of symptom recurrence and hospitalization, hinting at a significant hormonal link during these times. Regulating hormonal swings might be crucial in managing bipolar disorder, though more research is needed to fully understand this connection (14).

The role of estrogen seems particularly important. Research indicates that reduced estrogen levels are linked with postpartum psychosis in women with bipolar disorder, with symptoms improving following estrogen therapy. Moreover, tamoxifen, a drug that modulates estrogen receptors, has shown antimanic properties, further pointing to the influence of estrogen on bipolar disorder. Yet, these findings are initial, and more research is required to definitively establish the impact of estrogen and other sex hormones in bipolar disorder (29).

Lifestyle Modifications for Bipolar 2 Disorder

Managing bipolar 2 disorder necessitates careful lifestyle adjustments, such as regulating sleep patterns, staying physically active, and managing stress levels. Keeping to a routine daily schedule can help regulate moods effectively. It's worth noting that regular sleep patterns play a crucial role; changes in sleep duration could signal an impending manic or depressive episode. Thus, fostering soothing bedtime routines and creating a calming sleep environment are good choices for promoting healthy sleep habits. Starting with simple physical activities like walking and gradually ramping up can help improve mood and sleep quality.

Likewise, it's essential to keep stress in check. Activities like yoga, regular exercise, and meditation can help relieve anxiety and promote relaxation. Making changes in one's personal and professional life to alleviate stress can also be helpful. Limiting caffeine, which can disturb sleep and affect mood, is advisable. Abstaining from alcohol and drugs is a good choice, as these can worsen bipolar disorder symptoms and interfere with medications. If substance abuse is present, it's important to seek help immediately, as bipolar disorder treatments are not an effective substance abuse treatment option. It's worth noting that support groups or professional services can be beneficial in these circumstances (30).

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Summary

In summary, managing bipolar 2 disorder calls for a comprehensive care strategy. While traditional treatments remain critical, supplementary approaches like those offered by functional medicine can boost treatment results and better overall health. Patients with bipolar 2 disorder are encouraged to work with their healthcare professionals to develop a personalized, holistic treatment plan.