The Surprising Differences Between Bipolar I and Bipolar II

Bipolar I and Bipolar II

Bipolar disorder has been making headlines recently as a growing number of celebrities and influencers—including singers Halsey and Bebe Rexha—reveal their diagnoses with the condition that affects nearly 6 million Americans. Despite the increased awareness of the disorder, the condition that used to be called manic-depressive disorder remains shrouded in myths and misinformation.

Most people think bipolar disorder is a singular condition with a fixed set of symptoms—manic episodes that alternate with depressive episodes in a cyclical pattern. While that may be true for many people with the disorder, it isn’t so for everyone who has bipolar disorder. In fact, there are multiple types of bipolar disorder and the symptoms experienced depend on which type you have. The most common and most serious forms of the condition are bipolar I and bipolar I. What are the differences between these subtypes of bipolar disorder? To clear up the confusion, this blog will outline the main characteristics of each type.


Bipolar I is characterized by the presence of mania and may or may not include depressive episodes. During manic episodes, people feel abnormally energized, euphoric, and full of confidence. It is common for people in the throes of a manic episode to come up with lots of grandiose ideas, start several big projects, and skimp on sleep.

Common signs of mania include:

  • Unusually elevated mood
  • Inflated self-esteem
  • Decreased need for sleep
  • Increase in goal-oriented activity
  • Grandiose notions, ideas, or plans
  • Increased talking or pressured speech
  • Racing thoughts
  • Inability to “turn off the mind”
  • Poor judgment that leads to risk-taking behavior
  • Hypersexuality or hyper-religiosity
  • Excessive appetite
  • Inappropriate social behavior
  • Irritability or aggression
  • Delusions or hallucinations

With mania, behaviors can be so exaggerated that they disrupt daily life. People with bipolar I may impulsively buy expensive items they can’t afford, have sex with a colleague in the office during working hours, or engage in criminal activities. In some instances, mania may be so severe that a person requires hospitalization or suffers severe consequences, such as being injured, attempting suicide, getting arrested, being fired, being suspended from school, and more.


People with bipolar II typically experience both emotional highs and low moods that can occur in a cyclical pattern. However, the biggest difference between bipolar I and bipolar II is that episodes of elevated moods in bipolar II aren’t as intense as those in bipolar I and don’t reach the level of mania. Mental health experts call these episodes in bipolar II “hypomanic.”

The biggest difference between bipolar I and bipolar II is that episodes of elevated moods in bipolar II aren’t as intense as those in bipolar I and don’t reach the level of mania. Click To Tweet

During hypomanic episodes, you may feel a surge of energy, self-esteem, and productivity, but it usually doesn’t prevent you from handling everyday tasks and it isn’t likely to land you in trouble at work, at school, or with the law. People who are experiencing a hypomanic episode may seem like the life of the party—full of ideas, confidence, and high energy.


There can be a downside to the manic or hypomanic episodes seen in bipolar I and bipolar II, respectively. These emotional highs may be followed by periods of depression that can last weeks or months.

Symptoms of depressive episodes in bipolar disorder include:

  • Sad or negative mood
  • Low energy
  • Fatigue or feeling “slowed down”
  • Feelings of hopelessness and helplessness
  • Feelings of worthlessness
  • Difficulty concentrating
  • Insomnia, hypersomnia (sleeping too much), or early awakening
  • Suicidal thoughts and behaviors

In both bipolar I and bipolar II, depressive episodes occur more often, are longer in duration, and are more debilitating than manic or hypomanic episodes. Results from a study in the journal Bipolar Disorders show that people with bipolar I spend 3 times as much time in depressive episodes compared with manic periods. For those with bipolar II, nearly 4 times as much time is spent in a depressed mood compared with hypomanic episodes.


To be diagnosed with bipolar I, a person must have experienced at least I manic episode with or without a depressive episode. For a bipolar II diagnosis, there must be at least one hypomanic episode and one depressive episode. However, because the symptoms of hypomania are more subtle, it can be more challenging to get a definitive diagnosis of bipolar II.

What may complicate diagnosis even further is the fact that people struggling with both forms of bipolar disorder typically seek help related to the depression they experience. As a result, people with this condition may be misdiagnosed with major depressive disorder. In fact, research shows that 12% of people with hypomania initially received a diagnosis of depression.

People with bipolar disorder may also be misdiagnosed with ADHD or schizophrenia since there is some overlap in symptoms with these conditions. Brain SPECT imaging can be beneficial in getting an accurate diagnosis because it is helpful in identifying brain activity patterns associated with various conditions. SPECT, when included as part of a comprehensive evaluation, can help rule out other possible conditions or causes for symptoms, such as substance abuse.


There is hope for people who are struggling with either bipolar I or bipolar II. With a clear diagnosis, a targeted treatment plan can put you on a path to manage your condition. The most effective treatment plans for bipolar disorder take a multi-pronged approach and may include psychotherapy, nutritional supplements and medication, lifestyle changes, and more.

Bipolar disorder and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.


  1. Absolutely! How can a doctor caring for the brain, not look at the brain? SPECT should be part of the standard of care in psychiatry. Great article.

    Comment by liam Briones MD — December 10, 2021 @ 7:10 PM

  2. Bi polar I I could just be considered a “normal” person. People naturally go through ups and downs. Here is where personality may come into play. Some people by nature are the life of parties, energetic and fun and of course they are not like this every moment of the day or weeks maybe. It is just normal behavior. There are too many “LABELS” of mental illness far far too many it’s ridiculous.

    Comment by Kellie — December 11, 2021 @ 2:22 PM

  3. I agree with the last comment about brain health treatment including brain scans. Insurance companies should consider this evidence and pay for it.

    Comment by Donna Lee Ray — December 15, 2021 @ 3:21 AM

  4. My son needs a scan

    Comment by Karen — December 15, 2021 @ 3:33 AM

  5. I’ve been told that I have bipolar but I think I have more than bipolar I need to be tested I’m having trouble I don’t want even suicidal thoughts I’m looking for help I’ve been to doctors and all they do to give me selectza and a billabide which just amplified my suicidal thoughts I need help I want help

    Comment by Jaymes collard — December 15, 2021 @ 3:44 AM

  6. I agree with the comment above but why aren’t these scans covered under insurance?? Instead were left suffering and possibly taking our own life

    Comment by Kelly — December 15, 2021 @ 4:18 AM

  7. Great article. Thank you very much.

    Comment by Timothy Lee — December 15, 2021 @ 6:06 AM

  8. Bipolar I is a horrible disease. Our adult daughter was diagnosed with it around age 19. We took her to the AMEN Clinic where they helped confirm her problem and gave medication recommendations. Her psychiatrist used the information AMEN Clinic provided to help treat her. The sad part is Bipolar I patients start feeling good and stop their medication. In our daughter’s case, she does that and then self-medicates, which places her in the hospital. We finally found an injectable medication related to the original antipsychotic pill she was taking. This injectable has been wonderful in that her mood is more stable and she took it upon herself to find a part-time job, even though she is considered disabled. She also takes the supplements recommended by the AMEN Clinic to help heal her brain. I’m thankful for Dr. Amen who provided innovative ways to assess mental illness.

    Comment by Art Zeigler — December 15, 2021 @ 6:38 AM

  9. I really believe my 47 year old son has Bipolar 1, but because of his circumstances he doesn’t have access to SPECT and cannot afford it. To complicate matters he had a TBI about 12 years ago and was disabled even before that. What are people like him supposed to do? This is like hanging a “carrot” in front of a person with no chance of getting this needed help. I appreciate the information, but unfortunately we simply cannot afford it. Otherwise, keep up the great work. Maybe one day people like my son will have access. Thank you.

    Comment by Linda DiStefano — December 15, 2021 @ 7:41 AM

  10. The more I read these articles from the Amen Clinics, the more I am convinced that people in my family, myself included, have been misdiagnosed for years. This could be why we never feel better mentally and emotionally. I had an MRI earlier this year, and the neurologist stated that my brain looked fine, no mild cognitive impairment, yet I am receiving disability payments for brain health issues, which are real. It is critical that the brain be looked at through SPECT scans.

    Comment by Margaret — December 15, 2021 @ 7:56 AM

  11. I’m bipolar I and nothiIf Ifng about your definition is anything like my experiences of living with bipolar I.

    Comment by Kellie gardner — December 15, 2021 @ 8:27 AM

  12. I have been living with bi polar I for thirty years and this definition is just describing what people have noticed other “crazy” people do. It does not explain what is really happening. Nor does it explain anything about what is really going on in someone’s mind!

    Comment by Kellie — December 15, 2021 @ 8:36 AM

  13. Born 2-17-1952. Always nervous in early life. Started bipolar at 18 with severe depression and some occasional elevated moods. Hospitalized twice by choice to prevent suicide. Used combination of Parnate and Valium for 35 years with heavy exercise for 40 years to control symptoms enough to hold responsible job. Constant dorks of severe depression and moderate mania. Parnate stopped working and have been on antidepressants and mood stabilizers for last 15 years with limited success. Have been constantly depressed with highs feeling like I may get better. Stay in bed s lot. Don’t feel like doing anything. I wonder why I am alive and feel hopeless. . The depression is bad to moderate but no mania in years. Tried to get TMS treatment but Dr said it would not help me. My regular psychiatrist who manages my meds thinks it could. I don’t know what to do. They are arguing over treatment plan while I suffer. I could try kettermine but I don’t want to.
    I need help but don’t know where to go or what to do or if Medicare
    Part A B + supplement BCBS will cover any treatment I need. My life has been rewarding at times but very difficult to live. I hoped to get
    better with age. I don’t have a lot of severe depression but depressedcall the time now. Invbed a lot tiredcand isolates from people.,Do you have possible recommendation for a treatment plan?
    Thank You,
    Thomas Spain

    Comment by Thomas Spain — December 15, 2021 @ 8:52 AM

  14. I have Bipolar type I. I reached you several months ago and the prices are imposible to pay for a person like me with financial limitations. I Wonder the fact that you claim that are so interested in help patients with bipolar condition regarding the highly overprices to benefit from your services. You have to think about my point of view seriously to give better prices when charge for your services.

    Comment by Jacqueline Santiago — December 15, 2021 @ 9:24 AM

  15. Will you address the issue of self medicating with drugs and alcohol by bipolar people and how that complicates things

    Comment by Rose — December 15, 2021 @ 9:35 AM

  16. I have been bipolar all my life and I will be 65 Friday. I have been bipolar all my life and I will be 65 Friday. It has taken over my life no matter how hard I try. Right now the depression is very bad.

    Comment by Diane Krupa — December 15, 2021 @ 10:57 AM

  17. Hello, and thank you for reaching out. We’d be happy to contact you directly with more information. We look forward to speaking with you!

    Comment by Amen Clinics — December 15, 2021 @ 1:18 PM

  18. Hello Karen, thank you for reaching out. We’d be happy to provide you more information regarding treatment for your son. Please contact our Care Coordinators:

    Comment by Amen Clinics — December 15, 2021 @ 1:19 PM

  19. It would be magnificent if the tests that help people with brain injuries and illnesses were more affordable to them. If one’s mission is to study and help others, then part of the mission should be to make sure that people could afford the help instead of these tests and recommendations being financially unattainable to most. I do not say free. I’m all for people earning money for the services they provide but if it’s at a price point that mainly services those considered “wealthy”, then it seems it’s less a “mission in life” and more of a “niche” in it.

    Comment by Lee — December 15, 2021 @ 3:21 PM

  20. I’ve Been diagnosed with bipolar, it has ruined my life as I’ve asked for help but to no avail, my sex life has been zero for the last 10 years and all I’ve been told is that’s life, I get so depressed and my partner is abused verbally by me and he doesn’t deserve it at all, he is amazing to put up with the mental abuse, anyone else would’ve gone especially as he’s 16 years younger than me, I’m 68 and he’s 52.maybe you can help.

    Comment by Sharon — December 15, 2021 @ 4:42 PM

  21. You forgot to mention the derivation of the devastating affliction, mixed bipolar affective disorder (severe), from bipolar I disorder. Worse, I don’t appear the only one that ends up Borderpolar. They always throw BPII in the mix, it is frustrating. It appears that those of us with Mixed Bipolar, and especially the all too common occurrence of Borderline Personality Disorder, get thrown and kicked out of every Academic Teaching Hospital because we make the data bad. I did better doctoring myself with the aid of a psych NP. Could you please provide an article on the subject? There is a paucity of data and journals even on academic databases.

    Comment by Justin Markos — December 15, 2021 @ 7:56 PM

  22. Can you provide information on Borderpolar and Mixed Bipolar Affective Disorder (Severe), the basis of Bipolar I rapid cycling mixed states (DSM V TR)? Until reaching some stability, I used to cycle up to 6 times a day. Thankfully the cycling has stopped. The mixed episodes remain. I gave up on ECT after my 60th treatment and accept chronic depression is permanent. At least I am not end-stage Catalonia. That was miserable. The Borderline is partially under control. Please don’t delete my comment this time. I would just like information. The amount of information available is limited if any exists on any academic database.

    Comment by Justin Markos — December 15, 2021 @ 8:21 PM

  23. I recently turned 60. My first 31 years were the most difficult. I believed life and my feelings toward it was supposed to be the way it was. A day in my life was met with extreme highs, confusion with no attention span which affected my academics. My lows were so extreme that I hid behind my illness with humor. I pushed through it so no one would notice. I hid behind the smile. I experimented with alcohol and drugs to help cope. At age 31 I finally went to see a Doctor and I cried when he told me I had a condition and its name was Bipolar. Since then I’ve adjusted and readjusted my medication to where my days are made easier to handle. I must Also give credit to my family and particularly my husband whom without their encouragement, patience and love I may still be sinking. Medication is not the only way to help your bipolar. Its amazing when you see and feel someone communicate to you in your “ill” language. They just need to really hear you. When they know you well enough to know and say just the right thing to help you along. I’m fortunate to have this in my life. So no complaining, I remember and appreciate what I have.

    Comment by Deanna — December 16, 2021 @ 8:41 AM

  24. My son has Bipolar 1 , was diagnosed a few years ago . He’s in college in Washington state now but family homes in Sacramento region & SF Bay Area . Where would your closest
    clinic /Spect be and how much

    Comment by Cathy — December 16, 2021 @ 1:29 PM

  25. Hello Cathy, thank you for reaching out about your son. We actually have clinics in both Washington state (in Bellevue) and in the Bay Area (in Walnut Creek). We would be happy to contact you directly with more information about scheduling an appointment at one of our clinics. We look forward to speaking with you soon.

    Comment by Amen Clinics — December 16, 2021 @ 4:43 PM

  26. I remember going back to my teenage years always being extremely happy or extremely sad; I was always on a roller coaster of emotion and could never find a normal level. I was eventually diagnosed with major depression after a divorce and treatedwith anti-depresssants until I was a walking zombie. I was seeing therapists most of my life and was finally diagnosed when I was in my 50’s, when one of my therapists observed me in a hypomanic state. I was mostly depressed but loved my hypomanic episodes beecause I could get things done. I recently tried TMS therapy for depression and anxiety; through most of the treatment I was again on a roller coaster and almost quit several times, but decided to continue. I am so glad I did! I am so truly amazed that towards the end of the treatments and since, my depression is gone. It’s like a great cloud was lifted off of me. This has lasted at least 5 months. My psychiatrist said that some patients never need any further treatments and some may need to come back occasionally. I still enjoy my hyypomania because I “get more done”. One of my biggest problems now is learning how to deal with the feelings I was stuffing into my depression, but I am so much happier and it’s such a great comport to understand why I did some of the things I did in my hypomanic episodes that so confused me. I had never seen a better explanation of Bipolar 1 and 2 before and it truly helped me. Thank you.

    Comment by MARIANNE — December 17, 2021 @ 1:38 AM

  27. These scans are usually covered at the out of network pricing. They also usually need to be pre-approved. The entire, Insurance does not cover the full price.. The misunderstandung comes from people not knowing that they have to fill out the insurance claim forms. If you do these things you can save up to 70% off the cost.

    Comment by Jeff — December 19, 2021 @ 8:49 AM

  28. Hello Sharon, thank you for reaching out. For information about scheduling an appointment at one of our 9 clinics, please contact our Care Coordinators:

    Comment by Amen Clinics — December 20, 2021 @ 3:45 PM

  29. Hi there Im looking for arcticle on menopause and how it can make you feel crazy?

    A friend is suffering so bad and she Neds help?

    Thanks Shontelle from Canada

    Comment by Shontelle West — March 5, 2022 @ 11:32 AM

  30. Hello Shontelle, thank you for reaching out. Here are our articles related to menopause:

    Comment by Amen Clinics — March 6, 2022 @ 6:19 PM

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