Bipolar type 2 UNDIAGNOSED OR TAKING YEARS TO DIAGNOSE

@depressedbutnotdead: You have underscored the importance of having a skilled medical professional provide guidance to someone struggling with depressive episodes. I appreciate that you noted it’s important not to be opposed to antidepressants as they can certainly be effective in reducing depressive symptoms for many individuals. Additionally, as you pointed out, other medications can sometimes be beneficial, such as you found lamictal to work for you - as while this is frequently used to treat epilepsy, it has been found to have beneficial effects as a mood stabilizer. The same has been true for gabapentin, prescribed for neuropathy but has calming effects for anxiety.

Working in conjunction with a trusted provider and being open to trials of medications to find the best modality in mental health situations is a key factor in symptom management as you have learned in your situation. Thank you for sharing.

Maybe a definition will be helpful as to what Bipolar Type II is — and why is it often undiagnosed for years?

Bipolar Type II is a mood disorder characterized by recurrent depression and hypomania (not full mania).

The key reason it often goes undiagnosed for years is that:

- Depression is usually the dominant symptom.

- Hypomania can feel normal, productive, or even positive.

- People rarely seek help during hypomania—only during depression.

Bipolar II includes:

- Major depressive episodes (often long, severe, and recurring).

- Hypomanic episodes (shorter periods of:
- Increased energy
- Less need for sleep
- Racing thoughts
- Talkativeness
- Increased confidence or impulsivity).

What it does not include:

- Full manic episodes.
- Psychosis (unless during severe depression).

Why it’s frequently misdiagnosed:

- Often labeled as major depressive disorder.
- Antidepressants alone may help temporarily—or worsen mood cycling.
- Hypomania is mistaken for “just feeling good,” stress relief, or personality.

Why diagnosis can take years:

- Patients report depression, not hypomania.
- Hypomania may look like:
- High productivity
- Social confidence
- Creativity
- Symptoms don’t always appear extreme or disruptive.

Why proper diagnosis matters:

- Treatment differs from unipolar depression.
- Mood stabilizers are often needed
- Antidepressants alone can increase cycling or mood instability.

Many people only receive the correct diagnosis after years of depression treatment that never fully works.

If depression keeps returning—or antidepressants seem to cause agitation, insomnia, or emotional swings—it’s worth asking whether Bipolar II has been considered.

Source's:

What Bipolar II Disorder is:

Definition and Diagnostic Criteria (DSM-5): Bipolar II involves at least one major depressive episode and at least one hypomanic episode, without any full manic episodes — this is how it’s officially defined by psychiatric standards. Bipolar II disorder (Wikipedia)

Diagnostic criteria explained: The hypomanic episode must last at least 4 days and include elevated/irritable mood plus other symptoms, while depressive episodes must meet criteria for major depression. DSM‑5 Diagnostic Details for Bipolar II

Why it often takes years to diagnose

Underrecognized and underdiagnosed: Research shows Bipolar II is frequently misdiagnosed or missed by clinicians, leading to long delays (often more than 10 years) before correct diagnosis. Bipolar II disorder: Understudied and Underdiagnosed (PubMed)

Depression dominates clinical picture: Because depressive episodes are more frequent and longer than hypomanic ones, many people and clinicians only see depression and miss the hypomania. Bipolar II – diagnosis & misdiagnosis challenges (PubMed)

Misdiagnosis as depression: Patients often present to treatment only during depression and don’t recognize hypomania as a problem, so clinicians diagnose major depressive disorder instead. Why Bipolar II can be misdiagnosed (Dr Oracle article)

Diagnostic difficulty in practice: A review notes that differentiating bipolar disorders (especially II) from unipolar depression is tricky because symptoms overlap and subtle hypomania is easy to miss. Diagnostic challenges in bipolar disorder (PMC review)

Helpful screening tool:

Ways clinicians try to catch it:

Screening scales like the Bipolar Spectrum Diagnostic Scale (BSDS) help identify bipolar symptoms that might otherwise go unnoticed. Bipolar Spectrum Diagnostic Scale info (Wikipedia)

Download the Bipolar II Disorder Short Summary (PDF)

For context, I want to share where my comments are coming from. I’ve spent more than 20 years independently investigating epidemiological data, scientific literature, and peer-reviewed medical research across a wide range of topics. My focus has always been on primary sources—original studies, systematic reviews, and consensus statements—rather than summaries, headlines, or anecdotal reports.

I make a point of cross-checking claims, understanding study design and limitations, and distinguishing between correlation, causation, and hypothesis. When evidence is incomplete or evolving, I try to say so clearly. When strong data exist, I rely on that rather than speculation or opinion.

I’m not here to persuade or argue, but to contribute information that is evidence-based, transparent, and open to correction if better data emerge. Thoughtful discussion grounded in reliable science benefits everyone, and that’s the spirit in which I participate here.

I try anything I can to stay off of any medications.

I did use some mild anti depressant for a short time to help me sleep.

Then I changed my diet!

I was a good weight, now amazing with super change in energy and overall mental feelings. I am taking care of my husband, 10 plus year dementia.

We are now starting our journey on a keto diet. I have been researching diet and anything I can for my husband.

We drink beef broth and add powdered Lion's Mane. We eat SUPERGUT Yogurt from Dr. William Davis' book SUPERGUT and started our diet on his plan, which was easy to do knowing the health benefits.

YOU have to want to stick to the diet. When we cheated, we got rashes, fatigue, depressed, trouble sleeping came back. PROOF the diet was working in multiple ways.

Now we are preparing to go KETO for extra health benefits. The fats in the diet are good for the brain and the diet heals the cells, which heal the body. Also do intermittent fasting, which sounds tough, but is EASY because you feel so good!!!!! That is eating NO snacks, and trying to eat in an 8-6 hour window. Like 10-6pm or Noon to 6PM. Read up on it. Maybe three hard days for us with feeling hungry, then it was so easy, but not so for everyone. It ended up having the will power and WANTING to feel better. Not blaming ourselves if we cheated, but not cheating was the total goal...!

It is all about wanting to FEEL GOOD and have energy. You want it enough, you will make changes. Feeling better, energy... its a high. Michael is no longer diabetic, We both lost weight, he lost visceral fat. He is 90. I am 69 and VERY active.

doc wants me to try a new med to try and control the depressive episodes (that are really bad) I hate meds but ....... this depression is beyond anything.

@marilynon It sounds like you've found a plan that works for you and your husband.

Diet has certainly been shown to be helpful in the treament of many conditions which in some cases can ameliorate their symptoms, although there are several people who can use this as a supplement to, but not necessarily in place of, medications to treat to their depression, the depth of which varies tremendously amongst individuals. For such people struggling with extreme levels, that are frequently due to disruption in brain chemicals (such as serotonin and dopamine, even vitamin levels that may contribute) this may not be a universal solution even for those who are committed to achieving a healthy lifestyle, as stability often requires medical supervision that can include personalized nutritional counseling specifically geared to their needs.

@tisme: Depression can be debillitating, just as any physical condition can be. I know of people who have been diagnosed with diabetes who were terribly upset when they had to take insulin injections to control their blood sugar but eventually found how this improved their overall quality of life. My husband had faced a similar struggle when he learned he could benefit from hearing aids - but once tried, he saw (rather, he heard!) what a tremendous improvement this made in his daily functioning.

Needing or changing medication to adjust mood levels doesn't mean that you're weak or that you've failed. This is a tool to help you manage symptoms, many of which are beyond your control due to brain chemicals that may need some re-adjusting from time to time, to give your brain the support it needs and help you function at a level that brings about improvement in mood.

Often times with new medications, it can take up to four weeks to feel the full effects. Would you be able to check back in then to let me know how you're doing?

It is important to remember that the names of psychiatric conditions are completely human made, they are not cut and dried like a type of bone fracture or a contagious disease or the result of a dietary insufficiency, they are based on observation and opinion. There may be empirical indicators, such as a higher or lower amount of certain chemicals that influence mood, but they are adjuncts to the main diagnosis. So often one cannot really say "he/she has type 2 bipolar" or whatever else, with certainty any more than one can categorise with certainty the genre of a song.
I say this with experience of being a carer to someone who was never diagnosed for certain for the whole 40 years that they undoubtedly had a mental health problem. He was sometimes categorised as having a form of schizophrenia, sometimes bi polar, or manic depression as it was called, sometimes variations.
That is not a helpful answer to the primary question I am afraid, but just an observation to bear in mind.

@grammato3 if you remind me , im always around here .

@hectorheath: This is definitely an observation many of those working with or being in close contact to someone who is treating for such conditions have made.

It is true that mental health diagnoses are not equally reliable. Some conditions are identified more consistently, while mood and anxiety disorders have overlapping symptoms and/or symptoms that change over time. Unlike many physical ailments, there are generally no clear biological tests, therefore providers need to rely heavily on judgment. While the DSM provides helpful guidance, the evolving nature of research and diagnostic criteria makes accurate diagnosis difficult. Often, presentation results in application of overlapping diagnoses drawing on various demonstated traits, or Cluster B personality characteristics. This highlighting the need for ongoing and careful assessment over time.

Focusing on symptom management, as opposed to labels, is a key part of providing appropriate individualized care.

@tism: I will certainly try to make an effort to do so. As a mentor here, I'm on a few of these support groups, and as a Mayo patient myself going through immunotherapy with some recent related issues for which I have several upcoming appointments, I have to admit sometimes it's hard to keep track of everything on my plate! I'm trying my best to keep up with everything but if I don't circle back within about a month or so, if you post a follow up I'll be on the look out!