What We’ve Said

What we’ve said about Bipolar II disorder

6 points from 5 episodes, newest first

Also searched as bipolar 2, BP-II

In short

Bipolar II sits within a wider range of low-grade bipolar disorders, and a strict four-day hypomania cutoff can miss patients who would benefit from treatment such as low-dose lithium. By the DSM it technically allows psychosis without becoming bipolar I. In visits, name the problems you are treating and tie them to the diagnosis and the medication.

How we diagnose it

  1. Bipolar II technically allows psychosis without upgrading the diagnosis to bipolar I.

    “Number two, bipolar 2 disorder technically allows you to have psychosis without upgrading the bipolar 1”
    26:10Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026

  2. One of us no longer uses the four-day hypomania cutoff for screening. It misses many low-grade bipolar-type disorders that could benefit from low-dose lithium for their depression.

    “Personally, I don't like the four days. I used to do four days because of the DSM rules. But I think that if you do four days, you're going to miss a lot of low-grade bipolar type disorders that could benefit from low-dose lithium, for example, for their treatment of depression”
    33:42How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026

  3. Postpartum psychosis can be argued to be a unique syndrome that interacts with a baseline bipolar II disorder: the postpartum psychosis lifts, and the bipolar II remains.

    “you could argue that the postpartum psychosis is a unique syndrome limited to onset after the pregnancy period and that it is interacting with the baseline bipolar 2 disorder and that the postpartum psychosis will eventually lift, but that the bipolar 2 will remain”
    27:34Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026

Treatment

  1. Quetiapine is one of the only antipsychotics that covers the whole gamut of bipolar disorder, both the depressive episodes and the mania.

    “quetiapine is one of the only antipsychotics that kind of covers the whole gamut of bipolar. So it covers the depressive episodes. It covers the mania”
    16:21Antipsychotic Tier List: Ranking the Best and Worst Anti-psychoticsOct 2026

  2. Pitch lithium as: the second you get a side effect, we go back down to the lower dose. That changes the conversation.

    “when you pitch it to a patient as the second you get a side effect, we're going to go back down to the lower dose. Whoa, what a difference that makes”
    7:49Dr. Jim Phelps’ Bipolar Treatment Tier List: Lessons from 30+ Years in PsychiatryJul 2026

Talking to patients

  1. Name the problem and tie it to the treatment: these concentration and sleep problems are what I am medically calling bipolar II, and I expect this medication to improve both.

    “This problem you're having with concentration, these issues that you're having with sleep, that's what I'm medically calling a bipolar 2 disorder. And I'm expecting that with this medication, we're going to see improvements on both of those major issues”
    17:22Psychiatric Technique for Diagnostic Interviewing and Therapy: 6 Mantras Every Clinician Should KnowApr 2026

From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.