Front Matter

Contributors

Preface

Part I

Recognition

1 A Neglected Condition

2 Diagnosing Bipolar II Disorder

3 Interface Between Borderline Personality Disorder and Bipolar II Disorder

4 Psychiatric and Medical Comorbidities With Bipolar II Disorder

5 Suicide and Bipolar II Disorder

Part II

Understanding

6 Genetics of Bipolar II Disorder

7 Functional Brain Imaging and Neural Determinants in Bipolar II Disorder

Part III

Treatment

8 Mood Stabilizers and Antipsychotic Medications in Bipolar II Disorder

9 Antidepressant Medications in Bipolar II Disorder

10 Psychosocial Interventions in Bipolar II Disorder

Part IV

Special Populations

11 Bipolar II Disorder in Childhood and Adolescence

12 Reproductive-Age Women With Bipolar II Disorder

Index

Professor of Psychiatry and Endowed Chair in Early Bipolar Disorder, Director of the Child and Adolescent Bipolar Services Program, Co-Director of Psychiatry Research Pathway Program, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Assistant Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern Feinberg School of Medicine, Chicago, Illinois

Clinical Assistant Professor, University of Pittsburgh School of Medicine, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Psychiatrist, Department of Psychiatry and Psychology, Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain

Graduate Medical Resident in Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania

Doctoral Candidate and Research Assistant, Prevention and Intervention Laboratory, Stanford University School of Medicine, Stanford, California

Assistant Professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Chief Research Officer, Lindner Center of HOPE, Mason, Ohio; Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio

Thomas B. and Nancy Upjohn Woodworth Professor of Bipolar Disorder and Depression, Professor of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan

Professor of Psychiatry and Pharmacology, University of Toronto; University Health Network, Mood Disorder Psychopharmacology Unit (MDPU), Toronto, ON, Canada

Clinical Assistant Professor of Psychiatry, Brown University; Staff Psychologist, Rhode Island Hospital, Providence, Rhode Island

Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Clinical Psychologist, Outpatient Mood Disorders Clinic, Clinical Supervisor, Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

Associate Professor of Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine; Medical Director, VA/Stanford Bipolar and Depression Research Program, Veterans Affairs Palo Alto Health Care System, Palo Alto, California

Pittsburgh Foundation-Emmerling Endowed Chair in Psychotic Disorders, Professor in Psychiatry and Clinical and Translational Science, and Director of the Mood and Brain Laboratory, The Clinical and Translational Affective Neuroscience Program, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Child Psychiatry Fellow, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Chief Resident of Psychiatry, Clinician Scientist Program, University of Toronto; University Health Network, Mood Disorder Psychopharmacology Unit (MDPU), Toronto, ON, Canada

Deputy Psychiatrist-in-Chief, Head, Mood and Anxiety Disorders Program, Sunnybrook Health Sciences Centre; Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Psychiatrist, Sunnybrook Health Sciences Centre; Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Assistant Professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Psychiatrist, Department of Psychiatry and Psychology, Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain

Professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; VA Palo Alto Health Care System, Palo Alto, California

Professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Professor of Psychiatry, Chair, Department of Psychiatry and Psychology, Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain

Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology; Director, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Professor of Psychiatry and Human Behavior, Brown University; Director of Outpatient Psychiatry and Partial Hospital Program, Rhode Island Hospital, Providence, Rhode Island

What is bipolar II disorder? Are there really different types of bipolar disorder? Why does it matter?

Even many experienced clinicians may know surprisingly little about bipolar II disorder. Despite being a common illness, bipolar II disorder is misunderstood, neglected, and rarely receives the attention it deserves. When working with individuals diagnosed with bipolar II disorder, many clinicians have no clear roadmap for identifying or treating the disorder. As a result, bipolar II disorder often goes undiagnosed. Once the disorder is recognized, many clinicians use therapies that were tested in patients with bipolar I disorder to treat bipolar II disorder, even though the latter is quite different from the former. Shared frustrations about how little information is available to professionals about bipolar II disorder led us to write this book with the goal of providing a comprehensive resource for those interested in learning more. We hope it will serve as a resource for clinicians who care for individuals with bipolar II disorder, researchers who study bipolar II disorder, supporters who are concerned about someone with bipolar II disorder, and those who wish to learn more about their own diagnosis. All of these groups will find much to interest them in these chapters; the book, however, is written primarily for professionals rather than a lay audience.

The book is divided into four parts: 1) Recognition, focused on differential diagnosis of bipolar II disorder; 2) Understanding, focused on biology; 3) Treatment, focused on pharmacotherapy and psychotherapy; and 4) Special Populations, focused on bipolar II disorder in youth and women. Individual chapters are written by experts in the fields of phenomenology, genetics, neuroimaging, psychopharmacology, psychotherapy, child psychiatry, and reproductive mental health, who review what is currently known about bipolar II disorder and its management. Throughout the book, readers will find case vignettes illustrating clinical applications of the research literature discussed in each chapter. The main messages of each chapter are summarized as Key Points for easy reference and review.

We are thrilled to see that many advances have been made in understanding bipolar II disorder since the diagnosis was first codified in 1994. We are also humbled by the many holes that remain in the evidence base, particularly related to optimal treatments and neurobiology. This collection of writings highlights not only what we have learned about bipolar II disorder but also how much more we have yet to discover. This book seeks to answer many of the pressing, unresolved questions about bipolar II disorder facing those working in psychiatry. Our greatest hope, however, is that we will spur others to ask even more questions and find even better answers in the future.

Holly A. Swartz, M.D.

Trisha Suppes, M.D., Ph.D.