What’s the Difference Between Bipolar 1 and 2?

This content is for informational purposes only and is not a substitute for professional medical advice. Always consult a qualified mental health provider for diagnosis and treatment of bipolar disorder.

Quick Summary: The primary distinction between bipolar I and bipolar II disorder lies in the nature and intensity of elevated mood episodes. Bipolar I is characterized by at least one manic episode, which may be severe enough to require hospitalization. Bipolar II involves episodes of hypomania, a milder form of elevated mood, paired with more frequent and often prolonged depressive episodes. Both forms are serious and require professional evaluation and management.

Are you trying to understand the difference between bipolar 1 and bipolar 2? You’re not alone in feeling confused by these distinctions. Many people, including those recently diagnosed and their loved ones, find themselves searching for clear explanations of what these different types of bipolar disorder actually mean.

Whether you’re concerned about symptoms you’ve been experiencing, trying to understand a recent diagnosis, or supporting someone you care about, knowing the key differences between these conditions can help you feel more informed and empowered in your mental health journey.

Defining the condition and mood episodes

Bipolar disorder is a psychiatric condition marked by cyclical changes in mood, energy, and activity levels that can significantly impair daily functioning. Individuals with bipolar disorder experience distinct episodes of mania or hypomania (elevated or irritable mood) and depression (low mood, loss of interest, and fatigue). These episodes are not typical mood fluctuations; they are prolonged, often severe, and can affect decision-making, relationships, and overall quality of life.

During a manic or hypomanic episode, a person may feel excessively energetic, euphoric, impulsive, or irritable. In depressive episodes, individuals often experience pervasive sadness, loss of interest in usual activities, and feelings of worthlessness or hopelessness.

Epidemiological studies estimate that approximately 2.8% of adults in the United States are affected by bipolar disorder annually, with onset typically occurring in late adolescence or early adulthood [1]. The disorder is chronic but manageable, especially with a tailored treatment plan that may include medication, psychotherapy, lifestyle modifications, and support systems.

It’s important to understand that bipolar disorder affects everyone differently. Individual experiences with symptoms, episode frequency, and treatment response can vary significantly based on factors like genetics, life circumstances, and overall health.

Why Distinguishing Between Bipolar I and II Matters

Implications for diagnosis, treatment, and prognosisAccurately differentiating between bipolar I and bipolar II is essential, as it directly influences treatment decisions, safety considerations, and long-term outcomes. Bipolar I disorder requires the presence of at least one manic episode, which may include psychotic features or require hospitalization due to impaired judgment or risky behaviors. In contrast, bipolar II is defined by at least one major depressive episode and at least one hypomanic episode, without any history of full mania.

Because hypomania may not cause obvious impairment, bipolar II can be more challenging to diagnose. However, research indicates that individuals with bipolar II often experience greater chronicity of depressive symptoms, which may be equally or more disabling than the manic symptoms seen in bipolar I [2].

Understanding your specific diagnosis empowers both patients and clinicians to monitor early signs of mood changes, personalize treatment plans, and take preventative steps to reduce relapse risk. With proper care, many individuals with bipolar I or II can achieve mood stability and lead productive, meaningful lives.

What Is Bipolar 1 Disorder?

Bipolar I disorder is a psychiatric condition characterized by the presence of at least one manic episode lasting seven days or more, or of sufficient severity to require hospitalization, regardless of duration [1]. Manic episodes in bipolar I represent a significant deviation from baseline functioning and are not simply periods of increased energy or elevated mood. They are often disruptive, and in some cases, can become dangerous without medical intervention.

To meet diagnostic criteria for mania, individuals must exhibit at least three of the following symptoms (or four, if the mood is only irritable), occurring most of the day, nearly every day, during the episode:

• Inflated self-esteem or grandiosity
  
  
• Decreased need for sleep (e.g., feeling rested after only a few hours)
  
  
• Pressured speech or talking more than usual
  
  
• Flight of ideas or subjective experience that thoughts are racing
  
  
• Distractibility
  
  
• Increase in goal-directed activity or psychomotor agitation
  
  
• Excessive involvement in risky behaviors (e.g., reckless spending, sexual indiscretions, impulsive decisions) [2]
  
  

In more severe manic episodes, individuals may experience psychotic symptoms, such as delusions or hallucinations, especially when judgment is significantly impaired. These features distinguish mania from hypomania and underscore the seriousness of bipolar I.

Depression in Bipolar I: A Significant Clinical Burden

Although a depressive episode is not required for a bipolar I diagnosis, most individuals do experience recurrent depression alongside manic episodes. Studies show that individuals with bipolar I spend more time in depressive states than in manic ones: approximately 30% of the time in a given year [3].

Bipolar depression represents a major clinical challenge. It is not only the more frequent phase of the illness but is also associated with increased morbidity and mortality, including cardiovascular disease, metabolic disorders, and elevated suicide risk. Research indicates that the standardized mortality ratio (SMR) for suicide in bipolar disorder may be up to 20 times higher than that of the general population, exceeding that seen in many other psychiatric disorders [4].

Depressive and mixed states. Those that involve symptoms of both depression and mania or agitation are especially associated with increased suicide risk and hospitalization. In this context, treatment becomes urgent and often complex. While lithium has been shown to reduce suicide risk, other treatments such as clozapine and ketamine are still under investigation. The short-term efficacy of antidepressants in bipolar depression remains controversial, as they may worsen mood instability, especially in mixed states or rapid-cycling presentations. Newer atypical antipsychotics (e.g., cariprazine, quetiapine, lurasidone) show promise for bipolar depression, though they carry metabolic and neurological risks [4].

Hospitalization and Safety Considerations

Because of the severity of manic episodes, including impaired judgment, psychosis, or risk-taking behaviors, hospitalization is often necessary to ensure the individual’s safety and provide stabilization. This may occur during either manic or depressive phases and should not be viewed as a failure but rather as a proactive, essential step in recovery. Hospitalization enables close monitoring, medication initiation or adjustment, and reduction of risk for self-harm or harm to others.

In summary, bipolar I disorder is a serious mental health condition requiring comprehensive, long-term care. Its hallmark is full mania, but the burden of depression often defines the long-term impact on functioning and quality of life. A precise diagnosis is critical to implementing appropriate mood stabilizers, psychotherapeutic support, and medical oversight, especially given the heightened risks for suicide, medical comorbidities, and treatment-related side effects.

Mania, depression, and potential for hospitalization

Full mania in bipolar 1 is intense and unmistakable. During these episodes, people might feel invincible, make grandiose plans, engage in dangerous activities, or spend money impulsively without considering consequences. Some experience psychotic symptoms like delusions or hallucinations during severe episodes [3].

What Is Bipolar 2 Disorder?

Bipolar II disorder is defined by the presence of at least one hypomanic episode and at least one major depressive episode, without any history of full-blown mania [1]. The distinction between Bipolar I and II lies in the severity of the elevated mood state: individuals with Bipolar II experience hypomania, a less intense form of mania that does not typically require hospitalization and does not include psychosis.

To meet diagnostic criteria, a hypomanic episode must last for a minimum of four consecutive days, and involve elevated, expansive, or irritable mood, along with increased activity or energy. At least three (or four, if mood is only irritable) of the following symptoms must be present:

• Inflated self-esteem or grandiosity
  
  
• Decreased need for sleep
  
  
• More talkative than usual or feeling pressure to keep talking
  
  
• Flight of ideas or subjective racing thoughts
  
  
• Increased distractibility
  
  
• Increase in goal-directed activity or psychomotor agitation
  
  
• Engaging in activities with potential for negative consequences (e.g., spending sprees, risky sex, reckless driving) [2]
  
  

Unlike mania, hypomania does not cause marked impairment in social or occupational functioning, and does not involve delusions or hallucinations. However, it may still be noticeable to others and can affect interpersonal relationships and decision-making.

The Burden of Depression in Bipolar II Disorder

What often defines the lived experience of bipolar II is not the hypomania, but the recurrent and severe depressive episodes. These episodes tend to be longer-lasting and more frequent than in bipolar I disorder. Research indicates that individuals with bipolar II spend over 50% of their time in depressive states, compared to approximately 30% in bipolar I [3]. This chronic course can lead to significant impairment in daily life, relationships, and work functioning.

A major depressive episode in bipolar II includes five or more of the following symptoms (lasting at least two weeks), with at least one being either depressed mood or loss of interest/pleasure:

• Persistent sadness or emptiness
  
  
• Markedly diminished interest or pleasure in most activities
  
  
• Weight loss or gain, or appetite changes
  
  
• Insomnia or hypersomnia
  
  
• Psychomotor agitation or retardation
  
  
• Fatigue or low energy
  
  
• Feelings of worthlessness or excessive guilt
  
  
• Difficulty thinking, concentrating, or making decisions
  
  
• Recurrent thoughts of death or suicide [4]
  
  

Challenges in Diagnosis and Treatment

Due to the less conspicuous nature of hypomania, bipolar II disorder is frequently misdiagnosed as unipolar (major) depression. Many patients initially seek help during depressive episodes, and unless hypomanic symptoms are carefully assessed, the bipolar pattern may go unrecognized. Studies show that individuals with bipolar II disorder experience an average delay of 9–10 years before receiving an accurate diagnosis [5].

This delay can have significant consequences, including inappropriate treatment with antidepressants alone, which may exacerbate mood instability in bipolar spectrum conditions. Accurate diagnosis is essential to developing an appropriate treatment plan, which often includes mood stabilizers, atypical antipsychotics, and psychotherapy focused on mood regulation and relapse prevention.

In Summary: Bipolar II disorder is a serious mood disorder characterized by milder elevated states (hypomania) and more chronic, often disabling depression. While it lacks the dramatic mania seen in bipolar I, its burden of depressive symptoms is substantial and often underrecognized. Timely, accurate diagnosis and evidence-based treatment are essential to improving outcomes and reducing long-term psychosocial impairment.

Remember that receiving an accurate diagnosis, while it may take time, is an important step toward getting the right treatment and support you need.

Comparing Bipolar 1 and 2: Key Differences

Understanding the specific differences between these conditions helps clarify why treatment approaches vary and what to expect.

Feature	Bipolar 1	Bipolar 2
Type of elevated mood	Mania (severe, 7+ days)	Hypomania (milder, 4+ days)
Severity	Often severe; may require hospitalization	Less severe; no hospitalization needed
Depressive episodes	Common but not required for diagnosis	Required for diagnosis
Psychotic symptoms	Possible during mania	Rare
Functional impact	High; often disrupts daily life	Moderate; still can impede  function; varies by individual

Mania vs. hypomania

Understanding Differences in Severity, Duration, and Functional Impact

While mania and hypomania share overlapping symptoms, such as elevated mood, increased activity, and reduced need for sleep, the core distinction lies in their severity, duration, and effect on functioning. These differences are crucial for accurate diagnosis and treatment planning within the bipolar spectrum.

Mania, characteristic of bipolar I disorder, is a more intense and disruptive mood state. A manic episode must last at least seven days (or any duration if hospitalization is required) and is associated with marked impairment in occupational, social, or personal functioning. Individuals may demonstrate poor judgment, engage in risky or harmful behaviors, and in some cases, experience psychotic features, such as delusions or hallucinations. A key clinical feature of mania is lack of insight, or individuals often do not recognize that their behavior is problematic, a phenomenon referred to as anosognosia [1].

In contrast, hypomania, a defining feature of bipolar II disorder, is a milder and shorter-lasting episode, requiring a duration of at least four consecutive days. Although the symptoms are similar in type, such as elevated mood, increased self-confidence, and reduced need for sleep, they are not severe enough to cause marked functional impairment or require hospitalization. Psychotic symptoms are absent in hypomania. Individuals typically maintain the ability to function in daily life, although others may notice a clear deviation from their usual behavior [2].

It’s important to understand that while hypomania may seem less severe, bipolar II disorder is not simply a “milder” version of bipolar I. Both conditions are serious and can significantly impact your life, just in different ways.

Functional Differences: Examples and Clinical Implications

Mania (Bipolar I)	Hypomania (Bipolar II)
May stay awake for multiple nights with no fatigue	Sleeps less than usual, but without exhaustion
Quits job impulsively or engages in reckless ventures	Takes on extra work, often with increased productivity
Believes they have special powers or a unique destiny	Feels unusually confident or charismatic
Displays disorganized, risky, or aggressive behavior	Becomes more outgoing or talkative than usual
Often requires hospitalization or crisis intervention	Typically does not require hospitalization

Clinical Considerations

Although hypomania may seem less impairing, it should not be interpreted as a benign or less serious condition. Bipolar II disorder is not simply a “milder” version of bipolar I. In fact, research shows that individuals with bipolar II may experience a greater overall burden of illness, largely due to the chronic and recurrent nature of depressive episodes [3]. These depressive episodes often lead to significant functional impairment, emotional distress, and elevated suicide risk.

Both mania and hypomania are manifestations of mood dysregulation that require comprehensive evaluation and evidence-based treatment. Management typically involves mood stabilizers or atypical antipsychotics, along with targeted psychotherapy. Early recognition and proper diagnosis are essential for reducing relapse rates and improving long-term outcomes.

In summary, while mania and hypomania may share core features, they differ significantly in intensity, duration, and functional consequences. Understanding these distinctions is vital for accurate diagnosis and for developing treatment strategies tailored to the individual’s specific bipolar subtype.

Treatment and Management Options

Shared Foundations: Medications and Psychotherapy

Both bipolar I and bipolar II require long-term, often lifelong, treatment aimed at mood stabilization, relapse prevention, and quality-of-life improvement. Pharmacological and psychotherapeutic interventions remain central across both conditions.

Mood stabilizers form the cornerstone of pharmacologic treatment.

• Lithium remains the gold standard for preventing both manic and depressive episodes and has strong evidence for reducing suicide risk, particularly in bipolar I disorder [1].
  
  
• Other agents include valproate, lamotrigine, and atypical antipsychotics (e.g., quetiapine, lurasidone, cariprazine), each chosen based on symptom profile, tolerability, and individual risk factors [2].
  
  

Psychotherapy is critical in both types of bipolar disorder and can significantly reduce recurrence rates and improve functioning:

• Cognitive Behavioral Therapy (CBT) supports identification of cognitive distortions and early warning signs of relapse.
  
  
• Interpersonal and Social Rhythm Therapy (IPSRT) emphasizes maintaining stable daily routines, especially sleep and social activity timing, which are closely linked to mood regulation.
  
  
• Family-focused therapy and psychoeducation help improve communication, medication adherence, and support within the home environment [3].

Tailored Approaches: Differences by Bipolar Subtype

Treatment emphasis varies depending on the predominant clinical challenges and your treatment plan should be personalized to your specific needs and experiences:

For Bipolar I, the primary focus is on preventing manic episodes, which can be severe and may involve psychosis or require hospitalization.
 This often involves:

• Higher doses of mood stabilizers or antipsychotics during high-risk periods
  
  
• Close monitoring during early symptom emergence or stressors
  
  
• Crisis and hospitalization planning
  
  
• Ongoing education to support medication adherence, as discontinuation can trigger relapse

For Bipolar II, the emphasis typically centers on managing recurrent and often debilitating depressive episodes, while avoiding treatment-induced mood destabilization.
 Management may include:

• Cautious use of antidepressants only in combination with mood stabilizers, as monotherapy can trigger hypomania or cycling
  
  
• Greater reliance on psychotherapy for long-term depressive symptom management
  
  
• Therapy for seasonal affective features, under professional guidance
  
  
• Structured outpatient care to address chronic depressive burden

Supporting Long-Term Stability: Lifestyle, Sleep, and Nutrition

A personalized treatment plan should account not only for symptom type and severity but also for lifestyle, preferences, and co-occurring conditions such as anxiety or substance use. Holistic care supports recovery and relapse prevention.

Sleep and circadian rhythms are particularly influential in bipolar disorder.

• Research using wearable and ecological momentary assessment suggests that circadian rhythm disturbances may precede mood shifts, especially in bipolar I. This implies that interventions targeting circadian alignment, such as maintaining consistent wake/sleep times, structured routines, and light exposure, may have preventative value [6].
  
  
• In contrast, in bipolar II, the causal link between sleep timing and mood symptoms appears less direct but remains clinically relevant, particularly for managing depressive symptoms [4].

Sleep hygiene strategies shown to support mood stability include:

• Going to bed and waking at the same time daily
  
  
• Avoiding caffeine, alcohol, and screen time before bed
  
  
• Creating a calming bedtime environment
  
  
• Monitoring for early signs of sleep disruption, a potential relapse signal

Nutrition is emerging as a meaningful adjunct to standard treatment.

• A 2021 systematic review found that individuals with bipolar disorder often have suboptimal dietary patterns and higher cardiometabolic risk [7].
  
  
• Evidence supports benefits from diets high in omega-3 fatty acids, seafood, leafy greens, folic acid, and zinc in improving mood stability.
  
  
• Preliminary studies also suggest Coenzyme Q10, probiotics, and N-acetylcysteine (NAC) may offer mood benefits, although further trials are needed [7].
  
  
• Given the elevated rates of metabolic syndrome in bipolar disorder, patients should be counseled on maintaining a diet rich in fruits, vegetables, whole grains, and unsaturated fats.

Daily Management and Psychosocial Support

Effective management of bipolar disorder extends beyond clinical treatment to include self-monitoring, routine, and social connection:

• Mood tracking apps or journals can help identify early warning signs
  
  
• Daily structure, including consistent mealtimes, work hours, and social activities, promotes rhythm stability
  
  
• Engaging in regular physical activity and stress-reduction techniques such as mindfulness or breathing exercises can buffer against mood volatility

Support systems also play a pivotal role. Peer support groups, such as those offered by the Depression and Bipolar Support Alliance (DBSA), can reduce isolation and provide practical coping strategies. Educating loved ones about the condition enables more effective support and early intervention in case of relapse. Crisis plans shared with trusted individuals can provide a clear protocol if symptoms escalate

Individual responses to treatment vary significantly, so finding the right combination of medications, therapy, and lifestyle approaches often takes time and patience.

Summary: An Integrated and Personalized Approach

While bipolar I and II differ in symptom patterns and treatment priorities, both require comprehensive, tailored, and long-term care. Core treatment strategies, such as medications, psychotherapy, lifestyle modifications, and psychosocial support, must be adjusted to meet each individual’s needs [8-12].

Emerging research highlights the importance of:

• Stabilizing circadian rhythms to prevent relapse
  
  
• Nutrition and metabolic health as modifiable factors in mood outcomes
  
  
• Sleep quality and regularity as central to daily functioning
  
  
• Engaged social support and structured routines as critical protective factors
  
  

Working collaboratively with mental health professionals, individuals with bipolar disorder can develop meaningful, sustainable strategies for mood stability and quality of life.

Final Thoughts and Guidance

Summary of distinctions

Understanding the difference between bipolar 1 and 2 empowers you to seek appropriate treatment and develop realistic expectations. While bipolar 1 involves severe mania often requiring hospitalization, bipolar 2 features milder hypomania coupled with more persistent, chronic depressive episodes. Both conditions are serious in different ways. They’re different expressions of a complex brain condition affecting each person uniquely.

Both types are highly treatable with the right combination of medication, therapy, and lifestyle management. The key lies in accurate diagnosis, consistent treatment engagement, and building strong support systems.

When to seek a diagnosis or second opinion

If you’re experiencing mood episodes interfering with your life, seeking evaluation from mental health professionals is essential. Consider professional help if you notice:

• Periods of unusually high energy alternating with depression
• Sleep changes coinciding with mood shifts
• Others expressing concern about your mood swings
• Difficulty maintaining relationships or employment due to mood changes
• Previous treatment for depression without improvement

If you’ve been treated for depression without success, or if antidepressants seem to worsen symptoms, consider asking about bipolar disorder screening. Seeking a second opinion is always appropriate, especially given that bipolar 2 is frequently misdiagnosed.

Remember, having bipolar disorder doesn’t define you or limit your potential. With proper treatment and support, people with both bipolar 1 and 2 lead fulfilling, successful lives. The journey requires commitment and patience, but stability and wellness are absolutely achievable goals.

Ready to Find the Right Support?

Whether you’re considering a bipolar disorder evaluation or exploring treatment options, PsychPlus is here to help. Our experienced psychiatrists and therapists offer same-day appointments, accept most insurance plans including Medicare and Medicaid, and provide care both in-person and online.

You don’t have to navigate this alone. Take the first step today. Call 832-869-4818 or visit our online scheduling page to connect with a mental health professional who understands your journey.

Frequently Asked Questions

Q1: Which is more serious, bipolar 1 or bipolar 2?

Both bipolar 1 and bipolar 2 are serious mental health conditions requiring lifelong treatment. While bipolar 1 involves more severe manic episodes that may require hospitalization, bipolar 2 often includes more chronic and severe depression. Research shows that people with bipolar 2 spend significantly more time in depressive episodes and may experience equal overall disability.  Neither condition is “less serious.” They present different challenges requiring appropriate, individualized treatment approaches.

Q2: Can you switch from bipolar 2 to bipolar 1?

Yes, if someone diagnosed with bipolar 2 experiences a full manic episode, their diagnosis changes to bipolar 1. This progression can occur at any point during the illness course. However, the reverse isn’t possible. Once someone experiences true mania and receives a bipolar 1 diagnosis, they cannot be reclassified as bipolar 2, even if they never experience another manic episode. This emphasizes the importance of ongoing monitoring and honest communication with your treatment team.

Q3: How are bipolar disorders diagnosed?

Mental health professionals diagnose bipolar disorders through comprehensive clinical assessment using DSM-5 criteria. The diagnostic process includes:

• Detailed history of all mood episodes and their duration
• Assessment of symptom severity and functional impact
• Family history of mood disorders
• Ruling out other conditions or substances that could cause symptoms
• Sometimes mood tracking over several weeks or months

No blood tests or brain scans can diagnose bipolar disorder – diagnosis relies entirely on careful evaluation of symptoms and their patterns over time.

References

[1] Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251-269. https://pubmed.ncbi.nlm.nih.gov/30181867/

[2] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). https://www.psychiatry.org/psychiatrists/practice/dsm

[3] Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International Journal of Bipolar Disorders, 8, 1. https://pubmed.ncbi.nlm.nih.gov/31903509/

[4] Forte, A., Baldessarini, R. J., Tondo, L., Vázquez, G. H., Pompili, M., & Girardi, P. (2015). Long-term morbidity in bipolar-I, bipolar-II, and major depressive disorders. Journal of Affective Disorders, 178, 71-78. https://pubmed.ncbi.nlm.nih.gov/25797049/

[5] Swartz HA, Suppes T. Bipolar II Disorder: Understudied and Underdiagnosed. Focus (Am Psychiatr Publ). 2023 Oct;21(4):354-362. doi: 10.1176/appi.focus.20230015. Epub 2023 Oct 15. PMID: 38694998; PMCID: PMC11058947. https://pubmed.ncbi.nlm.nih.gov/38694998/

[6] Song YM, Jeong J, de Los Reyes AA 5th, Lim D, Cho CH, Yeom JW, Lee T, Lee JB, Lee HJ, Kim JK. Causal dynamics of sleep, circadian rhythm, and mood symptoms in patients with major depression and bipolar disorder: insights from longitudinal wearable device data. EBioMedicine. 2024 May;103:105094. doi: 10.1016/j.ebiom.2024.105094. Epub 2024 Apr 4. PMID: 38579366; PMCID: PMC11002811. https://pubmed.ncbi.nlm.nih.gov/38579366/

[7]Gabriel FC, Oliveira M, Bruna De M Martella, Berk M, Brietzke E, Jacka FN, Lafer B. Nutrition and bipolar disorder: a systematic review. Nutr Neurosci. 2023 Jul;26(7):637-651. doi: 10.1080/1028415X.2022.2077031. Epub 2022 May 24. PMID: 35608150. https://pubmed.ncbi.nlm.nih.gov/35608150/

[8] Severus, E., & Bauer, M. (2013). Diagnosing bipolar disorders in DSM-5. International Journal of Bipolar Disorders, 1, 14. https://pmc.ncbi.nlm.nih.gov/articles/PMC4230313/

[9] Judd, L. L., Akiskal, H. S., Schettler, P. J., et al. (2003). A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Archives of General Psychiatry, 60(3), 261-269. https://pubmed.ncbi.nlm.nih.gov/12622659/

[10] Scott, J., Graham, A., Yung, A., et al. (2022). A systematic review and meta-analysis of delayed help-seeking, delayed diagnosis and duration of untreated illness in bipolar disorders. Acta Psychiatrica Scandinavica, 146(5), 389-405. https://pubmed.ncbi.nlm.nih.gov/36018259/

[11] Liu, X., Ma, X., Wang, W., et al. (2021). Comparative study on psychosocial functioning, cognitive impairment, and real-world functioning between patients with bipolar I and II disorders in a Chinese population. BMC Psychiatry, 21, 240.

[12] Severus, E., Taylor, M. J., Sauer, C., et al. (2014). Lithium for prevention of mood episodes in bipolar disorders: systematic review and meta-analysis. International Journal of Bipolar Disorders, 2, 15. https://pubmed.ncbi.nlm.nih.gov/25530932/

[13] Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., et al. (2021). Adjunctive psychotherapy for bipolar disorder: a systematic review and component network meta-analysis. JAMA Psychiatry, 78(2), 141-150. https://pubmed.ncbi.nlm.nih.gov/33052390/