Heterogeneity in Bipolar II Disorder Treatments: A Literature Review

Diego F Tavares, Doris H Moreno and Ricardo A Moreno

Introduction: We reviewed the literature to examine: (1) Aspects related to the diagnostic boundaries of mild forms of bipolar disorder (BD); (2) The controversies related to the diagnostic criteria of phasic hypomania and chronic hypomania; (3) Aspects related to the treatment and the use of antidepressants in mild forms of BD.
Methods: Comprehensive computer literature search to find relevant peer reviewed articles related to this these topics.
Results: Mild forms of BD suffer from the big problem of misdiagnosis with recurrent and treatment resistant major depressive disorder. One factor explaining which explains this, at least in part, is the fact that the current diagnostic criteria for hypomania, as it is concepted today, are is still quite restrictive and often sensitive only to more exuberant clinical pictures, such as mild manias. In addition to this, the use of antidepressants in the mild cases of BD will hardly aid in diagnosis, because strong mood swings are not enough to permit diagnosis (leading to the emergence of hypomania) and are not common in these mild forms. The most important question in the treatment of BD II is not the acute treatment of hypomania itself but the recognition that they exist and influence the recurrence recurrence of depressive episodes.
Conclusion: This review showed the fragility and low sensitivity of the current criteria for diagnosis and management of BD II. Clinical trials evaluating the treatment of these conditions cannot be generalizable generalized for all the subpopulation of BD II we see in clinical practice.