ABSTRACT
Introduction ...................................................................................................... 80 Epidemiology .................................................................................................... 80 Diagnosis ........................................................................................................... 81
Conceptualisation and diagnostic validity ......................................... 83 Clinical features ............................................................................................... 84 Treatment .......................................................................................................... 87
Hypomania .............................................................................................. 87 Depression ............................................................................................... 88
Antidepressants........................................................................... 88 Mood stabilizers .......................................................................... 91 Atypical antipsychotics .............................................................. 91 Others ......................................................................................... 92
Maintenance ............................................................................................ 93 Rapid-cycling ........................................................................................... 94 Psychological therapies .......................................................................... 95
Clinical recommendations for management ................................................ 95 Conclusions ....................................................................................................... 96 References ......................................................................................................... 97
Introduction The longitudinal association of depression with hypomania was proposed as a distinct bipolar subtype over three decades ago (Dunner et al., 1976a), and was subsequently formally dened as a diagnostic entity called bipolar II disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994 (American Psychiatric Association [APA], 1994). However, controversies regarding its diagnostic criteria, validity, boundaries with other disorders, and treatment still exist. The meaningful application of a diagnosis of bipolar II disorder requires an understanding of its core features, heterogeneous aetiology, diagnostic boundaries and treatment options.
