Bipolar II disorder
Recurrent depression with prior hypomanic episode missed by prior providers; psychotherapy adjunct to mood stabilizer.
Presenting concern
Referred by psychiatrist after recent bipolar II diagnosis. Currently euthymic on lamotrigine. Seeking therapy for psychoeducation, episode prevention, and processing prior misdiagnoses (treated as MDD for 5 years on antidepressant monotherapy that caused mood instability).
History
First depressive episode at 18. Multiple antidepressant trials with limited response, two episodes of likely SSRI-induced hypomania misread as 'recovery.' Definitive hypomanic episode at 27 led to reassessment.
- History of misdiagnosis (relationship to medical system fragile)
- Hypomania often experienced as wellbeing — adherence risk
- Sleep disruption can precipitate episodes
- Family history of bipolar
- Now correctly diagnosed and medicated
- Engaged with psychiatry
- Stable partner
- Insight is forming
Conceptualization across modalities
Bipolar episodes triggered by disruptions in social rhythms (sleep, meals, social contact). Interpersonal conflicts and role transitions further destabilize. Stabilizing rhythms protects against episode recurrence.
- Social rhythm metric tracking
- Sleep regularization as primary intervention
- Identify and stabilize one interpersonal problem area
- Plan ahead for known rhythm disruptors
Early warning signs missed → episode escalation. Cognitive distortions differ by phase (depressive: catastrophizing; hypomanic: optimism bias). Behavioral targets differ by phase (depressive: activation; hypomanic: damping).
- Personalized warning signs map
- Phase-specific action plans
- Adherence and circadian routines
- Cognitive work on the meaning of having bipolar
Treatment plan
Stabilize routines (1–6)
Sleep, meals, social rhythm, medication adherence.
Warning signs map (7–12)
Personal early signs of hypomania and depression, action plans.
Process & adjust (13–20)
Working through misdiagnosis years, identity around the diagnosis.
Maintenance
Monthly check-ins, sustained social rhythm tracking.
Stable for 14 months at follow-up. Caught early signs of hypomania during a work travel stretch and intervened (sleep, brief medication adjustment with psychiatrist).