After Mariah Carey's diagnosis: What is bipolar II disorder?

After suffering in silence for nearly two decades with bipolar disorder, Mariah Carey reveals in this week's People magazine cover story that until recently seeking treatment, she lived in fear of someone finding out about her diagnosis. The disorder, which can cause unusual mood shifts and affect energy and activity levels, is characterized by swings from very "up" moods that are elated and manic to "down" periods marked by hopelessness and depression.

Carey says she was first diagnosed with bipolar disorder II in 2001 and is now in therapy and taking medication, which seems to have stabilized her condition. Carey told the magazine she was "in denial" about her diagnosis 17 years ago but realizes now that "it does not have to define you and I refuse to allow it to define me or control me." Billboard reached out to UPenn Perelman School of Medicine professor of psychiatry Michael Thase to find out more about the the impact and treatments for bipolar disorder.

First things first, Thase explained that there is a big difference between the more severe bipolar I disorder versus the type Carey says she has. "The classic form of manic depression is what's called bipolar I disorder, where there would be periods of depression and abnormal elation -- that's where the mania is," Thase tells Billboard about frantic periods where patients may not sleep for days, or weeks, as they seek out stimulus or plow their energy into multiple, ambitious tasks. "Take a peak experience and sustain it over days or weeks where you don't have a need to sleep, you feel more talented, smarter and more productive and sometimes you can even become convinced about things that are not true, like you have the secret to world peace." 

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BEVERLY HILLS, CA - JANUARY 07: Singer/actress Mariah Carey attends the 75th Annual Golden Globe Awards at The Beverly Hilton Hotel on January 7, 2018 in Beverly Hills, California. (Photo by Axelle/Bauer-Griffin/FilmMagic)
BEVERLY HILLS, CA - JANUARY 07: Singer Mariah Carey attends 19th Annual Post-Golden Globes Party hosted by Warner Bros. Pictures and InStyle at The Beverly Hilton Hotel on January 7, 2018 in Beverly Hills, California. (Photo by Lester Cohen/WireImage)
NEW YORK, NY - DECEMBER 31: Mariah Carey performs during Dick Clark's New Year's Rockin' Eve at Times Square on December 31, 2017 in New York City. (Photo by Taylor Hill/FilmMagic)
LONDON, ENGLAND - DECEMBER 11: Mariah Carey performs live on stage at The O2 Arena on December 11, 2017 in London, England. (Photo by Samir Hussein/Samir Hussein/WireImage)
PARIS, FRANCE - DECEMBER 08: (L-R) Bryan Tanaka and singer Mariah Carey are seen leaving the Royal Monceau hotel on December 8, 2017 in Paris, France. (Photo by Marc Piasecki/GC Images)
PARIS, FRANCE - DECEMBER 08: Singer Mariah Carey and son Moroccan Scott Cannon leave the 'Hermes' store on December 8, 2017 in Paris, France. (Photo by Marc Piasecki/GC Images)
PARIS, FRANCE - DECEMBER 06: Singer Mariah Carey is seen on December 6, 2017 in Paris, France. (Photo by Marc Piasecki/GC Images)
LOS ANGELES, CA - NOVEMBER 30: Mariah Carey attends the AHF World AIDS DAY Concert and 30th Anniversary Celebration featuring Mariah Carey and DJ Khaled at the Shrine Auditorium on November 30, 2017 in Los Angeles, California. (Photo by Tommaso Boddi/Getty Images for AIDS Healthcare Foundation)
LOS ANGELES, CA - NOVEMBER 30: Mariah Carey performs onstage during the AHF World AIDS DAY Concert and 30th Anniversary Celebration featuring Mariah Carey and DJ Khaled at the Shrine Auditorium on November 30, 2017 in Los Angeles, California. (Photo by Tommaso Boddi/Getty Images for AIDS Healthcare Foundation)
HOLLYWOOD, CA - NOVEMBER 01: Mariah Carey is honored with Hand and Footprint Ceremony at TCL Chinese Theatre on November 1, 2017 in Hollywood, California. (Photo by Axelle/Bauer-Griffin/FilmMagic)
HOLLYWOOD, CA - NOVEMBER 01: Mariah Carey is honored with Hand and Footprint Ceremony at TCL Chinese Theatre on November 1, 2017 in Hollywood, California. (Photo by Axelle/Bauer-Griffin/FilmMagic)
HOLLYWOOD, CA - NOVEMBER 01: Mariah Carey Hand And Footprint Ceremony at TCL Chinese Theatre on November 1, 2017 in Hollywood, California. (Photo by Steve Granitz/WireImage)
NEW YORK, NY - OCTOBER 23: Mariah Carey attends V Magazine honors Karl Lagerfeld after party at Le Bain on October 23, 2017 in New York City. (Photo by Gotham/WireImage)
NEW YORK, NY - OCTOBER 23: Mariah Carey at a dinner honoring Karl Lagerfeld on October 23, 2017 in New York City. (Photo by Gotham/GC Images)
LOS ANGELES, CA - SEPTEMBER 17: Mariah Carey performs onstage during VH1 Hip Hop Honors: The 90s Game Changers at Paramount Studios on September 17, 2017 in Los Angeles, California. (Photo by Maury Phillips/Getty Images)
BELLEVUE, WA - SEPTEMBER 06: Global Icon Mariah Carey Announces Mariah Carey Christmas Factory During The Grand Opening Of Sugar Factory American Brasserie on September 6, 2017 in Bellevue, Washington. (Photo by Mat Hayward/Getty Images for Sugar Factory American Brasserie)
NEW YORK, NY - AUGUST 19: (EXCLUSIVE COVERAGE) Mariah Carey and Bryan Tanaka perform in Concert - New York, New York at Madison Square Garden on August 19, 2017 in New York City. (Photo by Nicholas Hunt/Getty Images for imPRint)
NEW YORK, NY - AUGUST 17: Singer Mariah Carey and Bryan Tanaka are seen out on August 17, 2017 in New York City. (Photo by Raymond Hall/GC Images)
MIAMI BEACH, FL - AUGUST 10: Mariah Carey and her children Moroccan and Monroe attend the Mariah Carey concert after party at Sugar Factory American Brasserie on Ocean Drive on August 10, 2017 in Miami Beach, Florida. (Photo by Alexander Tamargo/Getty Images for Sugar Factory American Brasserie)
CORRECTION - US Singer Mariah Carey speaks at a press conference to announce an agreement with Israeli cosmetics brand Premier Dead Sea, in the coastal city of Tel Aviv on June 26, 2017. / AFP PHOTO / JACK GUEZ / The erroneous mention[s] appearing in the metadata of this photo by JACK GUEZ has been modified in AFP systems in the following manner: [Dead Sea] instead of [Red Sea]. Please immediately remove the erroneous mention[s] from all your online services and delete it (them) from your servers. If you have been authorized by AFP to distribute it (them) to third parties, please ensure that the same actions are carried out by them. Failure to promptly comply with these instructions will entail liability on your part for any continued or post notification usage. Therefore we thank you very much for all your attention and prompt action. We are sorry for the inconvenience this notification may cause and remain at your disposal for any further information you may require. (Photo credit should read JACK GUEZ/AFP/Getty Images)
PARIS, FRANCE - JUNE 24: Singer Mariah Carey leaves the Plaza Athenee Dorchester Collection Hotel on Avenue Montaigne on June 24, 2017 in Paris, France. (Photo by Marc Piasecki/GC Images)
LOS ANGELES, CA - MAY 25: Mariah Carey is seen on May 25, 2017 in Los Angeles, California. (Photo by gotpap/Bauer-Griffin/GC Images)
LOS ANGELES, CA - MAY 20: Mariah Carey is seen at 'Catch' on May 20, 2017 in Los Angeles, California. (Photo by BG008/Bauer-Griffin/GC Images)
LOS ANGELES, CA - MAY 13: (L-R) Monroe Cannon, Nick Cannon, Mariah Carey and Moroccan Scott Cannon attend the Moroccan Scott Cannon and Monroe Cannon Party on Mary 13 in Los Angeles, California. (Photo by Rich Polk/FilmMagic)
LOS ANGELES, CA - MAY 13: Singer Mariah Carey attends the Moroccan Scott Cannon and Monroe Cannon Party on Mary 13 in Los Angeles, California. (Photo by Rich Polk/FilmMagic)
LOS ANGELES, CA - MAY 04: Mariah Carey attends Mishka Bulochnikov's 14th Birthday Celebration at Tao Los Angeles on May 4, 2017 in Los Angeles, California. (Photo by FilmMagic/FilmMagic)
WEST HOLLYWOOD, CA - MAY 01: Mariah Carey attends the MC Records Launch Party, a joint venture with Epic Records at CATCH LA on May 1, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
ANAHEIM, CA - APRIL 30: (L-R) Monroe Cannon, Nick Cannon, Mariah Carey, and Moroccan Cannon pose with Disney characters at Disneyland on April 30, 2017 in Anaheim, California. (Photo by FilmMagic/FilmMagic)
LOS ANGELES, CA - MARCH 11: (L-R) Monroe Cannon, TV personality Nick Cannon, Moroccan Scott Cannon and singer Mariah Carey arrives at the Nickelodeon's 2017 Kids' Choice Awards at USC Galen Center on March 11, 2017 in Los Angeles, California. (Photo by Steve Granitz/WireImage)
LOS ANGELES, CA - MARCH 11: Recording artist/singer Mariah Carey (L) and Moroccan Cannon arrive at the Nickelodeon's 2017 Kids' Choice Awards at USC Galen Center on March 11, 2017 in Los Angeles, California. (Photo by Jeffrey Mayer/WireImage)
BEVERLY HILLS, CA - FEBRUARY 26: Mariah Carey attends the 2017 Vanity Fair Oscar Party hosted by Graydon Carter at Wallis Annenberg Center for the Performing Arts on February 26, 2017 in Beverly Hills, California. (Photo by Anthony Harvey/Getty Images)
BEVERLY HILLS, CA - FEBRUARY 26: Mariah Carey attends the 2017 Vanity Fair Oscar Party hosted by Graydon Carter at Wallis Annenberg Center for the Performing Arts on February 26, 2017 in Beverly Hills, California. (Photo by Anthony Harvey/Getty Images)
LOS ANGELES, CA - FEBRUARY 15: Mariah Carey and Bryan Tanaka are seen on February 15, 2017 in Los Angeles, CA. (Photo by gotpap/Star Max/GC Images)
LOS ANGELES, CA - FEBRUARY 15: Mariah Carey is seen at 'Jimmy Kimmel Live' on February 15, 2017 in Los Angeles, California. (Photo by BG017/Bauer-Griffin/GC Images)
LOS ANGELES, CA - FEBRUARY 15: Mariah Carey is seen at 'Jimmy Kimmel Live' on February 15, 2017 in Los Angeles, California. (Photo by RB/Bauer-Griffin/GC Images)
LOS ANGELES, CA - FEBRUARY 15: Mariah Carey (L) and Bryan Tanaka attend a basketball game between the Atlanta Hawks and the Los Angeles Clippers at Staples Center on February 15, 2017 in Los Angeles, California. (Photo by Noel Vasquez/Getty Images)
WESTWOOD, CA - FEBRUARY 04: Actress/singer Mariah Carey arrives at the premiere of Warner Bros. Pictures' 'The LEGO Batman Movie' at Regency Village Theatre on February 4, 2017 in Westwood, California. (Photo by Axelle/Bauer-Griffin/FilmMagic)
WEST HOLLYWOOD, CA - FEBRUARY 04: (L-R) Gerrick Kennedy, Mariah Carey and guest attend a private party at Catch for Mariah Carey's New Single 'I Don't' ft YG at Catch LA on February 4, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
WEST HOLLYWOOD, CA - FEBRUARY 04: Singer Mariah Carey attends a private party at Catch for Mariah Carey's New Single 'I Don't' ft YG at Catch LA on February 4, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
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Thase -- who has not treated Carey and has no firsthand knowledge of her case but was speaking in more general terms about the disorder -- adds that those suffering from bipolar I disorder can also develop delusions of grandeur. By contrast, he describes bipolar II as something between recurrent depression and classic manic depression, where there may be abnormal elation for a period that doesn't rise to the level of mania or involve a psychotic episode that requires hospitalization, as well as periods marked by depression. "You might be more irritable or headstrong, do things your trusted advisers might think are beyond your abilities," he says. 

Though there is no known definitive cause for bipolar disorders -- which are considered to affect the patient for their lifetime -- doctors believe it might be a result of either environment or genetics, or both. Another dangerous factor is the possibility that a patient may have a higher risk of developing other disorders, including addictions to legal or illegal substances. "Anytime you hear about a celebrity who becomes 'exhausted' ... three or four weeks is the typical amount of time needed to recover from a manic episode," he says, noting that it's possible that someone might self-medicate as they seek to balance their wild mood swings.

The manic episodes in bipolar II sufferers can be disruptive and are often characterized by rapid, disorganized speech, long stretches of sleeplessness and unpredictable mood swings that can make completing professional tasks difficult, if not impossible as the patient moves unpredictably from enthusiasm to lethargy. Extreme stress, sleep disruption and drugs or alcohol can also trigger episodes in patients vulnerable to bipolar II.

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Mariah Carey flaunts curves in LBD
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Mariah Carey flaunts curves in LBD
WEST HOLLYWOOD, CA - MAY 01: Mariah Carey attends the MC Records Launch Party, a joint venture with Epic Records at CATCH LA on May 1, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
WEST HOLLYWOOD, CA - MAY 01: Mariah Carey attends the MC Records Launch Party, a joint venture with Epic Records at CATCH LA on May 1, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
WEST HOLLYWOOD, CA - MAY 01: Mariah Carey attends the MC Records Launch Party, a joint venture with Epic Records at CATCH LA on May 1, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
WEST HOLLYWOOD, CA - MAY 01: Mariah Carey and L.A. Reid attend the MC Records Launch Party, a joint venture with Epic Records at CATCH LA on May 1, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
WEST HOLLYWOOD, CA - MAY 01: Mariah Carey and L.A. Reid attend the MC Records Launch Party, a joint venture with Epic Records at CATCH LA on May 1, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
WEST HOLLYWOOD, CA - MAY 01: (L-R) Nick Cannon, Mariah Carey and Floyd Mayweather attend the MC Records Launch Party, a joint venture with Epic Records at CATCH LA on May 1, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
WEST HOLLYWOOD, CA - MAY 01: (L-R) Nick Cannon, Mariah Carey and Floyd Mayweather attend the MC Records Launch Party, a joint venture with Epic Records at CATCH LA on May 1, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
WEST HOLLYWOOD, CA - MAY 01: Stella Bulochnikov and Mariah Carey attend the MC Records Launch Party, a joint venture with Epic Records at CATCH LA on May 1, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
WEST HOLLYWOOD, CA - MAY 01: Mariah Carey and Joey Arbagey attend the MC Records Launch Party, a joint venture with Epic Records at CATCH LA on May 1, 2017 in West Hollywood, California. (Photo by FilmMagic/FilmMagic)
LOS ANGELES, CA - MAY 02: Mariah Carey is seen on May 02, 2017 in Los Angeles, California. (Photo by PG/Bauer-Griffin/GC Images)
LOS ANGELES, CA - MAY 02: Mariah Carey is seen on May 02, 2017 in Los Angeles, California. (Photo by PG/Bauer-Griffin/GC Images)
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Compared to 20 years ago, Thase says the stigma around bipolar disorder is much lower today, noting that 12 percent of the population suffer from a level of depression that should be treated, with half falling squarely into the sphere of the bipolar spectrum and one percent of that 12 percent susceptible to manic episodes. "That means if you're in a room with 50 people, one of them likely has bipolar disorder," he says, with the American Psychiatric Association noting that 80-90 percent of sufferers having a relative with either depression or bipolar disorder. "They're not rare conditions and if treated well and detected early -- and you don't get into other trouble, it's easy to pick up drug and alcohol issues during these manic periods -- they are easy to pick up and treat. It's nothing to be ashamed about." 

About two-thirds of bipolar cases can be treated fairly easily, according to Thase, with those that are more challenging often manageable through a combination of treatment by a trained therapist and more aggressive strategies. The good news for Carey is that there are proven treatments that most patients benefit from, including the mood stabilizer Lithium, as well as alternatives such as the anticonvulsants Depakote and Tegretol and newer anti-psychotic drugs such as Seroquel. The downside is that drugs such as Lithium come with side effects such as tiredness and sluggishness, as well as weight gain.

Doctors also recommend getting regular sleep and maintaining a healthy, balanced diet in order to help 

"Sixty years ago we thought we couldn't treat manic individuals because they were too in their head and they couldn't focus, but modern psychiatry has proven very useful," says Thase.

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