Ancient Origins
The phrase “manic depression” has its origins rooted in ancient Greece, where the term was used as early as the first century to describe symptoms of mental illness. In her book “Bipolar Expeditions: Mania and Depression in American Culture,” author Emily Martin writes, “The Greeks believed that mental derangement could involve imbalance among the humors, as when melancholy, heated by the fluxes of the blood, became its opposite, mania.” In the late 1800s, Jean-Pierre Falret, a French psychiatrist, identified “folie circulaire,” or circular insanity, manic and melancholic episodes that were separated by periods that were free of symptoms. It is through his work that the term manic-depressive psychosis became the name of this psychiatric disorder. It’s noteworthy that “psychosis” was included, thus excluding all types of what we know as bipolar disorder that do not include psychotic features. In 1902, Emil Kraepelin organized and classified what used to be thought of as unitary psychosis into two categories. Manic-depression was the term he used to describe mental illnesses centered in emotional or mood problems. Dementia praecox, literally meaning “premature madness,” and later renamed schizophrenia, was his title for mental illnesses derived from thought or cognitive problems. In the early 1950s, Karl Leonhard introduced the term bipolar to differentiate unipolar depression (major depressive disorder) from bipolar depression. In 1980, with the publication of the third edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM), the term manic depression was officially changed in the classification system to bipolar disorder.
Bipolar Disorder vs. Manic Depression
In the last few decades, the medical profession, and psychiatry specifically, has made a concerted effort to shift the vernacular to the official DSM diagnostic term of bipolar disorder. There are a number of reasons cited for this shift, including:
Manic depression has generally been used to denote a wide array of mental illnesses, and as classification systems have become more sophisticated, the new term of bipolar disorder allows for more clarity in diagnosis. The terms “manic” and “mania” have been greatly stigmatized. Consider popular phrases such as “Manic Monday,” Animaniacs, homicidal maniac, and the like. Similarly, the term “depression” is used flippantly by the general public for periods of sadness that don’t really qualify as clinical depression. Bipolar disorder is more of a clinical term and therefore, less emotionally loaded. Manic depression emphasizes the predominant emotional symptoms but seems to exclude the physical and/or cognitive symptoms also present. The term manic depression excludes the cyclothymic or hypomanic (bipolar II disorder) versions of the disorder.
Types of Bipolar Disorder
There are three types of bipolar disorder recognized in DSM-5. They include:
Bipolar I disorder: For this type to be diagnosed, you must have manic or mixed episodes lasting at least a week or manic symptoms that were severe enough that you needed to be hospitalized. Depressive episodes are often present too.Bipolar II disorder: Hypomanic, or depressive episodes happen in this type, but not manic episodesCyclothymic disorder or cyclothymia: This type is a milder kind of bipolar and is diagnosed when you’ve had both hypomanic and milder depressive episodes for at least two years.
Recent Findings
In addition to changing how the disorder is classified in the DSM, researchers have developed a better understanding of how the symptoms present in different populations. For example, while the condition affects men and women at approximately the same rates, they may experience symptoms differently. Men tend to experience more severe mood episodes and are more likely to also have a comorbid substance use disorder. Women tend to cycle between manic and depressive episodes more frequently and experience more depressive episodes. There is no cure for the condition, but treatments have emerged that can help people manage their symptoms effectively. Medications used to treat bipolar disorder include anticonvulsants, antipsychotics, antidepressants, benzodiazepines, and other medications. Psychotherapy is also often used alongside medication and can include dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT). It has been revised a number of times since its introduction in 1952. The most recent major revision happened with the 2013 publication of the DSM-5, with a text revision known as the DSM-5-TR published in May of 2022. Other factors that may play a role include brain structure, brain injury, stress, trauma, substance use, and hormonal changes.
