Bipolar Disorder Recognizing the signs, getting help

Author Virginia Woolf described her depressive periods as “an exaggerated tiredness; such anguishes and despair; and heavenly relief and rest; and then misery again.” To explain the commotion this disorder caused, action star Jean Claude Van Damme used the analogy of water “moving left and right around me” that “became like a lake.” The experience of bipolar disorder is often as unique as the individuals who have this condition. Without treatment, bipolar disorder can cause a great deal of distress and impairment. Fortunately, effective treatments are available and people who have bipolar disorder can live meaningful and productive lives.

In this report, you’ll learn more about the biology, history, and causes of bipolar disorder and who is at highest risk of developing the condition. We’ll describe the symptoms to watch for and the risks of ignoring them, as well as how to seek a diagnosis. Finally, we’ll explain what treatments are available and describe self-help techniques that can help you manage life with bipolar disorder

Prepared by the editors of Harvard Health Publishing in conjunction with Ann K Shinn, MD, MPH Assistant Professor of Psychiatry, Harvard Medical School Director of Clinical Research, Schizophrenia and Bipolar Disorder Research Program, McLean Hospital. 18 pages. (2023)

History of bipolar disorder Descriptions of the mood fluctuations that characterize bipolar disorder date back to antiquity. Hippocrates (460–370 B.C.), the Greek physician who is often referred to as “the father of medicine,” believed that illnesses were caused by imbalances of four bodily fluids, or “humors”: blood, black bile, yellow bile, and phlegm. He associated imbalances in these humors with specific temperaments and mood states, including “melancholia” (from the words “mela” meaning “black” and “chole” meaning “bile”) and mania. Hippocrates was thus the first to separate mental illnesses from mysticism, instead attributing their origins to physical disturbances in the body.

Another Greek physician, Aretaeus of Cappadocia (second century A.D.), first connected the states of melancholia and mania as two different parts of the same illness. However, it wasn’t until the turn of the 20th century that German psychiatrist Emil Kraepelin merged both states into a single condition that he referred to as “manic-depressive insanity.”

In the 1950s, German psychiatrist Karl Leonhard introduced the idea of splitting mood disorders into unipolar (people who experience only depressive episodes) and bipolar (those who have both manic or hypomanic and depressive episodes). His ideas were incorporated into the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I), which was published in 1952 to standardize the diagnosis of mental illness. The DSM-I referred to people who experienced symptoms of both mania and depression as having “manic depression.” The phrase “bipolar disorder” was first introduced in the DSM-III, released in 1980.

A variety of treatments were used to manage bipolar disorder, but they didn’t work very well. Then, in 1949, Australian psychiatrist John Cade began to treat the disorder with the mood stabilizer lithium, which proved to be the breakthrough needed to manage symptoms in many patients. Lithium has experienced the greatest longevity among bipolar therapies. It continues to be a staple of treatment today, along with newer treatments such as anti-seizure medications and antipsychotics.

• What is bipolar disorder?
• Who is at risk for bipolar disorder?
• The biology of bipolar disorder
• Symptoms and signs
• Risks of untreated bipolar disorder
• Getting a diagnosis
• Treatment—there is hope
• Living well with bipolar disorder
• Resources

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