Bipolar disorder, formerly known as manic depression, is a mental illness characterized by extreme mood swings. The disorder causes people to alternate between episodes of mania (high energy and euphoria) and depression (low energy and sadness). Bipolar disorder has likely existed for centuries, but our understanding of the illness has evolved over time. Treatments for bipolar disorder have also changed considerably throughout history.
Early History
References to symptoms of bipolar disorder date back to ancient times. The ancient Greeks and Romans recognized extreme moods of mania and depression. However, they viewed these mood states separately and did not conceptualize them as part of one overarching disorder. Greek physician Aretaeus of Cappadocia, who lived in the 2nd century AD, was the first to describe the link between mania and depression. He noted that the mood states seemed to occur in the same person, alternating between the “two maladies which vary in their course.” His writings formed the basis of the modern conception of bipolar disorder.
In the Middle Ages, mentally ill individuals were often treated cruelly. People with psychiatric disorders were sometimes blamed as being possessed by demons or evil spirits. There was little medical understanding of mental illness, including bipolar disorder, at this time. Some attempted treatments included bloodletting, primal screaming, fasting, and physical restraints. People with bipolar disorder were often imprisoned, executed as witches, or left to become homeless vagrants. These inhumane forms of “treatment” persisted well into the 18th century in Europe.
19th Century
In the early 19th century, Philippe Pinel, a French physician, argued for more humane treatment of psychiatric patients. He suggested that mental illness was a medical condition, not a supernatural phenomenon or demonic possession. Pinel advocated removing chains and restraints and introducing more benign interventions like improved living conditions and talk therapy. While this was an improvement, treatment options for bipolar disorder remained extremely limited during this time period.
In 1854, French neurologist Jean-Pierre Falret used the term “folie circulaire” (“circular insanity”) to describe patients who seemed to cycle between mania and depression. His student Jules Baillarger described “dual-form insanity,” referring to the same concept. In 1899, German psychiatrist Emil Kraepelin first introduced the single diagnostic term “manic depressive insanity.” Kraepelin believed the illness was a whole-body disease and was the first to make a clear distinction between bipolar disorder and schizophrenia.
Early 20th Century
In the early 20th century, Sigmund Freud’s psychoanalytic theory dominated psychiatry. Freud theorized that bipolar disorder was caused by unconscious conflicts and repressed sexuality. Freudian psychoanalysis treated bipolar disorder through methods like dream analysis and free association. However, such talk therapies proved relatively ineffective for managing severe mood episodes.
In the 1920s, some doctors began experimenting with inducing insulin comas to treat schizophrenia. It was later found that insulin coma therapy could temporarily relieve symptoms of mania and depression. Electroconvulsive therapy (ECT) was also introduced in the 1930s as a treatment for bipolar disorder. ECT induced seizures through electric currents applied to the brain. The procedure sometimes improved mood symptoms when other options failed. Both insulin coma therapy and ECT were used for bipolar disorder for decades, despite side effects like confusion and memory loss.
Lithium’s mood stabilizing effects were discovered by Australian psychiatrist John Cade in 1949. However, it was not until the 1970s that lithium became widely accepted in psychiatry as an effective long-term treatment for controlling bipolar disorder. Early antipsychotic medications like chlorpromazine were also used to help stabilize manic symptoms.
Late 20th Century
In 1980, the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) officially replaced “manic depression” with the term “bipolar disorder.” Throughout the late 20th century, more medications were developed to expand treatment options for bipolar disorder:
- Anticonvulsants like valproic acid for mood stabilization
- Second generation antipsychotics like olanzapine for mixed episodes
- Antidepressant medications for depressive episodes
In addition to pharmacotherapy, psychotherapy became an important component of treatment. Cognitive behavioral therapy and interpersonal therapy showed efficacy in managing bipolar disorder when combined with medication. Researchers also made strides in elucidating the biological and genetic underpinnings of bipolar disorder. Technological advances like neuroimaging and genetic testing allowed greater understanding of the complex biochemistry behind the illness.
21st Century
Treatment of bipolar disorder today focuses on long-term management through a combination of medication and psychotherapy. Lithium remains a first-line mood stabilizer for many patients. Anticonvulsants like valproate and lamotrigine are also commonly prescribed. Second generation antipsychotics are often used to control acute manic symptoms and prevent relapse. Antidepressants may be used sparingly and with caution.
Psychotherapy like cognitive behavioral therapy can teach coping skills to manage symptoms and change unhealthy thought and behavior patterns. Psychoeducation helps patients understand the nature of their disorder. Social rhythm therapy uses daily scheduling to maintain healthy routines and prevent episodes. Interpersonal therapy aims to improve personal relationships often affected by the illness. Other psychosocial interventions include family therapy and support groups.
In cases of treatment resistance, options like ECT and transcranial magnetic stimulation may be considered. Experimental treatments on the horizon include deep brain stimulation and drugs targeting the biological clock. As the stigma around mental illness declines, more people with bipolar disorder are seeking help and speaking openly. Greater awareness and compassion for those suffering contributes to ongoing progress in treatment and research.
Key Developments in Treating Bipolar Disorder
| Time Period | Key Developments |
|---|---|
| Ancient Greece & Rome | – Recognition of mania and depression as separate conditions |
| 2nd century AD | – Aretaeus links mania and depression, notes they occur in the same person |
| Middle Ages | – Mentally ill treated cruelly as possessed by spirits/demons |
| Early 19th century | – Pinel advocates more humane treatment in asylums |
| 1850s | – Falret describes “circular insanity,” cycles between mania and depression |
| 1899 | – Kraepelin coins term “manic depressive insanity” |
| Early 20th century | – Insulin coma and ECT introduced as treatments |
| 1949 | – Lithium’s mood stabilizing effects discovered |
| 1970s | – Lithium gains wide acceptance for treating bipolar disorder |
| Late 20th century | – Development of anticonvulsants, atypical antipsychotics, psychotherapy |
| 21st century | – Combination pharmacotherapy and psychotherapy common |
Conclusion
In summary, our understanding and treatment of bipolar disorder has evolved greatly over the centuries. Early management centered around asylums andphysical methods like restraints or ECT. In the 20th century, pharmacotherapy became the foundation of treatment with medications like lithium and valproic acid. Today, combining medications with psychotherapy is the gold standard for controlling symptoms, managing episodes, and improving quality of life for those living with bipolar disorder. Ongoing research and reduced stigma around mental illness will hopefully fuel further advances in the future.