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Bipolar Awareness: The History of Bipolar Disorder and How Treatment Has Changed Today

“I was actually manic a lot of the times that I would take on workloads, and I would say, ‘Yes, I can do this.’ I was conquering the world, but then it would all come crashing down and I would be more depressed than ever.”

Demi Lovato

Milestones in the study of bipolar disorder (manic depression)

As recently as the 1990s, bipolar disorder was thought to be very rare and found exclusively in adults. Fast-forward to the 2020s and scientists recognise that 4% of Americans have the disorder, and that this percentage includes children. Bipolar UK states that: “1.3 million people in the UK have bipolar. That is one in fifty people. 1% to 2% of the population experience a lifetime prevalence of bipolar and recent research suggests as many as 5% of us are on the bipolar spectrum. Bipolar is one of the UK’s commonest long-term conditions with almost as many people living with bipolar as cancer (2.4%), it is more than twice as common as dementia (0.8%), epilepsy (0.8%), autism (0.8%), rheumatoid arthritis (0.7%) and learning disabilities (0.5%).”

In this article, we’ll explore the breakthroughs in the study of bipolar disorder. Bipolar, formerly known as manic depression, was first documented by the ancient Greek physician, Hippocrates of Kos (460-370 BC). He recognised that some of his patients had the conditions of melancholia and mania, although worded differently. Symptoms of the mental illness at the time were described as fright and despondency, and “as states of agitation related to an excess of yellow bile” (keep in mind this was thousands of years before the advent of modern medicine in). Another milestone in the history of bipolar treatment, and an expansion on Hippocrates’ understanding of the mental illness, was establishedin 1st Century AD by Aretaeus of Cappadocia. He introduced the idea of “pneuma” (spirit)to the humoral system, established a link between melancholia and mania, and defined episodic and recurring mania as “a chronic derangement of the mind without fever.”

Another significant advance in psychiatry came about thanks to French psychiatrist Jean Pierre Falret (1794–1870). Falret introduced the concept of ‘circular insanity’ and recognised that the disorder had a strong genetic basis. The American Journal of Psychiatry writes: “Jean Pierre Falret’s once celebrated but now neglected 1854 description of ‘circular insanity’ has not been translated into English until now. This seminal essay clearly articulated for the first time the rudimentary elements of our present diagnosis of bipolar affective disorder. It contains lucid descriptions of manic excitement and depression and the ‘switch’ from one to the other; moreover, it emphasizes the importance of course and prognosis, as well as hereditary and epidemiologic factors.”

Simultaneously, Jules Baillarger, a French neurologist and psychiatrist, observed a condition in bipolar and called it “folie à double forme.” Baillarger delivered a lecture to the French Imperial Academy of Medicine describing “folie à double forme” describing the occurrence of both manic and depressive episodes in the same person. This lecture prompted Jean Pierre Falret to accuse Jules Baillarger of plagiarism, arguing that he had published the very same disorder description, “folie circulaire.”

WebMD states: “A German psychiatrist named Karl Kahlbaum (1828–1899) grouped mental disorders into two categories: those that caused a limited disturbance of the mind and those that caused a complete disturbance in the mind. By the turn of the century, Emil Kraepelin (1856–1926), another German psychiatrist who’s considered the founder of modern psychiatry, unified all types of affective disorders into one condition called manic-depressive insanity. And despite some opposition, Kraepelin’s theory was adopted—for a time.”

Some years later, in 1902, Emil Kraepelin was credited for organising and classifying unitary psychosis into two categories. He identified ‘manic-depression’ and ‘dementia praecox’ as the two forms/manifestations of psychosis. Manic-depression was used to describe mental illnesses centered in mood and emotional issues. Whereas, dementia praecox, later renamed schizophrenia, was used to describe mental illness caused by cognitive and thought issues.

In 1957, the German psychiatrist Karl Leonhard, coined the term ‘bipolar.’ He used the term bipolar to describe individuals with both manic and depressive symptoms, and unipolar to characterise people who only experienced depressive low moods. In the same decade, medical professional and experts created Diagnostic and Statistical Manual of Mental Disorders (DSM-I) to guide the diagnosis of mental disorders. Whilst medical experts created (DSM-I), they categorised Kraepelin’s condition of manic depression into three types: manic, depressed and others, while bipolar disorder was recognised as “other.” The language used to describe manic-depression changed yetagain in the late 1960s, from manic-depression insanity to manic-depressive illness.

In 1980 in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the term manic depression was changed in the classification system to bipolar disorder. Bipolar disorder, as a condition, was classed separately from generalised depression. With respect to this breakthrough in classification, Medical News Today states: “One of the main differences was the requirement of various episodes for the diagnosis of bipolar disorder, as health experts had begun to call it at the time. This was also the time when detailed definitions of both manic and depressive episodes were available—these also included mixed episodes. Additionally, health experts introduced the term hypomania in the third edition of the DSM. The types of bipolar disorder were also beginning to receive classifications. It was the realization of the complexity of symptoms of the condition that led, at least in part, to the change from manic depression to bipolar disorder.”

Understanding how bipolar treatment has changed

As attitudes changed towards what was once called manic-depression but now termed bipolar disorder, so too did the methods for treatment. There has been all manner of experimental treatments, some of which may well be considered absurd or even harmful today, nevertheless modern medicine has come a long way in its treatment of the disorder in the last eighty years. During the psychopharmacological era, sedatives were used to treat manic symptoms. This changed when lithium salts treatments were introduced. Opium was also widely prescribed to agitated and anxious patients. Barbiturates were the most widely used agents in treating manic patients in the early 1900s right up until the mid-1950s.

Although the earliest use of lithium used for medicinal purposes was used to treat gout, it garnered interest among medical professionals treating manic depression. Antimanic Efficacy of Lithium was discredited among many psychiatrists until the mid-to-late 20th century. In 1970, lithium was approved by the US Food and Drug Administration (FDA) in the United States for the treatment of bipolar disorder, and is still widely used today. Although lithium’s side effects can be significant (such as diabetes and lithium toxicity), it’s still seen as an effective way to reduce suicidality among patients with bipolar disorder.

New and future treatment for mental health disorders

Medications to treat bipolar disorder are used for mood stabilisation, hypomania, mania, bipolar depression, and associated problems. Careful blood monitoring will occur as lithium has been known to affects the liver, kidneys, and thyroid. Physical health checks will take place to look out for risk of diabetes and to monitor anychanges in metabolism and cholesterol.

Typically, medical doctors in the UK will prescribe the following drugs to treat and stabilise bipolar (if an individual believes they have bipolar disorder, it’s crucial that they discuss their concerns with a professional and under no circumstances self-prescribe any of the medications mentioned in this article):

  • Lithium
  • Carbamazepine
  • Divalproex
  • Valproic acid
  • Olanzapine
  • Quetiapine

Medical doctors in the UK may prescribe the following drugs for acute mania and depression symptoms of bipolar affective disorder:

  • Aripiprazole
  • Haloperidol
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Clozapine

Medical doctors in the UK may prescribe the following drugs for hypomania/mania:

  • Lithium
  • Lithium plus antidepressants
  • Lamotrigine
  • Olanzapine and fluoxetine
  • Quetiapine

In an interesting article titled Diagnosing and Treating Bipolar Spectrum Disorders, published by American Psychological Association (APA), the authors report a growing convictionamong frontline clinicians that medications alone are not sufficient in treating bipolar disorder: “Increasingly, psychopharmacology research is offering alternatives, such as the new antipsychotic drug lurasidone (Pikalov, A., et al., International Journal of Bipolar Disorders, Vol. 5, No. 9, 2017) and the anesthetic ketamine, which has been proven effective for treatment-resistant depression (Kryst, J., et al., Pharmacological Reports, Vol. 72, 2020). Rapid transcranial magnetic stimulation, which involves electrical activation of the frontal cortex, is also showing promise for depression and may help patients with bipolar disorder, Miklowitz said, but more research is needed (Nguyen, T. D., et al., Journal of Affective Disorders, Vol. 279, 2021).”

American Psychological Association (APA) article reveals how a change in lifestyle and nutrition can help to improve the quality of life for those with bipolar disorder: “Growing evidence also supports lifestyle changes in nutrition and physical activity. Eating and exercising in accordance with U.S. Department of Health and Human Services guidelines can improve emotional well-being, Goldstein said, and it can also boost cardiovascular health, which is implicated in bipolar disorder. Research by Goldstein and others shows that chronic inflammation harms brain health and may predict worse treatment outcomes in bipolar disorder (Bipolar Disorders, Vol. 22, No. 5, 2020).”

Contact us today

At Addcounsel, we understand just how much of an impact bipolar disorder can have on your day-to-day life. The combination of extreme mood swings and depressive episodes may be making it extremely challenging, if not impossible to function effectively either in or outside the workplace.

Without proper treatment, bipolar disorder will significantlyaffect both your mental and physical well-being. Those who suffer from recurringlow mood episodes are more prone to suicidal ideation which is another major concern. In some cases, bipolar disorder can also present noticeablephysical symptoms such as aches and pains.

You don’t have to go through this alone. With the right treatment and support, you can go on to lead a happy and fulfilling life. Our clinic takes an integrative and ‘whole person’ approach to treatment, focusing on the symptoms, triggers, and causes of your bipolar disorder. We will set you up with a personalised treatment plan designed to help you overcome bipolar disorder and better manage your condition. Our dedicated team will help and guide you through the entire process in the comfort and anonymity of our luxury, private treatment accommodation in Mayfair, Chelsea, Knightsbridge or Notting Hill in London, UK.

Contact us today to start your recovery journey.

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