History of bipolar disorder

Short description: none

Cyclical variations in moods and energy levels have been recorded at least as far back as several thousand years. The words "melancholia" (an old word for depression) and "mania" have their etymologies in Ancient Greek. The word melancholia is derived from melas/μελας, meaning "black", and chole/χολη, meaning "bile" or "gall", indicative of the term's origins in pre-Hippocratic humoral theories.[1] A man known as Aretaeus of Cappadocia has the first records of analyzing the symptoms of depression and mania in the 1st century of Greece.[2]

Greek physician Soranus of Ephesus recommended the use of alkaline waters to treat those with mania or melancholia.[3] Today, lithium is used as a treatment for bipolar disorder. Lithium may have been an ingredient in the Greek mineral waters.[3] Centuries passed and very little was studied or discovered. It wasn't until the mid-19th century that a French psychiatrist by the name of Jean-Pierre Falret wrote an article describing "circular insanity" and this is believed to be the first recorded diagnosis of bipolar disorder. Years later, in the early 1900s, Emil Kraepelin, a German psychiatrist, analyzed the influence of biology on mental disorders, including bipolar disorder. His studies are still used as the basis of classification of mental disorders today.[4][5]

## Contents

* 1 The linguistic origins of mania in relation to bipolar disorder
* 2 Relationship between mania and melancholia
* 3 Origin of bipolar disorder as a mental illness
* 3.1 Distinction between manic-depression with and without psychotic states
* 4 Initial treatment options
* 5 Progression from manic-depressive "reaction" to manic-depressive "illness"
* 6 Current classification of bipolar disorder
* 7 See also
* 8 Citations
* 9 References
* 10 Further reading

## The linguistic origins of mania in relation to bipolar disorder

The linguistic origins of mania, however, are not so clear-cut. Several etymologies are proposed by the Roman physician Caelius Aurelianus, including the Greek word ""ania", meaning to produce great mental anguish, and "manos", meaning relaxed or loose, which would contextually approximate to an excessive relaxing of the mind or soul.[6] There are at least five other candidates, and part of the confusion surrounding the exact etymology of the word mania is its varied usage in the pre-Hippocratic poetry and mythologies.[6]

## Relationship between mania and melancholia

The idea of a relationship between mania and melancholia can be traced back to at least the 2nd century AD. Soranus of Ephesus (98–177 AD) described mania and melancholia as distinct diseases with separate etiologies;[7] however, he acknowledged that "many others consider melancholia a form of the disease of mania".[8]

The earliest written descriptions of a relationship between mania and melancholia are attributed to Aretaeus of Cappadocia. Aretaeus was an eclectic medical philosopher who lived in Alexandria somewhere between 30 and 150 AD.[9][10] Aretaeus is recognized as having authored most of the surviving texts referring to a unified concept of manic-depressive illness, viewing both melancholia and mania as having a common origin in "black bile".[10][11]

## Origin of bipolar disorder as a mental illness

A clear understanding of bipolar disorder as a mental illness was recognized by early Chinese authors. The encyclopedist Gao Lian (c. 1583) describes the malady in his Eight Treatises on the Nurturing of Life (Zun Sheng Ba Qian).[12]

The basis of the current conceptualisation of manic-depressive illness can be traced back to the 1850s; on January 31, 1854, Jules Baillarger described to the French Imperial Academy of Medicine a biphasic mental illness causing recurrent oscillations between mania and depression, which he termed folie à double forme ('dual-form insanity').[13] Two weeks later, on February 14, 1854, Jean-Pierre Falret presented a description to the academy on what was essentially the same disorder, and designated folie circulaire ('circular insanity') by him.[14] The two bitterly disputed as to who had been the first to conceptualise the condition.

Woman with "circular insanity", showing manic (left) and depressed (right) states

These concepts were developed by the German psychiatrist Emil Kraepelin (1856–1926), who, using Kahlbaum's concept of cyclothymia,Cite error: Closing `</ref>` missing for `<ref>` tag

### Distinction between manic-depression with and without psychotic states

The first diagnostic distinction to be made between manic-depression involving psychotic states, and that which does not involve psychosis, came from Carl Jung in 1903.[15][16] Jung's distinction is today referred to in the DSM-IV as that between 'bipolar I' (mania involving possible psychotic episodes) and 'bipolar II' (hypomania without psychosis). In his paper Jung introduced the non-psychotic version of the illness with the introductory statement, "I would like to publish a number of cases whose peculiarity consists in chronic hypomanic behaviour" where "it is not a question of real mania at all but of a hypomanic state which cannot be regarded as psychotic".[15][17] Jung illustrated the non-psychotic variation with 5 case histories, each involving hypomanic behaviour, occasional bouts of depression, and mixed mood states, which involved personal and interpersonal upheaval for each patient.[15]

## Initial treatment options

After World War II, John Cade, an Australian psychiatrist was investigating the effects of various compounds on patients with manic depressive psychosis. In 1948, Cade discovered that lithium could be used as a successful treatment of manic depressive psychosis.[18][19] Because there was a fear that table salt substitutes could lead to toxicity or death, his findings did not immediately lead to treatments.

Mogens Schou organized a randomly controlled trial for mania using lithium in 1954.[20] Schou and colleagues later researched lithium extensively.[21] Before the advent of lithium, barbiturates were the standard treatment for mania.[22][21] In the 1950s, U.S. hospitals began experimenting with lithium on their patients. By the mid-60s, reports started appearing in the medical literature regarding lithium's effectiveness.[23] The U.S. Food and Drug Administration did not approve of lithium's use until 1970.[24][25]

## Progression from manic-depressive "reaction" to manic-depressive "illness"

The term "manic-depressive reaction" appeared in the first American Psychiatric Association Diagnostic Manual in 1952, influenced by the legacy of Adolf Meyer who had introduced the paradigm illness as a reaction of biogenetic factors to psychological and social influences.[26] Subclassification of bipolar disorder was first proposed by German psychiatrist Karl Leonhard in 1957; he was also the first to introduce the terms bipolar (for those with mania) and unipolar (for those with depressive episodes only).[27]

In 1968, both the newly revised classification systems ICD-8 and DSM-II termed the condition "manic-depressive illness" as biological thinking came to the fore.[28]

## Current classification of bipolar disorder

The current nosology, bipolar disorder, became popular in 1980,[29] and some individuals prefer the older term because it provides a better description of a continually changing multi-dimensional illness.[30][31]

Empirical and theoretical work on bipolar disorder has throughout history "seesawed" between psychological and biological ways of understanding. Despite the work of (Kraepelin 1921) emphasizing the psychosocial context, conceptions of bipolar disorder as a genetically based illness dominated the 20th century. Since the 1990s, however, there has been a resurgence of interest and research into the role of psychosocial processes.[32]

## See also

* Bipolar disorder
* Outline of bipolar disorder

## Citations

1. ↑ Liddell, Henry George and Robert Scott (1980). A Greek-English Lexicon (Abridged ed.). United Kingdom: Oxford University Press. ISBN 0-19-910207-4.
2. ↑ Mason, Brittany L.; Brown, E. Sherwood; Croarkin, Paul E. (2016-07-15). "Historical Underpinnings of Bipolar Disorder Diagnostic Criteria". Behavioral Sciences (Basel, Switzerland) 6 (3): 14. doi:10.3390/bs6030014. ISSN 2076-328X. PMID 27429010.
3. ↑ 3.0 3.1 Radanovic, Marcia; Singulani, Monique Patricio; De Paula, Vanessa de Jesus R.; Talib, Leda Leme; Forlenza, Orestes Vicente (2025-04-05). "An Overview of the Effects of Lithium on Alzheimer's Disease: A Historical Perspective" (in en). Pharmaceuticals 18 (4): 532. doi:10.3390/ph18040532. ISSN 1424-8247. PMID 40283967.
4. ↑ Stephens, Stephanie (2024-03-26). "The History of Bipolar: Through the Ages — It's Been There" (in en-US). https://www.bphope.com/history-of-bipolar/.
5. ↑ Hoff, Paul (March 2015). "The Kraepelinian tradition". Dialogues in Clinical Neuroscience 17 (1): 31–41. doi:10.31887/DCNS.2015.17.1/phoff. ISSN 1294-8322. PMID 25987861.
6. ↑ 6.0 6.1 Angst & Marneros 2001.
7. ↑ Marneros, Andreas; Goodwin, Frederick K. (2005). "Bipolar disorders beyond major depression and euphoric mania". Bipolar disorders: Mixed states, rapid cycling and atypical forms. Cambridge. ISBN 9780521835176. http://assets.cambridge.org/97805218/35176/excerpt/9780521835176_excerpt.pdf. Retrieved 1 January 2018.
8. ↑ Mondimore 2005, p. 49.
9. ↑ Roccatagliata 1986.
10. ↑ 10.0 10.1 Akiskal 1996.
11. ↑ Marneros 2001.
12. ↑ "Refined Pleasures in the Study :Treasures and Curios from Traditional Study". http://www.nmh.gov.tw/nmh_web/english_version/exhibition/exhibition_s0703.cfm.
13. ↑ Pichot 2004.
14. ↑ Sedler 1983.
15. ↑ 15.0 15.1 15.2 Thompson, J. (2012) A Jungian Approach to Bipolar Disorder, Soul Books
16. ↑ Jung 1970.
17. ↑ Jung 1970, p. 109-111.
18. ↑ Cade JF (September 1949). "Lithium salts in the treatment of psychotic excitement". Med. J. Aust. 2 (10): 349–52. doi:10.1080/j.1440-1614.1999.06241.x. PMID 18142718. PMC 2560740. https://www.who.int/docstore/bulletin/pdf/2000/issue4/classics.pdf.
19. ↑ "Obituary - Shirley Aldythea Andrews - Obituaries Australia". https://oa.anu.edu.au/obituary/andrews-shirley-aldythea-14936.
20. ↑ Schou, M.; Juel-Nielsen, N.; Stromgren, E.; Voldby, H. (November 1954). "The treatment of manic psychoses by the administration of lithium salts". Journal of Neurology, Neurosurgery, and Psychiatry 17 (4): 250–260. doi:10.1136/jnnp.17.4.250. ISSN 0022-3050. PMID 13212414.
21. ↑ 21.0 21.1 Shorter, Edward (June 2009). "The history of lithium therapy". Bipolar Disorders 11 Suppl 2 (Suppl 2): 4–9. doi:10.1111/j.1399-5618.2009.00706.x. ISSN 1399-5618. PMID 19538681.
22. ↑ Fornari Caprara, Ana Leticia; Durante, Icaro; Pitton Rissardo, Jamir (July 2023). "The Intermittencies of Lithium" (in en). Journal of SAARC Psychiatric Federation 1 (2): 94–96. doi:10.4103/jspf.jspf_18_23. ISSN 3050-631X.
23. ↑ Fountoulakis, Konstantinos N. (2025-08-20). "The Rise of a Legend: Lithium and the Extraordinary Story of Its Discovery". Pharmaceuticals (Basel, Switzerland) 18 (8): 1230. doi:10.3390/ph18081230. ISSN 1424-8247. PMID 40872619.
24. ↑ "Lithium treatment for bipolar disorder". Bull. World Health Organ. 78 (4): 515–7. 2000. PMID 10885179. PMC 2560742. https://www.who.int/docstore/bulletin/pdf/2000/issue4/classics.pdf.
25. ↑ López-Muñoz, Francisco; Shen, Winston W.; D’Ocon, Pilar; Romero, Alejandro; Álamo, Cecilio (2018-07-23). "A History of the Pharmacological Treatment of Bipolar Disorder" (in en). International Journal of Molecular Sciences 19 (7). doi:10.3390/ijm. ISSN 1422-0067. https://www.mdpi.com/1422-0067/19/7/2143.
26. ↑ Goodwin & Jamison 1990, p. 60–61.
27. ↑ Goodwin & Jamison 1990, p. 62.
28. ↑ Goodwin & Jamison 1990, p. 88.
29. ↑ Nelson, Angela. "The History of Bipolar Disorder" (in en). https://www.webmd.com/bipolar-disorder/history-bipolar.
30. ↑ Goodwin, Frederick K.; Redfield Jamison, Kay (2007). Manic-depressive illness: bipolar disorders and recurrent depression Vol. 2. Oxford university press.
31. ↑ Goodwin, Frederick K.; Ghaemi, S. Nassir (1998-01-01). "Understanding Manic-depressive Illness" (in en). Archives of General Psychiatry 55 (1): 23. doi:10.1001/archpsyc.55.1.23. ISSN 0003-990X. PMID 9435756. http://archpsyc.jamanetwork.com/article.aspx?doi=10.1001/archpsyc.55.1.23.
32. ↑ Alloy, LB; Abramson, LY; Urosevic, S; Walshaw, PD; Nusslock, R; Neeren, AM (2005). "The psychosocial context of bipolar disorder: environmental, cognitive, and developmental risk factors.". Clinical Psychology Review 25 (8): 1043–75. doi:10.1016/j.cpr.2005.06.006. PMID 16140445.

## References

* Akiskal, H. S. (1996). "The prevalent clinical spectrum of bipolar disorders: Beyond DSM-IV". Journal of Clinical Psychopharmacology 16 (2): 4S–14S. doi:10.1097/00004714-199604001-00002. PMID 8707999.
* Angst, Jules; Marneros, Andreas (2001). "Bipolarity from ancient to modern times: Conception, birth and rebirth". Journal of Affective Disorders 67 (1): 3–19. doi:10.1016/s0165-0327(01)00429-3. ISSN 0165-0327. PMID 11869749.
* Goodwin, F. K.; Jamison, K. R. (1990). Manic-depressive Illness. Oxford University Press. ISBN 978-0-19-503934-4. https://archive.org/details/manicdepressivei00good.
* Jung, Carl G. (1970). "On Manic mood disorder". Psychiatric Studies. The Collected Works of C. G. Jung. 1 (2nd ed.). Routledge and Kegan Paul.
* Marneros, Andreas (2001). "Expanding the group of bipolar disorders". Journal of Affective Disorders 62 (1): 39–44. doi:10.1016/s0165-0327(00)00349-9. ISSN 0165-0327. PMID 11172872.
* Mondimore, Francis M. (2005). "Kraepelin and manic-depressive insanity: An historical perspective". International Review of Psychiatry 17 (1): 49–52. doi:10.1080/09540260500080534. ISSN 0954-0261. PMID 16194770.
* Pichot, P. (2004), "Circular insanity, 150 years on" (in fr), Bulletin de l'Académie Nationale de Médecine 188 (2): 275–284, doi:10.1016/S0001-4079(19)33801-4, ISSN 0001-4079, PMID 15506718
* Roccatagliata, G. (1986). "Aretaeus of Cappadocia: The clinician of mania". A History of Ancient Psychiatry. pp. 223–235.
* Sedler, M. J. (1983). "Falret's discovery: the origin of the concept of bipolar affective illness. Translated by M. J. Sedler and Eric C. Dessain". American Journal of Psychiatry 140 (9): 1127–1133. doi:10.1176/ajp.140.9.1127. ISSN 0002-953X. PMID 6351641.

## Further reading

* Angst, Jules; Sellaro, Robert (2000). "Historical perspectives and natural history of bipolar disorder". Biological Psychiatry 48 (6): 445–457. doi:10.1016/s0006-3223(00)00909-4. ISSN 0006-3223. PMID 11018218. https://pdfs.semanticscholar.org/141f/0703e484b9120b8950b3e1ee82a216993b84.pdf. Retrieved 1 January 2018.
* Marneros, Andreas (2009). "The history of bipolar disorders". in Zarate, Carlos A.. Bipolar Depression: Molecular Neurobiology, Clinical Diagnosis and Pharmacotherapy. Basel: Birkhäuser Basel. pp. 3–16. doi:10.1007/978-3-7643-8567-5_1. ISBN 978-3-7643-8566-8.

* v
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Mood disorder (F30–F39, 296)

History|

* Emil Kraepelin
* Karl Leonhard
* John Cade
* Mogens Schou
* Frederick K. Goodwin
* Kay Redfield Jamison

Symptoms|

* Hallucination
* Delusion
* Emotional dysregulation
* Anhedonia
* Dysphoria
* Suicidal ideation
* Mood swing
* Sleep disorder
* Hypersomnia
* Insomnia
* Psychosis
* Racing thoughts
* Reduced affect display
* Depression (differential diagnoses)

Spectrum|

* Bipolar disorder
* Bipolar I
* Bipolar II
* Cyclothymia
* Bipolar NOS
* Depression
* Major depressive disorder
* Dysthymia
* Seasonal affective disorder
* Atypical depression
* Melancholic depression
* Schizoaffective disorder
* Mania
* Mixed affective state
* Hypomania
* Major depressive episode
* Rapid cycling

Treatment|

| Anticonvulsants|

* Carbamazepine
* Lamotrigine
* Oxcarbazepine
* Valproate
* Sodium valproate
* Valproate semisodium

|

Sympathomimetics,
SSRIs & similar|

* Dextroamphetamine
* Methylphenidate
* Bupropion
* Sertraline
* Fluoxetine
* Escitalopram

Other mood stabilizers|

* Antipsychotics
* Lithium
* Lithium carbonate
* Lithium citrate
* Lithium sulfate
* Lithium toxicity
* Atypical antipsychotics

Non-pharmaceutical|

* Clinical psychology
* Electroconvulsive therapy
* Involuntary commitment
* Light therapy
* Psychotherapy
* Transcranial magnetic stimulation
* Cognitive behavioral therapy
* Dialectical behavior therapy

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