Why Did Manic Depression Become Bipolar Disorder?

The term manic depression was changed to bipolar disorder with the 1980 publication of the third revision of the "Diagnostic and Statistical Manual of Mental Disorders." The terms manic and manic-depressive had become highly stigmatized, so changing the label to something more clinical was intended to help minimize negative attitudes toward the condition.

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 on 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 historically been used to denote a wide array of mental illnesses. As classification systems have become more sophisticated, the new term of bipolar disorder allows for more clarity in diagnosis, including variants like bipolar I, bipolar II, and cyclothymia.
• The term "manic" may be used differently in colloquial settings. Imagine someone saying, "I've been cleaning the house today in a manic frenzy," which would refer to feeling highly energetic and moving fast but not reflective of a manic episode.
• The terms "manic" and "mania" have been greatly stigmatized. Consider popular phrases such as "Manic Monday," "Manic Panic," and the like.
• The term "depression" is used loosely by the general public for periods of sadness that don't qualify as clinical depression.
• Manic depression can be misleading because it emphasizes the predominant emotional symptoms of bipolar disorder but ignores the physical and/or cognitive symptoms also present.

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 and depressive episodes are present in this type, but not manic episodes. Hypomania is a milder form of mania and does not typically lead to severe dysfunction or hospitalization.
• Cyclothymic 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. 

Medications used to treat bipolar disorder include a variety of psychotropic drugs, including anticonvulsants, antipsychotics, antidepressants, and benzodiazepines. Psychotherapy is also often used alongside medication and can include dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), and others.