Essay on Depression and Mania in Bipolar Disorder

Introduction

As the field of medicine continues to expand and new fields are discovered, there is a need to clearly define the various forms of medical conditions, especially in the field of bipolar. Since the discovery of bipolar in ancient medieval times. Many physicians have written on this subject, where every one of them describes in their words, a condition which takes multiple forms, is sometimes sudden with gradually increasing seriousness. Towards the end of the nineteenth century, Tondo (2017) observes the work of Kraepelin and compares it with the developments in modern medicine. This article seeks to highlight these comparisons in the development of our understanding of bipolar.

Summary

Bipolar disorder (BD) dates back to the 18^th century. An early scholar of mania and depression, Kraepelin, noted that manic excitation could last from weeks to months and even longer for more server forms of mania. Kraepelin also noted that as mania develops into depression, periods of manic excitement are followed by durations of exhaustion. Generally, this study sought to collect more information on the duration and timing of depression and mania in BD patients.

1130 clinically treated DSM-IV-TR BD patients were involved in the study in which the duration and timing of episodes of mania and depression were recorded. Duration for mania was compared with the duration for depression during the 16.7 average years at risk. Diagnostic assessments and treatments of participants were done based on interviews conducted. Data were analyzed through bivariate and ANOVA methods.

Depressive episodes were 50% longer than manic episodes, 5.2 months, and 3.5 months respectively. The longest depressive episodes were in BD-II followed by DMI and MDI course-types. Manic episodes were also longer in DMI and MDI course-types. The rate of recurrence of mani and depression episodes averaged at one episode per year. The longest time being ill was noted in BD-P subjects.

The main finding of this study was confirming that there longer durations of episodes of depression compared to mania in BD, even though there were similar rates of recurrence. A limitation of this study is that depressive morbidity may have been over-presented. Generally, depressive durations of BD are more significant than those of mania.

Discussion

Tondo et al. (2017) propose that patients of depressive BD spend more time in the depressed state than those of manic BD polarity. Episodes of depression last longer than those of mania and are more common among BD-II and BD-Mx prone patients. Moreover, other sub-types of BD patients are prone to particular forms of illnesses depending on the ‘sub-type’ of BD with which they are diagnosed. These findings are in agreement with those of Kraepelin, who came up with the general concept of manic depressive insanity, where the present-day definitions of these insanities which take multiple forms (Trede et al. 2005)

Although Kraepelin came up with a single model for a condition that affected the mind in two different ways, the current concept of polarity separates the various extremes of the condition. Apart from episodes of major depressive disorder and mania, patients also showed signs of hypomania, leading to the third category of major recurring disorder. However, Ballesadrini et al. (2014) caution that the duration of major depressive disorder episodes is not indicative of a particular polarity predominance. The various forms of bipolar are observed when it is certain that one form of either mania or depression is dominant to the other

Conclusion

To sum up, bipolar is a condition that was discovered a long while ago. The nature and description of this ailment have changed and grown over time. Despite the advancement in medical knowledge and technology as well as the availability of new and vast information databases, there are many unknowns when it comes to the differentiation of highly related but separate forms of mania. To aid in the clinical and therapeutic efforts, the forms of bipolar are specified as well as the relationship between predominant polarity is highlighted.

References

[1] Trede, K.; Salvatore, P.; Baethge, C.; Gerhard, A.; Maggini, C.; Baldessarini, R.J. Manic-depressive illness: evolution in Kraepelin’s Textbook, 18831926. Harv. Rev. Psychiatry, 2005, 13(3), 155-178. [http://dx.doi.org/10.1080/10673220500174833] [PMID: 16020028]

[2] Baldessarini, R.J.; Undurraga, J.; Vázquez, G.H.; Tondo, L.; Salvatore, P.; Ha, K.; Khalsa, H-M.; Lepri, B.; Ha, T.H.; Chang, J.S.; Tohen, M.; Vieta, E. Predominant recurrence polarity among 928 adult international bipolar I disorder patients. Acta Psychiatr. Scand., 2012, 125(4), 293-302. [http://dx.doi.org/10.1111/j.1600-0447.2011.01818.x] [PMID: 22188017]