Today is World Bipolar Day, when charities and patients seek to raise awareness of a mental health condition estimated to affect around 2-3% of the population. 

In most cases, disease onset begins in adolescence or early adulthood, but can occur later. 

There is no single known cause, but genetics, childhood trauma, and some environmental factors appear to increase the risk. 

When was bipolar disorder first described - and who 'discovered' it? 

In 1851, French psychiatrist Jean-Pierre Falret wrote about an illness where patients switch been episodes of severe depression and manic excitement on a repetitive cycle, labelling the condition “folie circulaire” (circular insanity). This is generally considered to be the first documented diagnosis of bipolar disorder.

However, the symptoms were being described as far back as 1st Century Greece when Aretaeus of Cappadocia began compiling medical texts. His notes on the link between mania and depression went largely unnoticed for many centuries.

In the 20th Century, German psychiatrist Emil Kraepelin became one of the first to recognise that mental illnesses could have a biological cause - as opposed to the Freudian idea that they were rooted in suppressed desires.

In 1921, Kraepelin's influential book 'Manic Depressive Insanity and Paranoia' described the differences between manic depression and what is now known as schizophrenia. His classification of mental disorders remains the basis used by professional associations today.

In 1980, the third edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) began using the term 'bipolar' for the first time, to signify the polar opposites of mania and depression. 

The Herald: Psychiatrist Joseph Cade was the first to discover lithium as a possible treatment for bipolarPsychiatrist Joseph Cade was the first to discover lithium as a possible treatment for bipolar (Image: Getty)

How has it been treated over the years?

Australian psychiatrist, Joseph Cade, was working at Bundoora Repatriation Mental Hospital in Melbourne when he first discovered the effects of lithium carbonate as a mood stabiliser in the treatment of bipolar disorder in 1948.

Until then, the standard treatments for psychosis were electroconvulsive therapy and lobotomy.

Dr Cade's experiments mostly consisted of injecting urine from mentally ill patients into the abdomen of guinea pigs, but this led him to a chance discovery that adding lithium carbonate made the rodents more restful.  

A small-scale trial on some of his patients, including those with "mania", revealed "fast and dramatic improvements".


The findings were published in the Medical Journal of Australia in1949, in a paper entitled  'Lithium salts in the treatment of psychotic excitement'. 

However, the results were largely ignored until a series of studies in the 1950s and 1960s by Danish psychiatrists Mogens Schou and Poul Baastrup, culminating in a double-blind, placebo-controlled clinical trial whose results were published in The Lancet in 1970.

It showed "beyond doubt" that lithium was effective for most people with bipolar disorder.

It continues to be prescribed today, but electro-convulsive therapy can also be prescribed for severe mania which does not respond to treatment. 

The Herald: From left to right, Poul Baastrup, John Cade and Mogen SchouFrom left to right, Poul Baastrup, John Cade and Mogen Schou (Image: Getty)

What are the signs and symptoms of bipolar?

People with bipolar will experience extreme mood swings, with prolonged periods of stability - or "equilibrium" - in between episodes. 

During a manic phase, symptoms of bipolar can include: extreme happiness and excitement; excessive energy; reduced need for sleep; euphoria; reduced appetite; extreme irritability; impulsiveness; poor concentration; racing thoughts; loss of inhibitions; over-spending; and increased libido. 

Depressive episodes can be characterised by: suicidal thoughts; loss of confidence; guilt; difficulty making simple decisions; lethargy; paranoia; sleeping too much; and feelings of sadness, hopelessness, and emptiness. 

The Herald: Carrie Fisher was diagnosed with bipolar in her early 20sCarrie Fisher was diagnosed with bipolar in her early 20s (Image: Getty)

Who are some of the best known people with the condition?

Comedian and actor Stephen Fry was 37 when he was diagnosed with bipolar disorder. At the time, in 1995, he had quit his London West End play, contemplated suicide, and fled to Europe. 

Talking about the experience in 2006, Fry said the diagnosis finally explained "the massive highs and miserable lows I've lived with all my life", adding: "There's no doubt that I do have extremes of mood that are greater than just about anybody else I know."

The late Star Wars actress Carrie Fisher was diagnosed with bipolar aged 24. At one point, she said she had self-medicated by taking 30 tablets of Percodan a day - strong painkillers combining aspirin and the prescription opioid oxycodone. 

She was a champion for patients and challenged lingering stigma surrounding the condition, writing in her one-woman play 'Wishful Drinking': "In my opinion, living with manic depression takes a tremendous amount of balls...At times, being bipolar can be an all-consuming challenge, requiring a lot of stamina and even more courage, so if you’re living with this illness and functioning at all, it’s something to be proud of, not ashamed of."

Other celebrities who have spoken of their experiences with bipolar include action hero, Jean-Claude Van Damme; singer Mariah Carey; and reality star, Kerry Katona. 

The Herald: Stephen Fry has been outspoken about his own experiences with the conditionStephen Fry has been outspoken about his own experiences with the condition (Image: PA)

What should you do if you suspect yourself or a loved one might have bipolar? 

The first step is to see a GP, who can make a referral to a psychiatrist. A psychiatrist is the only healthcare professional who can make a full assessment and diagnosis of bipolar disorder and begin prescribing treatment.

Information and support for patients, carers and family members is also available online from charity Bipolar Scotland  , including via email on or telephone on: 0141 560 2050.