Hundreds of thousands of people experience mania without ever getting depressed. Why does psychiatry insist on calling them bipolar?

Thousands of people experience mania, the “upside” of bipolar disorder, without ever falling into depression.

Mania is best known as one of the two sides of bipolar disorder. There are many cases of people going through manic episodes regularly, but never falling into depression. Mania is often described as the “upside of bipolar disorder” and can manifest in bursts of energy and creativity, but also in reckless behavior, delusion, inflated self-esteem and grandiosity. In extreme instances, mania may require hospitalization.

While depression has its own distinct diagnosis, mania is still only seen as one side of bipolar disorder.

In the 1960s a study found that depression should have its own diagnosis separate from bipolar disorder. This was officially implemented in the 1980s. In contrast, psychiatry does not recognize unipolar mania as a condition distinct from bipolar disorder.

“Unlike those who experience only depression, however, patients with mania alone are lumped with those who have bipolar disorder.”

Mania is classified as part of bipolar disorder as an endogenous psychosis, meaning it doesn’t happen in response to outside events but is innate.

Diversity of symptoms, funding conditions and methodological problems prevent unipolar mania from getting its own diagnosis.

Those who want to see unipolar mania get its own diagnosis face many challenges. Pharmaceutical companies are funding more and more research, and their aim is generally to prove that a new drug is more effective than a placebo. These types of studies require large patient groups and subcategorizing would undermine the weight of their results.

“Modern investigative techniques have revealed surprisingly little about what happens in the brain during mania, partly because brain imaging requires minimal head movement.”

In addition, officially categorizing a new condition requires fresh evidence and review by committees, both of which can take a lot of time. The lack of categorization also means that there is no standardized methodology or definition, making it difficult to compare results.

There are subtle differences between bipolar disorder and unipolar mania.

Unipolar mania appears to occur more often in non-Western countries. However, this might be because depression may be accepted as normal in countries like Africa. A study that consolidated data from various epidemiological studies found that psychotic symptoms often come hand-in-hand with unipolar mania, whereas there is a notable absence of anxiety, which is usually associated with depression.

“Unipolar mania is thus at the hub of a catch-22: the absence of a diagnosis is an impediment to research, and the paucity of research makes creation of a diagnosis less likely.”

People suffering from unipolar mania also tend to have fewer episodes and recover more quickly than those diagnosed with bipolar disorder. Also, administering lithium, the first choice for bipolar disorder, has proven less effective for those who suffer from unipolar mania. Finally, brain imaging studies have shown that unipolar mania causes less damage to the brain than bipolar disorder.