The primacy of mania: A reconsideration of mood disorders

The primacy of mania: A reconsideration of mood disorders

In contemporary psychiatry, depression and mania are conceived as different entities. They may occur together, as in bipolar disorder, or they
may occur separately, as in unipolar depression. This view is partly based on a narrow definition of mania and a rather broad definition of
depression. Generally, depression is seen as more prominent, common, and problematic; while mania appears uncommon and treatment-
responsive. We suggest a reversal: mania viewed broadly, not as simply episodic euphoria plus hyperactivity, but a wide range of excitatory
behaviors; and depression seen more narrowly. Further, using pharmacological and clinical evidence, and in contrast to previous theories of
mania interpreted as a flight from depression, we propose the primacy of mania hypothesis (PM): depression is a consequence of the excitatory
processes of mania.If correct, current treatment of depressive illness needs revision. Rather than directly lifting mood with antidepressants,the
aim would be to suppress manic-like excitation, with depression being secondarily prevented. Potential objections to, and empirical tests of,the
PM hypothesis are discussed.