There is so much noise about bipolar disorder, but often very little insight. However, every so often new viewpoints emerge that can illuminate or even revolutionize our understanding. This has recently been achieved by the Greek psychiatrist Athanasios Koukopoulos in a theory described as "The Primacy of Mania".

Suppose that bipolar disorder is not primarily characterized by the mood swings from depression to mania?

Ask "are we really correct in our understanding that most people with bipolar disorder spend the majority of their time in a depressed state?"

What if mixed states are not only common and frequent, but are not the paradox or the treatment challenge that we have feared?

There is a alternative theory of bipolar disorder, first proposed in 2006 by Greek psychiatrist Athanasios Koukopoulos, that argues for "The Primacy of Mania".

As Dr Koukopoulos sees it:

"Circular mood disorders have been the focus of increasing attention and research, but the issue of a possible intrinsic link between the phases of the manic-depressive cycle has never been investigated. The general assumption is that mania and depression are manifestations of two different phases of the same process without questioning whether one of the phases gives rise to the other."

The primacy of mania argument is that there IS a direct link between mania and depression. Further, it is MANIA that is the PRIMARY neurophysiological event, and the depression is merely the consequence.

This turns much of the established wisdom on its head. For a start, if depression only ever arises as a consequence of mania, then our existing definition of mania is narrow and cliched - a much broader and accurate understanding of the manic state needs to be formulated. To some extent this has already started to happen. Irritability and other states of agitation, anxiety, stress, and excitation are increasingly seen as variations of mania, or at least as hypomania.

Why then does mania invariably morph into depression? Dr Koukopoulos puts it this way:

"excitatory processes are harmful to the nervous system while depression is the psychic expression of this impairment and a period of reparation".

In other words, our mania actually causes our depression. This explains why mood stabilizers, rather than antidepressants, have the strongest preventative effect. It may SEEM as if most people afflicted with manic-depressive illness are suffering mainly from their depression, but the evidence shows that it is the drugs with anti-manic properties that are most helpful in the long term. In fact, there is a growing belief that antidepressants can do more harm than good as they eventually trigger a switch into mania.

Rethinking bipolar disorder in terms of the primacy of mania shows the inevitability of this. How can we improve the metal health of the manic by giving them medication that may be stimulating in any way? This theory has some significant implications. In particular, it suggests that our definition of mania is too narrow, and our definition of depression is too broad.

In my own life, it is these subtle variations of mania that plague me - and those around me. Of most pain to my self and my loved ones are my bouts of anxiety and irritability. Understanding these as manifestations of mania has transformed my life. Considerable improvement has taken place since my focus shifted to the pursuit of calmness.

How is this done? For me, I applied the insights from the primacy of mania theory by:

1. Making medication a daily practice.
2. Sticking with a daily exercise program.
3. Changing my diet to exclude stimulants. For me this meant less caffeine and sugar.
4. Avoiding stress (working from home more, jettisioning toxic pastimes and people).
5. Focusing on the pursuit of calm as opposed to the pursuit of happiness.

Pulling out of an episode of depression can be one of the hardest things in the world.

It seems it is possible to reduce depression by reducing the mania that precedes it. Further, that the way to do this is not through chasing after happiness and pleasure - dangerous if it involves excessive stimlation - but by pursuing calm.