Bipolar Disorder in Lebanon

My mood is seesaw: Bipolar disorder. Bipolar disorder is a disease in which the mood fluctuates beyond the normal limits, ranging from the upper positive of mania to the lower negative pole of depression, passing by periods where all is well.

Bipolar disorder in Lebanon

Dr. Abboud Assaf - Tuesday, October 23, 2012

A very important question people ask me in the clinic:"Am I bipolar?" In the era of the Internet, knowledge had become accessible to all. Therefore, a common scenario any psychiatrist may face in Lebanon or abroad is someone seeing him in consultation, carrying with him psychiatric symptoms' checklists he downloaded from some websites, with this very simple, though delicate question:"Am I bipolar?"

Let me begin answering this question by telling you that, to this current date, bipolar disorder is a clinical diagnosis. Hence, there are no blood or urine tests, imaging techniques or genetic studies that would allow us to pose the diagnosis of bipolar disorder. So it's all left to the psychiatrist's clinical judgement. Tricky, isn't it?

Well, it gets even trickier...Bipolar disorder is a mood disorder characterized by abnormal mood episodes ranging from the negative pole of depression to the positive pole of mania, with all the intermediates possible. But most importantly, studies have shown that bipolar patients are not constantly in abnormal mood episodes. In fact, they spend almost half of their lives in normal mood states, also known as "euthymia", where they are clinically undistinguishable from non bipolar individuals. Imagine someone in the clinic while in this euthymic phase with the famous question:"Am I bipolar?" Obviously, you cannot count on his current status to evaluate if he is bipolar or not. If you commit this fatal mistake, your answer would be for half of those bipolar patients who ask you this question: "No".

Well, there are huge differences between a bipolar patient when he is in a manic, depressed or normal phase. Practically, it's like there are three versions of him. Typically, patients describe their mood as a seesaw...Sometimes up, sometimes down..But what is important to understand is that those mood episodes are far more intense than the "normal" mood fluctuations that anyone can have in response to life events. For example, it would be highly improbable for someone to have the exact same mood the day he got his degree form the university and the day he learned that his dad had lung cancer...

In previous blogs, I have already talked about depression and its symptoms. A bipolar individual experiencing a depressive episode will look quite the same. In fact, the current psychiatric classifications give the same defining criteria for depression, whether it is bipolar or "classical" (also known as "unipolar", meaning that those individuals will never shift to the opposing positive pole of mood but may relapse only in a depressive way within what is called the "major depressive disorder").

As for mania, here is what it looks like: unrealistically happy mood, irritable and labile, sleeping barely 3 hours daily with an astonishing energy that the patient has never felt in his life, excess of pleasurable activities the patient indulges himself with (overspending, addictions, hypersexuality, commercial projects,...) not caring about the negative consequences that may result, acting in a totally reckless, thoughtless and impulsive way, speaking too much and too fast, overflow of ideas that come like shooting stars, barely connected to each other, low concentration span, thinking you are superintelligent, sometimes even a messenger of God with a divine mission to save mankind...

If you think your mood is a seesaw, contact us...




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