More Than Just a Bad Day

By Marion Scher

We've all had days when even getting out of bed is a mission. But where does a bad dayend and depression start?

Barry Swartz was 33 when he had the worst day of hislife. Then he had it again. And again. And again. After a while, he felt like a character in

As the months progressed, the dreams got worse. Helost his appetite. Then, one day, he woke up and started crying uncontrollably.Unable to stop himself, he eventually called his mother in despair. She tookhim to see a psychiatrist, who prescribed antidepressants.

The weeks that followed were dangerous for Swartz. Asthe antidepressants started working his energy improved, but his mood remaineddark.

It's the sort of story that makes you think, Man, couldn't he just pull himself together?Some of us can, but some of us can't. For Swartz, those interminable nightshifts triggered something that had been lurking in the shadows for months. Forthe next guy, the onset could be more sudden, the trigger the sudden death of aclose friend, a mild drug experiment or being the victim of crime. The truthis, we never really know how we're going to react to any given situation – andif you look at the figures, you feel kind of vulnerable. The latest statisticson depression show that one in four people will suffer from depression and onein 10 from panic attacks during the course of his or her lifetime.

What isDepression?

Depression is more than just that down feeling you geton a Sunday evening as you contemplate the week of work ahead. It is a deep andsometimes debilitating decline that can leave you feeling unable to meet thedemands of your day or enjoy the things in life that you once loved the most. Itcan emerge out of nowhere or it can be triggered by an unpleasant experiencethat causes a chemical imbalance in your brain – a shock powerful enough tochange the way your neurons behave.

Studies show that depression is linked to changes inthe normal functioning of brain chemicals, called neurotransmitters. There areseveral different neurotransmitter systems that can be involved, but the twonormally associated with depression are serotonin and noradrenalin. Serotoningoverns our moods, emotions, sleep and appetite, while noradrenalin excitesneuronal receptors in the brain. When levels of these substances drop, itcauses depression. Antidepressants restore imbalances in theseneurotransmitters.

So depression is not just a case of feeling a tad sad.It's a psychological illness, like diabetes, that causes a change in yourbiological make-up. And when you can't shake a severe case of the blues youshould begin to seek help. The problem is that very few men do. For most men,the mere mention of "psych" – as in the words "psychiatrist" or "psychologist" –sends shivers down spines. "We see so much depression," says psychiatrist Dr.Sheldon Zilesnick of the Crescent Clinic in Randburg, "but sadly few men come looking for help. Women findit easier to admit they have a problem and want to talk about it.

"It's the 'illness' concept of depression that worriesmen – but what they don't understand is that depression is treatable. Antidepressantsare very effective."

There's the other problem for most guys – a dislike ofpill-popping, especially to tranquillise the mind. "There are so many mythsabout antidepressants because people simply don't know what they are or howthey work," says Zilesnick, adding that people oftenconfuse antidepressants with tranquillisers such as Valium,which are addictive. "People think if they're on antidepressants they'll bewalking around like zombies, but the opposite is true. Today's antidepressantscan, where needed, give you back a normal life and are definitely notaddictive. They're not the chemotherapy but the antibiotics of psychiatry. Theremay be side effects, but today these are usually mild and don't last long."

TreatingDepression

Donovan Miller, a 31-year-old from Cape Town, was a typical antidepressantsceptic: "I thought I could beat my depression on my own. My GP suggested I wastaking strain at work and gave me a sick note for a week." His doctor also puthim on sedatives, which helped him sleep but left him feeling sad and anxious.

"Looking back, I now know I've always suffered fromdepression, even as a child." He felt a constant need to please other people,coupled with a pressure to succeed. But it was only after a bad work experiencethree years ago that he crashed. A friend persuaded him to see a psychologistand he went twice a week for a couple of months. "This helped me open up to mypast and work on my future, but I was still crippled by a constant fear offailure."

After two months of therapy, Miller realised he neededto do more than just reflect on his past. His psychologist referred him to apsychiatrist, who prescribed Efexor, anantidepressant that has given him back his life.

The best treatment for depression is usually a combinationof therapy and drugs, says psychologist Kevin Bolon,a specialist in cognitive behavioural therapy. "If the depression is mild tomoderate, a six-week course should be enough. If we don't see any improvement,medication is usually prescribed."

He explains that cognitive behavioural therapy is goodfor lifting a depressive mood and helping a person improve his problem-solvingskills. "When you're depressed you see problems as mountains – as loomingcatastrophes. With cognitive behavioural therapy, people learn to recognise andcorrect what have become totally distorted or irrational patterns of thinking,which often causes the depression in the first place."

MoodDisorder

To complicate matters, depression is often mistakenlydiagnosed when the real problem is Bipolar Mood Disorder.

There are two types of Bipolar Mood Disorder in psychiatry:Bipolar I and Bipolar II. The second type, Bipolar II, looks very similar todepression but is punctuated by "hypomanic" episodes –mild highs during which the person actually feels quite good. "Most people don'tknow Bipolar II and so the symptoms aren't easily picked up," explains Zilesnick. "Many people think bipolar is a very severe formof depression, but it is a completely different illness that is totally unrelatedin that it can occur in someone who's never had depression."

During a hypomanic episode,a person with Bipolar II experiences a degree of happiness that's totally outof proportion with what's going on around him. The problem is that the personalmost always crashes into depression afterwards – and the condition gets worseevery time. Doctors often only identify Bipolar II when the "depressed" persondoesn't respond to antidepressants.

The other type of Bipolar Mood Disorder, Bipolar I,used to be known as manic depression and is marked by extreme changes in mood,thoughts, energy and behaviour. A person's emotional state tends to alternatebetween extreme highs and extreme lows, with a "mood swing" lasting anywherefrom hours or days to weeks or months. Like Bipolar II, Bipolar I has no clear cause, although the illness tends to run infamilies. It can lie dormant until a trigger such as recreational drugs or atrauma sets off a manic or depressive episode. Often there is no identifiable trigger.

Usually, men with Bipolar Mood Disorder first shootoff into mania, while women first experience depression. Mania sounds like agreat night out, actually. You feel energetic and confident. You're convincedyou're the smartest guy in the room. You can go for ages without needing sleep.It would be fun, if you didn't also suffer from delusions of grandeur,aggressive behaviour, impulsivity and spectacularly bad judgement. And goingwithout sleep for three days is never good, no matter how much work you thinkyou can get done.

As a result, a typical bipolar in a manic state willthrow in his job in a fit of impudence, buy an expensive car using the kids'education fund and have unprotected sex with five women in one night – just becausehe can. In extreme cases, he may also experience hallucinations.

A Manic Man

Just ask Braam Meiring of Pretoria.Life was pretty good for him until three years ago, when mental illness turnedhis world upside down. "It was on my thirty-first birthday that I had my firstmanic upset. I'd had a couple of bouts of depression before, so although I felta bit down I never thought there was anything wrong. In my case, my manicbehaviour causes me to think I own the world. I become abnormally assertive."

That day he found himself wandering into a movie housethat was advertising the movie The Sum ofAll Fears as a forthcoming attraction. It's about a CIA hotshot who huntsdown a group of terrorists who plan to detonate a nuclear device. In his manicstate, Meiring managed to convince the movie houseemployees that, if the movie was shown in Africa,it could encourage that type of terrorist behaviour here.

"In my gratitude, I gave each of them a watch. In fact,giving away things was what I did every time I had a manic episode, which wouldlast a week or more. Every face I saw was the face of God. At the end of theepisode, I realised what I'd done and felt like the lowest form of life. By thenI realised something was wrong and desperately wanted help."

His bother had him committed to hospital, where he wasprescribed Lithium, a drug used to treat manic episodes. Within three or fourdays he started to recover, but he remained in hospital for about two months. Heremained on medication after he got out, but has had a couple of manic episodessince.

GettingHelp

The South African Depression and Anxiety SupportGroup, founded over 10 years ago by Zane Wilson, hasseen a gradual increase in the number of men seeking help from the organisation.

"One of the biggest problems with anything associatedwith the words mental health is the stigma attached," says Wilson. "People feel once their bosses orfriends know they're on medication for depression or anxiety they'll look atthem in a different way, or – worse – they'll get overlooked for promotion orlose their jobs. It's perceived as a sign of weakness. And to overcome theirfeelings, many men turn to alcohol." This is the irony of any psychiatricillness – that it takes grater bravery to seek help than to hold on to themistaken belief that you have everything you need to solve your problems rightthere inside your head.

But what if that is exactly where the problem lies?What if your brain, as an organ, has its weaknesses, just like every otherorgan in your body?

Think of it this way: if you were diabetic, you wouldn'tthink of using willpower to fix your pancreas. You would adapt your eatinghabits and take insulin. Similarly, you wouldn't expect to cure high bloodpressure by the sheer force of concentration. You would exercise, cut back onsalt and pop whatever pills your doctor prescribed. So whythe resistance to fixing one's brain in the same way?

SouthAfrican Depression and Anxiety Group

Tel (011) 783 1474

Website www.sadag.co.za

Copyright 2006.Used with permission from Marion Scher.