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BY GLYNIS HORNING Depression manifests differently in men and in women, and in young people and old. Learn to spot the signs and get help early for this devastating but treatable condition. Depression affects around 20 percent of us during our lives, reports the SA Anxiety and Depression Group (SADAG). It strikes both sexes and all ages, but not in the same way, which can delay diagnosis — sometimes with serious implications. A year after David*, a retired Pietermaritzburg property developer, lost his wife to cancer, his children noticed changes in the once-outgoing 71-year-old. He lost weight, grew withdrawn and irritable, and complained of back pain and insomnia. 'But when the caretaker rang to say he'd found Dad unconscious with empty bottles of Mom's old painkillers beside him, we were shocked', says his son Sean, 42, who lives in Pretoria.'We'd thought he was just getting over Mom, but the doctor said it was more than that —he had clinical depression: Bulelwa,* a Durban dental nurse, was just as shocked when her daughter received a similar diagnosis — at just 14. 'Her school marks had dropped and she'd started crying a lot, sleeping all the time, and being cheeky to me when I tried to talk to her! It was when the school called Bulelwa in to discuss her daughter's disruptive class behaviour, and advised that she see a psychologist, that she realised this was 'not just normal puberty behaviouri 'Clinical depression affects your mood, mind, body and behaviour; says Cassey Chambers, operations director at SADAG.'It's not the same as a transient "blue" mood. It can't be willed away. But appropriate treatment can help most sufferers: The earlier they get help the better — so it's important to know the different faces the disorder presents. Depression takes an array of forms. Major depression interferes with the ability to work, sleep, eat and enjoy activities you once found pleasurable, says Dr Moosa Moola, a psychiatrist at Life Fourways Hospital in Johannesburg. Dysthymia is a less severe type of depression where you can function, but far from your full potential, and it can linger for years. With bipolar disorder, episodes of depression alternative with episodes of elation or mania, which can affect your thinking, judgment and social behaviour. 'Undiagnosed or untreated depression is the leading contributing factor to suicide, so the sooner you get help for it the better,' emphasises Chambers. Depression can have numerous possible causes, from external events, such as loneliness, financial worries or grief, to genetics — having close relatives with depression makes you more susceptible to the condition. Today, much research focuses on physiological or'biochemical' factors, and depression is widely seen as the result of an imbalance of brain chemicals (neurotransmitters), says Dr Moola. Medical illnesses such as stroke and thyroid problems can be contributory factors, as can medications, including those used to treat high blood pressure, birth control pills and steroids (cortisone). Alcohol and other substances can also play a role in the development of depression. The symptoms of depression for men and women, children and the elderly can differ (see next page), but treatment is the same — usually a combination of medication and therapy, depending on individual needs. Medication is mostly with antidepressants, particularly a class known as selective serotonin reuptake inhibitors (SSR1s), which have few and mild side effects and are non-addictive. They take two to six weeks to work and are effective in about 70 percent of people, says Chambers. Cognitive behavioural therapy teaches you to challenge negative ways of thinking and behaving, and interpersonal therapy can help you cope with relationship and other problems that worsen depression. In severe cases, modern electroconvulsive therapy can give quick, safe relief, says Dr Moola, but it doesn't protect against future depressive episodes. IN WOMEN depression is twice as common as in men. Hormonal changes can play a role, and women are more susceptible at puberty, during pregnancy and after giving birth (when mood may also be affected by hormones, lifestyle and work changes, lack of social support, relationship problems or mixed feelings about having a baby), around menopause, or after a hysterectomy, says Dr Moola. Women may also be more at risk because of social inequality— many still earn less than men and have a double workload, shouldering domestic responsibilities and careers. They are also more at risk of physical or sexual abuse. SPOT IT: The most common signs in women are tiredness, sadness, crying, low self-esteem, guilt, anxiety, loss of interest in life, loss of libido, changes in sleeping patterns or appetite, and suicidal thoughts. Women are more likely to attempt suicide than men, says Chambers, but less likely to succeed, as they use less violent means.