A neighbour of mine, a highly successful scientist and a charming person in his mid-fifties, seemed to undergo a change of personality over the course of about a year. During this time he walked around feeling fatigued and down in the dumps for many months. His sleep was restless and he would frequently wake up during the night. These symptoms might easily have been mistaken for depression. A visit to his doctor and, subsequently, to a sleep laboratory, revealed that he had a condition known as sleep apnoea. He stopped breathing for short intervals numerous times during the course of the night, which would wake him up. As a result of his breathing difficulties, his brain was not receiving sufficient oxygen. Small wonder that he was exhausted during the day, felt miserable and had difficulty concentrating. The problem was entirely corrected by a continuous positive air pressure (CPAP) machine, which ensures that he receives sufficient oxygen throughout the night. He became once more his cheerful self and I would see him tirelessly mowing his lawn and attending to his garden. We would once again chat and share jokes and his mood was completely restored with the help of one critical substance upon which all of our lives depend, namely oxygen.

This same person later developed weakness and tiredness and again lost his usual ability to concentrate and function normally. Another visit to the doctor and some simple blood tests revealed that his blood chemistry was abnormal. This turned out to be due to a rare tumour of the adrenal gland. Removal of the tumour corrected the problem and restored him once again to his previous high level of functioning.

In summary, many of the symptoms of depression are not unique to this condition, but may also be the result of medical conditions, some of which such as low thyroid levels or sleep apnoea are relatively common, while others such as tumours of the adrenal are rather rare. A visit to a competent doctor can often help sort out whether there may be a medical condition masquerading as depression. Even if you choose not to go to a doctor in the first instance but decide instead to try and treat your own depression, it is still worth bearing these other medical conditions in mind in case the symptoms do not resolve within a reasonable amount of time.

*62\75\2*

faxing, planning, and implementing numerous schemes. Hypomanic women in the home are often described as “super moms.” Everyone tends to admire hypomaniacs except when they seem to lose judgment or snap back angrily when their opinion is challenged or when they are crossed. Their minds often race, and they periodically overestimate their own abilities. Their judgment in politics, business, and the arts may be extremely sharp. Yet at other times their judgment is poor. As the hypomanic mood develops, at times coming dangerously close to a full mania, they may take irresponsible risks, drive recklessly, go on spending sprees, or participate in a multitude of sexual liaisons.

In the most severe form of the illness, manic-depressive patients become psychotic. Those who experience four or more mood swings a year are referred to as rapid cycling manic depressives.

Even though patients often use the word “high” to describe these hypomanic or manic episodes, the mood in many cases is not euphoric but irritable, paranoid, and angry, leading to confrontations and rage attacks. In its most severe form, known as psychotic mania, the manic-depressive patient may hallucinate or have grandiose religious or paranoid delusions. Because manic patients seldom perceive that they are ill, they often refuse to see psychiatrists or take any medication. However, if severe mania is left untreated, there is a risk of full psychosis and collapse brought on by physical and mental exhaustion. Hospitalization is usually required to prevent harm to themselves or others. Often, this hospitaliza-tion must be made at the request of the family, and, unfortunately, it must occasionally be legally forced when two psychiatrists deem that the patient presents a threat to him or herself or to others in the community.

*2\22\6*