Depression in Men

Tough guys -- real men -- don't get depressed. After all, depression is a "women's disease." If only it were that simple.
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Tough guys -- real men -- don't get depressed. After all, depression is a "women's disease." If only it were that simple.

With more than 6 million men in the U.S. being affected by depression each year, the prevalence of depression in men is more common than some might guess.

Depression is not just a "women's disease." It affects men, women and children differently.

In our culture, men are discouraged from expressing emotion. The stoic man is a real man. The man who is "in control" of all aspects of his being is a real man. Successful men should be able to "snap out of it" and carry on with life. Unfortunately, these views don't fit well with the realities of depression.

There are emotional, behavioral, cognitive (thought) and somatic (physical) consequences to depression. Common symptoms of depression in men include fatigue, changes in appetite, sleep disturbances, decreased focus and concentration, and loss of interest in usually pleasurable activities. Other symptoms may include aggression, increased drug or alcohol consumption, being chronically tired, and loss of productivity at work and involvement with family. Depression is different from the blues. Depression can be measured on a continuum from mild to severe, but it is chronic, pervasive and more serious than the blues. Depression can also co-occur with other disorders, making it complicated to identify and treat.

One of the most obvious concerns of depression is suicide. Many people and cultures think that suicide is cowardly, but it's more complicated than that. While more women attempt suicide than men, the CDC reports that 79 percent of people who complete suicide are male, probably due to the more lethal means that men use compared to women. One of the most important factors in suicidal ideation is hopelessness. Believe it or not, most depressed people who are suicidal don't really want to die; they just want their pain to stop -- the pain of hurt, the pain that nothing will change, the pain of suspecting that the current misery will persist into the future. But they should know that things can change.

Depression in men, women and children can be especially complicated to understand because of a phenomenon that I call the etiology-maintenance-treatment confound: what causes a psychological problem isn't necessarily what maintains it, and the treatment might be unrelated to what caused it or what's maintaining it. For example, the thing that causes depression (a single event) might be unrelated to what keeps a person depressed (it can last for years), and the treatment might be unrelated to the cause or the thing that keeps someone depressed.

There are various types of treatment. Various forms of psychotherapy ("talk" therapy) and antidepressants are two very common approaches, as well as a combination of both. On the issue of medication, our brains respond to our environments. Sometimes the environment can have such an impact on our thinking that it essentially "rewires" our brains. There is a growing line of research that shows that psychotherapy can help fix this, but sometimes it isn't enough. There is no shame in medication. Examples of the strongest people, the brightest people, good people and very popular people can be found who take medications. The wrong medication or level can lead to problems, but the right medication and level can be just the thing that is needed to feel a bit better without feeling like one is on a drug.

While this issue is very personal and private, it is also a public health issue. Politicians must make sure that what we know about depression is up-to-date with the public support networks. Politicians are in a great position to use the "bully pulpit" to raise awareness of this issue and make sure that laws don't discriminate against men who are depressed, and that privacy is protected, which it largely is through HIPPA. The National Institute of Mental Health lists a host of forums to find help for depression: community mental health centers; employee assistance programs; family doctors; family service/social agencies; health maintenance organizations; hospital psychiatry departments and outpatient clinics; local medical and/or psychiatric societies; mental health specialists such as psychiatrists, psychologists, social workers or mental health counselors; private clinics and facilities; state hospital outpatient clinics; and university or medical school affiliated programs.

Depressed people aren't weak or defective people. But depression can hinder their full potential. No one asks to be depressed, and no one wants to be depressed. If you think you or someone you know is depressed, seek help. Sometimes it might take several tries before the right clinician and/or treatment is found. The right fit with a clinician is perhaps as important as the treatment.

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