Men Can Get the Blues
Depression has traditionally been considered a female disorder. But, men can and do get depressed. The big difference is that men may be less likely to seek treatment for depression because they see mental illness as a sign of weakness.
Depression is not a sign of weakness, however. It is a disease with biochemical causes. More than 17 million Americans suffer from depression every year, according to the American Psychiatric Association (APA). And, the APA estimates that at least one out of every 10 men will have depression during their lifetime.
Many of those men will never get treated for their depression for a variety of reasons. The most important is that men are less willing to admit depression, according to Teodoro Bottiglieri, Ph.D., a senior research scientist and associate professor at Baylor University Medical Center and the author of Stop Depression Now. "There is a stigma attached to having any psychiatric illness. It's a point of vulnerability, like admitting you're impotent in public," he says.
Men, he said, are taught to just grin and bear it, get on with life and provide for their families. Dr. Norman Sussman, a psychiatrist at New York University Medical Center, agrees. "Men are less likely to seek treatment, in part because there's a tendency for men to tough it out," she says.
It's important for men to realize that "depression is a medical disorder that affects one's ability to feel and think in certain ways. It's a form of reversible brain failure," says Sussman. "It's not an indication of their character."
The problem with not coming forward is that depression tends to get worse, and affects all areas of a man's life. Many men will self-medicate with alcohol or drugs, says Sussman. And, men -- especially older men -- have higher rates of suicide than women do.
Another reason men don't get treatment may be that their doctors are missing the signs of depression. Sussman says it's possible that there may be a biased tendency in diagnosing depression, with doctors looking for it more in women than in men because the disease is so much more prevalent in women. Men also tend to downplay their symptoms if they discuss them with their doctors at all.
Depression, particularly in older men, may not always be obvious, says Dr. Steven Roose, a professor of clinical psychiatry at Columbia University and the director of the Neuropsychiatric Research Clinic at the New York State Psychiatric Institute. He says the symptoms are a little bit different, with older men reporting sleep disturbances, pain and loss of energy. Older men may not complain about having a depressed mood, he says. And many primary care physicians lack the training to recognize that it's depression. According to Roose, suicide is an epidemic in men over 60 -- 20 percent of older men who attempted suicide had seen their doctor that day, and 70 percent had seen their doctor during the month leading up to their suicides.
"A review of mood state and ruling out the diagnosis of depression should be as much a standard procedure as taking a blood pressure," says Roose.
Roose adds that undiagnosed depression can also affect other areas of health. For example, men diagnosed with heart disease who are also depressed do much worse in terms of survival, according to Roose.
Signs and Symptoms
It's important that family members -- particularly spouses -- be on the lookout for signs of depression, says Bottiglieri, because many depressed people will not seek help.
- sad mood that lasts for more than two weeks
- feelings of hopelessness
- lack of enjoyment from everyday activities, such as playing with children or playing golf
- changes in sleep patterns
- changes in appetite
- trouble concentrating and making decisions
- preoccupation with death and thoughts of suicide
In more severe cases of depression, people can be agitated or very lethargic. Eventually, they may be unable to function in their daily routine.
There are a number of medications available to treat depression and according to the APA, up to 90 percent of those treated have significant improvements. Treatment options include tricyclic antidepressants, MAO inhibitors, and the very popular selective serotonin reuptake inhibitors or SSRIs, like Prozac and Zoloft. Alternative treatments such as St. John's Wort and SAM-e are also available. Psychotherapy is sometimes useful in treating depression, though it is most effective when used in conjunction with medication. But, Sussman says, some men have difficulty opening up in psychotherapy.
The problem with some of the medical treatments is that they cause other problems, such as a loss of interest in sex. "SSRIs are well tolerated and safe, but they do have an effect on quality of life," says Sussman. Depending on which medication you take, side effects can include a loss of libido, difficulty or an inability to achieve orgasm, sleep problems, weight gain and a lack of feeling the full range of emotions. Tricylcic antidepressants may have dangerous interactions with heart medication.
"Patients should be told up front of the likelihood of side effects happening," says Sussman. "But, in primary care, people are often not forewarned."
Patients need to talk to their doctors about side effects because there are many choices out there, and if one medication produces unpleasant side effects, it's possible a different medication may not.
SSRIs can also have unexpected benefits. They are fairly effective at treating premature ejaculation, which may be something a man hasn't even discussed with his doctor. Also, according to Roose, they seem to have an antiplatelet effect similar to that of aspirin. So, while taking a medication to cure depression, men may also be improving their cardiovascular health.
St. John's Wort and SAM-e have also been used to treat depression. St. John's Wort doesn't appear to be as effective as was once believed, says Bottiglieri. He says it depends a lot on the dose taken and the actual amount of St. John's Wort in the product.
However, Bottliglieri does believe that SAM-e can be very useful in treating depression and says it's often used as a first-line treatment in Europe. It also has fewer side effects than other medications. He adds that dietary supplements like SAM-e have been criticized because doctors fear patients will self-medicate themselves instead of seeking help. But, he feels they have a place.
"At least they have a choice of something that may help if they're the type of person that won't seek help anyway," he says. He recommends 400 milligrams per day for mild depression, and for more severe depression, he recommends 800-1200 milligrams.
SAM-e also may work well in conjunction with SSRIs and may reduce the need for a high dose of the SSRI. Such a combination would have to be prescribed and monitored by a physician, however.
"Men really should seek medical attention for their depression. It is a life threatening situation that needs to be properly diagnosed and monitored," says Bottiglieri.
Roose concurs. "Depression is an illness and men should not feel it results from weakness. It doesn't reflect on their character any more than a broken leg does," he says.
Last reviewed: By John M. Grohol, Psy.D. on 9 Oct 2013
Published on PsychCentral.com. All rights reserved.
Two roads diverged in a wood, and I--
I took the one less traveled by,
And that has made all the difference.
-- Robert Frost