Men Can Get the Blues
Depression traditionally has 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). The APA estimates that at least one out of every 10 men will have depression during his lifetime.
The Stigma of Dealing with Depression in Men
Many of those men will never seek treatment for their depression. 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, Dallas, 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,” he 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.
Doctors may miss the signs of men’s depression. Sussman says it’s possible that there may be a bias tendency in diagnosing depression, with doctors looking for it more in women, in whom the disease is more prevalent. If they discuss them with their doctors at all, men tend to downplay their symptoms.
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.
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,” Roose said.
Roose added that undiagnosed depression also can affect other areas of health. For example, depressed men diagnosed with heart disease have much worse survival rates.
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.
Treatment for Men and Depression
There are a number of medications available to treat depression. 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, such as Prozac and Zoloft. Alternative treatments such as St. John’s Wort and SAM-e are also available.
Psychotherapy is 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.
Some of the medical treatments may cause other problems. “SSRIs are well tolerated and safe, but they do have an effect on quality of life,” Sussman said. Side effects can include a loss of libido, difficulty or 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,” Sussman said. “But, in primary care, people are often not forewarned.” Different medications may cause different side effects, so men should talk to their doctors about their experiences with various medications.
SSRIs also can 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 also have been used to treat depression. St. John’s Wort doesn’t appear to be as effective as was once believed, Bottiglieri said. Its efficacy depends on the dose taken and the actual amount of St. John’s Wort in the product.
However, Bottliglieri said, SAM-e can be very useful in treating depression and is often used as a first-line treatment in Europe. It also has fewer side effects than other medications. Dietary supplements like SAM-e have been criticized because doctors fear patients will self-medicate themselves instead of seeking help. But Bottliglieri 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 said.
On 13 Feb 2006
By John M. Grohol, Psy.D.
Gordon, S. (2020). Men Can Get the Blues. Psych Central. Retrieved on February 29, 2020, from https://psychcentral.com/lib/men-can-get-the-blues/