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Depression: In Men

Researchers estimate that at least 6 million men in the U.S. suffer from a depressive disorder every year. Depression is a serious but treatable medical condition that can strike anyone regardless of age, ethnic background, socioeconomic status, or gender. However, depression may go unrecognized by those who have it, their families and friends, and even their physicians. Men, in particular, may be unlikely to admit to depressive symptoms and seek help.

Primary Types of Depression in Men

Depression comes in different forms, just as is the case with other illnesses such as heart disease. The three main depressive disorders that occur in men are:

  1. Major depressive disorder
  2. Dysthymic disorder
  3. Bipolar disorder (manic-depressive illness)

Not everyone with a depressive disorder experiences every symptom. The number and severity of symptoms may vary among individuals and also over time.

How depression affects men differently than women

Research and clinical findings reveal that while both men and women can develop the standard symptoms of depression, they often experience depression differently and may have different ways of coping. Men may be more willing to report fatigue, irritability, loss of interest in work or hobbies, and sleep disturbances rather than feelings of sadness, worthlessness, and excessive guilt.

Some researchers question whether the standard definition of depression and the diagnostic tests based on it adequately capture the condition as it occurs in men. Men are more likely than women to report alcohol and drug abuse or dependence in their lifetime; however, there is debate among researchers as to whether substance use is a "symptom" of underlying depression in men, or a co-occurring condition that more commonly develops in men. Nevertheless, substance abuse can mask depression, making it harder to recognize depression as a separate illness that needs treatment.

Instead of acknowledging their feelings, asking for help, or seeking appropriate treatment, men may turn to alcohol or street drugs when they are depressed, or become frustrated, discouraged, angry, irritable and, sometimes, violently abusive. Some men may deal with depression by throwing themselves compulsively into their work, attempting to hide their depression from themselves, family, and friends; other men may respond to depression by engaging in reckless behavior, taking risks, and putting themselves in harm's way. Four times as many men as women die by suicide in the United States, even though women make more suicide attempts during their lives. In light of research indicating that suicide is often associated with depression, the alarming suicide rate among men may reflect the fact that men are less likely to seek treatment for depression. Many men with depression do not obtain adequate diagnosis and treatment.
 
In focus groups conducted to assess depression awareness, men described their own symptoms of depression without realizing that they were depressed. Notably, many were unaware that “physical” symptoms, such as headaches, digestive disorders, and chronic pain, can be associated with depression. In addition, men were concerned that seeing a mental health professional or going to a mental health clinic would have a negative impact at work if their employer or colleagues found out. They feared that being labeled with a diagnosis of mental illness would cost them the respect of their family and friends, or their standing in the community.

Depression in elderly men

Men must cope with several kinds of stress as they age. If they have been the primary wage earners for their families and have identified heavily with their jobs, they may feel stress upon retirement¬loss of an important role, loss of self esteem¬that can lead to depression. Similarly, the loss of friends and family and the onset of other health problems can trigger depression.

Depression is not a normal part of aging. Depression is an illness that can be effectively treated, thereby decreasing unnecessary suffering, improving the chances for recovery from other illnesses, and prolonging productive life. However, health care professionals may miss depressive symptoms in older patients. Older adults may be reluctant to discuss feelings of sadness or grief, or loss of interest in pleasurable activities. They may complain primarily of physical symptoms. It may be difficult to discern a concurrent depressive disorder in patients who present with other illnesses, such as heart disease, stroke, or cancer. These conditions may cause depressive symptoms or may be treated with medications that have side effects that cause depression. If a depressive illness is diagnosed, treatment with appropriate medication and/or brief psychotherapy can help older adults manage both diseases, thus enhancing survival and quality of life.

Identifying and treating depression in older adults is critical. There is a common misperception that suicide rates are highest among the young, but it is older white males who suffer the highest rate. More than 70 percent of older suicide victims visit their primary care physician within the month of their death; many have a depressive illness that goes undetected during these visits. This fact has led to research efforts to determine how to best improve physicians’ abilities to detect and treat depression in older adults.

Approximately 80% of older adults with depression improve when they receive treatment with antidepressant medication, psychotherapy, or a combination of both. In addition, research has shown that a combination of psychotherapy and antidepressant medication is highly effective for reducing recurrences of depression among older adults.

Psychotherapy alone has been shown to prolong periods of good health free from depression and is particularly useful for older patients who cannot or will not take medication. Improved recognition and treatment of depression in later life will make those years more enjoyable and fulfilling for the depressed elderly person and his family and caregivers.

How to help if you are depressed

Depressive disorders can make one feel exhausted, worthless, helpless, and hopeless. It is important to realize that these negative views are part of the depression and do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

  • Engage in mild exercise. Go to a movie, a ballgame, or participate in religious, social, or other activities.
  • Set realistic goals and assume a reasonable amount of responsibility.
  • Break large tasks into small ones, set some priorities, and do what you can as you can.
  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
  • Participate in activities that may make you feel better.
  • Expect your mood to improve gradually, not immediately. Feeling better takes time. Often during treatment of depression, sleep and appetite will begin to improve before depressed mood lifts.
  • Postpone important decisions. Before deciding to make a significant transition–change jobs, get married or divorced–discuss it with others who know you well and have a more objective view of your situation.
  • Do not expect to ‘snap out of’ a depression. But do expect to feel a little better day by day.
  • Remember, positive thinking will replace the negative thinking as your depression responds to treatment.
  • Let your family and friends help you.

How family and friends can help

The most important thing anyone can do for a man who may have depression is to help him get to a doctor for a diagnostic evaluation and treatment. First, try to talk to him about depression¬help him understand that depression is a common illness among men and is nothing to be ashamed about. Perhaps share this booklet with him. Then encourage him to see a doctor to determine the cause of his symptoms and obtain appropriate treatment.

Occasionally, you may need to make an appointment for the depressed person and accompany him to the doctor. Once he is in treatment, you may continue to help by encouraging him to stay with treatment until symptoms begin to lift (several weeks) or to seek different treatment if no improvement occurs. This may also mean monitoring whether he is taking prescribed medication and/or attending therapy sessions. Encourage him to be honest with the doctor about his use of alcohol and prescription or recreational drugs, and to follow the doctor’s orders about the use of these substances while on antidepressant medication.

The second most important thing is to offer emotional support to the depressed person. This involves understanding, patience, affection, and encouragement. Engage him in conversation and listen carefully. Do not disparage the feelings he may express, but point out realities and offer hope.Do not ignore remarks about suicide. Report them to the depressed person’s doctor. In an emergency, call 911. Invite him for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push him to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of laziness or of faking illness, or expect him to "snap out of it." Eventually, with treatment, most people do get better. Keep that in mind, and keep reassuring him that, with time and help, he will feel better.


© 2010 Vivacare. Last updated: April 4, 2013.

Reference: National Institutes of Mental Health

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