The Sad Truth Men Often Deny It, but Depression Isn’t Just a Women’s Disease

When it comes to depression, men are better at some things than women. Killing themselves, for one thing.

“It gets dangerous when men experience despondent, hopeless, and suicidal feelings,” said Baxter Chandler, manager of Outpatient Behavioral Health and the Partial Hospitalization Program at Holyoke Medical Center. “To many men, feeling helpless is unacceptable” — and rather than seek help, many turn to suicide, too often successfully.

“Men are more likely to employ a more lethal means of suicide than women,” noted Dr. Nathan Somers, a child and adolescent psychiatrist at Providence Hospital. Indeed, suicidal men are statistically more apt to use violent methods such as firearms, whereas women gravitate toward pill overdoses or superficial cutting, which have a greater margin for survival. That explains why between 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} and 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all suicides are men, even though women comprise the majority of all suicide attempts.

Health professionals wish men were as efficient at sharing their feelings. Although clinical depression strikes both men and women in significant numbers, far more women than men seek the medical treatment they need, largely because men are simply reluctant to admit they have a problem.

“The problem is a lot more prevalent than some people think because it doesn’t get reported as often in men,” Chandler said. “A lot of the symptoms that people experience are the same; it’s just that men might express and report their symptoms differently.

“Men may be more willing to report that they’re feeling tired or fatigued, or that they might be more irritable than normal,” he continued. “But they’re not as likely to report things like sadness or depressed mood, the things we think about when we consider depression. And because men are more likely to report only physical symptoms, they may not even think it’s depression. They may think they’re just overworked or not getting enough sleep, chalking up their depression to other things.”

Even though the common symptoms of depression — which include changes in mood, sleep patterns, and appetite; inability to concentrate or to enjoy favorite activities; and feelings of guilt and hopelessness — manifest in both genders, Somers explained, “men may be more sensitive to a perceived stigma about depression and might be less likely to seek help.”

This month, The Healthcare News explores this common but all-too-undertreated condition that, despite its reputation as a ‘women’s disease,’ in reality does not discriminate by gender.

Feeling Blue

More than 6 million men in the U.S. have at least one episode of major depression each year, struggling with symptoms ranging from less interest in hobbies all the way to suicidal despondency.

Still, Chandler cited a quip from Ronald Kessler, professor of Health Care Policy at Harvard Medical School, who noted that “men get irritable, women get depressed” in explaining the perceptions people have of their own symptoms. But men who do stop denying their depression and accept that they need help overwhelmingly improve their quality of life.

“So many men come in for treatment, and one of their main complaints is, ‘I feel I’m snapping at people, yelling. I had an anger problem when I was younger, but I haven’t for years, and now I’m yelling again.’ The thing is, the more men start talking about this irritability, the more they can lift back the layers and start seeing their symptoms of depression — the sadness, the hopelessness. And when they acknowledge it, they get less irritable. Once they grasp that it may be a mood disorder or depression, they get some relief. It’s freeing.”

“Depression can make it difficult for people to work, it can make it difficult to maintain a positive relationship with a spouse or take care of children, and it makes it very difficult to maintain interests in recreational activities,” Somers said, so misdiagnosing or ignoring the condition can lead to a host of serious interpersonal problems.

However, the widespread misreading of depression is not limited to adult males. As a child psychiatrist, Somers recognizes the way both preadolescent and teenage boys are misdiagnosed.

“Boys, when they’re depressed, are more likely to act out or externalize their feelings,” he explained, “so with a teenage boy, you see someone who’s getting into fights, being suspended from school, maybe engaging in some delinquent behavior, and those behaviors can be related to depression” — even though they might be misread as typical teenage rebellion or ‘boys being boys.’

“With a girl, you’re more likely to see some self-injurious behavior and more textbook signs of depression,” he said. “And girls are more likely to tell you about their feelings, while boys deny them. Again, it’s related to what society, and maybe what males internally, think is acceptable to say about themselves. Feelings of fear, sadness, anxiety, being vulnerable, needing help — those aren’t necessarily feelings looked upon favorably by males.”

Seeking Answers

Many men face their first episode of clinical depression late in life, Somers said, when they lose a spouse — a situation that tends to hit men harder than women, perhaps because women tend to have a better-developed support network and are far less likely than men to think they should face hardships on their own. “Men may feel they need to go it alone,” he said.

Chandler said both men and women who seek help for depression want a quick fix, but every case is different, and the course of treatment — which may include drugs, counseling, psychotherapy, or other modalities — often requires some patience and personal commitment.

“Usually the best success we see is from a combination of medication and counseling, whether individual or group counseling,” he said. “I personally think group counseling is an excellent option for many men, because the more they can feel like they’re not alone in this, that other men are experiencing it, the faster it gets rid of the stigma. Many men come in thinking they’re the only depressed man on the face of the planet.”

The most common prescriptions that target depression are in the class of drugs known as selective serotonin reuptake inhibitors (SSRI); they include well-known products such as Prozac, Zoloft, and Celexa.

“Those are the most common and safest medications,” Somers said. “Unfortunately, they don’t work immediately, but over one or two months, because it takes time for the actual physiologic changes to occur in the neurons of the brain. Then there are other groups of antidepressant medications available that we can try if SSRIs are not effective or well-tolerated.”

Chandler added that simply taking care of oneself — through proper rest, nutrition, exercise, and moderating alcohol intake — can keep depression at bay. After all, men who dismiss depression as simply physical woes are half-right, in that everyone should take care of their bodies. “There’s a huge mind-body connection,” he said, “and there certainly can be an external trigger.”

Despite some progress, that nagging stigma about men and depression lingers, Chandler told The Healthcare News. “They think, ‘if I go to a psychotherapist, I must be crazy … or weak,’” he said. “Yes, more men are reporting, ‘I actually do feel depressed.’ But there’s still a stigma attached to it.”

That’s why it’s a good idea to start by telling a primary care physician, with whom there’s usually more of a comfort zone, about symptoms of depression.

“Of course, men aren’t terribly well-known for going to the doctor,” Chandler added. “But it’s not a bad place for men to at least start talking. And primary care doctors need to be educated that, when a man comes in complaining that he’s feeling irritable, they should at least consider the possibility of depression.”

It’s critical to make those connections, Somers said, stressing that reaching out for any sort of help is far from a show of weakness.

“Men should know that there are good treatments out there, and there’s no shame in coming in and asking for help,” he said. “In fact, taking care of yourself is really a strength.”

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