Men and Depression
Clinical depression differs from normal sadness. A clinically depressed person cannot just "snap out it." Left untreated, serious, disabling depression compromises health, relationships, and work, sometimes for months or even years. There are 3 types of depression that are most common:
- Major depression or major depressive disorder exhibits a series of symptoms (Table 1) that can seriously interfere with all aspects of life. A person feels "empty" and shuns previously pleasurable activities. One major depressive episode is highly predictive of future episodes.1
- Dysthymia or dysthymic disorder, a less disabling form of depression, can still be long-lasting. Dysthymia prevents people from feeling their very best and performing to their fullest potential.
- Bipolar disorder or manic depressive disorder is characterized by cycles of major depression followed by extreme energy (mania), which can worsen to a psychotic state if untreated.
Depressed men and women both experience symptoms of sadness, guilt, worthlessness, and sleep disruption. Depressed men also tend to be angry, frustrated, violent, and socially isolated. They often abuse alcohol or drugs or take serious risks, such as engaging in reckless driving or extramarital sex.3-5 They frequently have job-related stress.
Each year approximately 6 million men and 12 million women are diagnosed with depression. The actual number of men suffering from depression is probably much greater, because men are less likely than women to seek treatment. Many men who do not consider themselves depressed still report depressive symptoms, however.2
The exact causes of depression are unknown. Certain medical conditions are linked to depression, such as hypogonadism (low levels of the male hormone testosterone) and thyroid disorders. In addition, some medications can cause depression. Several genes have been identified that are unique to depressed people,6 and chemical imbalances are observed in depressed people.4 Upbringing also contributes to the prevalence of depression in men. Raised to be strong and independent, men may see themselves as failures when uncontrollable situations arise, such as the loss of a job.
Depression and Other Conditions
Treating depression has been shown to improve men's health in other areas, including heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's disease. For example, for people with untreated depression, the risk of dying following a heart attack is up to 5 times greater.7,8
Depression also is related to alcoholism, drug addition, anxiety, panic disorders, obsessive-compulsive disorders, and social phobias. Up to 40% of people suffering from posttraumatic stress disorders are depressed.2
Suicide is depression's most tragic outcome. More than 90% of those who commit suicide suffer from depression.3 Four times as many men commit suicide as women, although women tend to make more suicide attempts. White males >60 years old are at the highest risk.9 Men's high rate of suicide may be a consequence of failure to seek treatment for depression. Patients who are depressed and have thoughts of suicide should get help immediately or call the National Suicide and Crisis Hotline at 800-SUICIDE (800-784-2733).
Diagnosis and Treatment
In diagnosing depression, a physician may first conduct a physical examination, with blood work and possibly a brain scan, to rule out other medical conditions as a cause. The physician also will ask about the patient's history and severity of symptoms. Once a diagnosis has been made, treatment choices generally involve medication, psychotherapy, or a combination of both.
Each of the medications for depression has side effects (Table 2). They are not addictive, however. Many doctors prefer the newer antidepressants (selective serotonin reuptake inhibitors); they have fewer side effects than older drugs. Antidepressant medications must be taken regularly, and it may take up to 4 weeks to see improvement. Once patients feel better, they might be tempted to stop taking the medication. Stopping abruptly can be dangerous. Patients never should discontinue antidepressant medication without talking to a doctor. Also, alcohol usage may reduce the medication's effectiveness. Physicians may advise patients about avoiding certain OTC and prescription medications.
Two types of short-term psychotherapy (10 to 20 weeks) are effective for depression: cognitive behavioral therapy (CRT) and interpersonal therapy (IPT). With CRT, patients begin to view their circumstances more positively and break old negative thought associations. IPT focuses on disturbed interpersonal relationships that contribute to and/or worsen depression. Its focus is on conflict resolution.
Combining therapy and medication usually is best. Patients who do not improve with therapy and medication, or whose depression may be life-threatening, may be candidates for electroconvulsive therapy (ECT). Unlike in the movies, a person receiving ECT does not consciously experience the electrical stimulus. The physician performs the procedure while the patient is under anesthesia.
Depression is abnormal. Although men's symptoms may not involve crying, fatigue, or helplessness, untreated depression is nevertheless disabling. Patients should not wait "until things get worse," because they eventually will. For referrals, patients may visit www.mentalhealth.samhsa.gov/data bases or call 800-789-2647, which is a government-operated service that will identify resources in the local area. Real men do get depressed, and they need real help.
Dr. Zanni is a psychologist and health-systems consultant based in Alexandria, Va.
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