Depression and Anxiety White Paper - 2007

MEN AND THE BLUES
Depression looks different in men than in women

Is depression really less common in men than in women? Researchers are beginning to wonder. In fact, some experts believe that depression may actually be just as common in men as in women but is often overlooked because of its different signs and symptoms. Rather than feeling sad, weepy,
worthless, or guilty, as women usually do, men are more inclined to get angry and irritable, feel an increasing loss of control over their lives, take greater risks, become more aggressive, and complain about problems at work.

But the consequences of depression in men—and of not being diagnosed and treated—can be even more dangerous than for women. Tragically, men are four times more likely than women to commit suicide. And while depression
is associated with a greater risk of coronary heart disease in both genders, a study in the Archives of Internal Medicine shows that only depressed men, not
depressed women, suffer a higher death rate from heart disease.

Roughly six million of the 18 million Americans who experience depression each year are men—many famous “manly men” among them, too, including the
late writer William Styron (author of Sophie’s Choice), 60 Minutes correspondent Mike Wallace, and baseball hitter Mark McGwire.

Researchers believe that men are more vulnerable than women to stressful life changes that can trigger depression, such as divorce, loss of a spouse, unemployment, or retirement. This may be a result of their having a different
genetic makeup that makes their susceptibility to depression different from that of women. In a study published in the American Journal of Medical Genetics, researchers found 19 chromosomal regions connected to major
depression—but men and women shared only three of these regions; the rest were linked to one gender or the other.

The Strong, Silent Type

All too often, men fail to get treatment because they may not recognize
the symptoms of depression or, even if they notice something is wrong, they can’t admit they have a problem for fear of being perceived as “weak” or “dependent.” They may see themselves as independent or rugged and believe there is shame attached to being diagnosed with depression. Older men are especially apt to adopt a “John Wayne” attitude; they’re also more prone to depression and suicide than younger men. And healthcare providers may
overlook depression in older men because their symptoms can be more physical than psychological, they could have other medical illnesses that mask depression, or they may be using medications that can cause depression. Naturally declining testosterone levels may also contribute to the onset of the blues in older men.

Typically, when men try to cope with depression on their own, they often become argumentative and combative, withdraw from relationships, engage
in dangerous sports or unprotected sex with multiple partners, and self-medicate with alcohol or drugs. Ultimately, these risky behaviors only make the condition much worse.

Getting Help

The stigma surrounding depression is lessening in this country, even for men, as researchers are learning about the physical basis for depression—it’s not a sign of weakness, but rather a brain disorder that can be treated. Because
of the change in thinking, men are slowly coming around to the idea that it’s okay to get help for a mental illness.

So if you’ve noticed that you’re feeling more irritable or withdrawn than usual, be sure to tell your primary care doctor about it. He or she can perform
tests to check for illnesses that could be causing depression, assess whether your medications are a contributing factor, and evaluate the need for antidepressant medication or psychotherapy.

If you’d rather not discuss the way you’re feeling with your regular doctor, you can also seek help from:

• Mental health specialists (psychiatrists, psychologists, social workers, mental health counselors)
• Religious leaders or counselors
• Health maintenance organizations
• Community mental health centers
• Hospitals (psychiatry departments or outpatient mental health clinics)
• Social service agencies
• Private clinics and facilities
• Employee assistance programs
• Local medical and psychiatric societies.

  Common Symptoms of Depression in Men Irritability Anger Withdrawal from relationships Loss of interest in work or hobbies Increased alcohol and substance    use Greater risk taking and reckless    behavior Aggression Suicidal thoughts Sexual problems (loss of interest,      erectile difficulties Sleep disturbances

The point: Assistance is readily available in a variety of treatments that can help manage depression and make you feel better. The good news is that
men who receive treatment respond as well as women do to medication and psychotherapy, although they, too, may have to try a few different medications to find the one that works best.

There is no disgrace in seeking help—and no one except you and your doctor needs to know you’re doing so. The only shame is in letting outdated
notions about depression and masculinity stop you from taking advantage of the support that is available. Now all you need to do is take the first step.