Men and Depression
Depression is a serious medical condition that affects the body, mood, and thoughts. It affects the way one eats and one sleeps, one’s self-concept, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely “pull themselves together” and get better.
Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, often involving medication and/or short-term psychotherapy, can help most people who suffer from depression.
“I can remember it started with a loss of interest in basically everything that I like doing. I just didn’t feel like doing anything. I just felt like giving up. Sometimes I didn’t even want to get out of bed.”
—Rene Ruballo, Police Officer
Depression can strike anyone regardless of age, ethnic background, socioeconomic status, or gender; however, large-scale research studies have found that depression is about twice as common in women as in men.1,2 In the United States, researchers estimate that in any given one-year period, depressive illnesses affect 12 percent of women (more than 12 million women) and nearly seven percent of men (more than six million men).3 But important questions remain to be answered about the causes underlying this gender difference. For example, is depression truly less common among men, or are men just less likely than women to recognize, acknowledge, and seek help for depression?
In focus groups conducted by the National Institute of Mental Health (NIMH) 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, they expressed concern about seeing a mental health professional or going to a mental health clinic, thinking that people would find out and that this might have a negative impact on their job security, promotion potential, or health insurance benefits. 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.
Over the past 20 years, biomedical research including genetics and neuroimaging has helped to shed light on depression and other mental disorders—increasing our understanding of the brain, how its biochemistry can go awry, and how to alleviate the suffering that mental illnesses can cause. Brain imaging technologies are now allowing scientists to see how effective treatment with medication or psychotherapy is reflected in changes in brain activity.4 As research continues to reveal that depressive disorders are real and treatable, and are no more a sign of weakness than cancer or any other serious illness, more and more men with depression may feel empowered to seek treatment and find improved quality of life.
Types of Depression
Depression comes in different forms, just as is the case with other illnesses such as heart disease. This booklet briefly describes three of the most common types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity, and persistence.
Major depression (or major depressive disorder) is manifested by a combination of symptoms (see symptom list below) that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A major depressive episode may occur only once; but more commonly, several episodes may occur in a lifetime. Chronic major depression may require a person to continue treatment indefinitely.
A less severe type of depression, dysthymia (or dysthymic disorder), involves long-lasting symptoms that do not seriously disable, but keep one from functioning well or feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.
Another type of depressive illness is bipolar disorder (or manic-depressive illness). Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression), often with periods of normal mood in between. Sometimes the mood switches are dramatic and rapid, but usually they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of depression. When in the manic cycle, the individual may be overactive, over-talkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees and unsafe sex. Mania, left untreated, may worsen to a psychotic state.
Symptoms of Depression and Mania
Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms; some people suffer many. The severity of symptoms varies among individuals and also over time.
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, being “slowed down”
- Difficulty concentrating, remembering, making decisions
- Trouble sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Restlessness, irritability
- Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain, which do not respond to routine treatment
“You don’t have any interest in thinking about the future, because you don’t feel that there is going to be any future.”
—Shawn Colten, National Diving Champion
“I wouldn’t feel rested at all. I’d always feel tired. I could get from an hour’s sleep to eight hours sleep and I would always feel tired.”
—Rene Ruballo, Police Officer
- Abnormal or excessive elation
- Unusual irritability
- Decreased need for sleep
- Grandiose notions
- Increased talking
- Racing thoughts
- Increased sexual desire
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior
Co-Occurrence of Depression with Other Illnesses
Depression can coexist with other illnesses. In such cases, it is important that the depression and each co-occurring illness be appropriately diagnosed and treated.
Research has shown that anxiety disorders, which include post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder, commonly accompany depression. Depression is especially prevalent among people with PTSD, a debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging, natural disasters, accidents, terrorism, and military combat. PTSD symptoms include: reexperiencing the traumatic event in the form of flashback episodes, memories, or nightmares; emotional numbness; sleep disturbances; irritability; outbursts of anger; intense guilt; and avoidance of any reminders or thoughts of the ordeal. In one NIMH-supported study, more than 40 percent of people with PTSD also had depression when evaluated at one month and four months following the traumatic event.
Substance use disorders (abuse or dependence) also frequently co-occur with depressive disorders.5,6 Research has revealed that people with alcoholism are almost twice as likely as those without alcoholism to also suffer from major depression.6 In addition, more than half of people with bipolar disorder type I (with severe mania) have a co-occurring substance use disorder.
Depression has been found to occur at a higher rate among people who have other serious illnesses such as heart disease, stroke, cancer, HIV, diabetes, and Parkinson’s.6,9 Symptoms of depression are sometimes mistaken for inevitable accompaniments to these other illnesses. However, research has shown that the co-occurring depression can and should be treated, and that in many cases treating the depression can also improve the outcome of the other illnesses.
Causes of Depression
Substantial evidence from neuroscience, genetics, and clinical investigation shows that depressive illnesses are disorders of the brain. However, the precise causes of these illnesses continue to be a matter of intense research.
Modern brain-imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters—chemicals used by nerve cells to communicate—are out of balance. Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other nongenetic factors. Studies of brain chemistry and the mechanisms of action of antidepressant medications continue to inform our understanding of the biochemical processes involved in depression.
Very often, a combination of genetic, cognitive, and environmental factors is involved in the onset of a depressive disorder.10 Trauma, loss of a loved one, a difficult relationship, a financial problem, or any stressful change in life patterns, whether the change is unwelcome or desired, can trigger a depressive episode in vulnerable individuals. Later episodes of depression may occur without an obvious cause.
In some families, depressive disorders seem to occur generation after generation; however, they can also occur in people who have no family history of these illnesses.11 Whether inherited or not, depressive disorders are associated with changes in brain structures or brain function, which can be seen using modern brain imaging technologies.
Men and Depression
Researchers estimate that at least six million men in the United States suffer from a depressive disorder every year.3 Research and clinical evidence reveal that while both women and men can develop the standard symptoms of depression, they often experience depression differently and may have different ways of coping with the symptoms. Men may be more willing to acknowledge 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 upon it adequately capture the condition as it occurs in men.
“I’d drink and I’d just get numb. I’d get numb to try to numb my head. I mean, we’re talking many, many beers to get to that state where you could shut your head off, but then you wake up the next day and it’s still there. Because you have to deal with it, it doesn’t just go away. It isn’t a two-hour movie and then at the end it goes ‘The End’ and you press off. I mean it’s a twenty-four hour a day movie and you’re thinking there is no end. It’s horrible.”
—Patrick McCathern, First Sergeant, U.S. Air Force, Retired
Men are more likely than women to report alcohol and drug abuse or dependence in their lifetime;16 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 use 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 drugs when they are depressed, or become frustrated, discouraged, angry, irritable and, sometimes, violently abusive. Some men 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
“When I was feeling depressed I was very reckless with my life. I didn’t care about how I drove, I didn’t care about walking across the street carefully, I didn’t care about dangerous parts of the city. I wouldn’t be affected by any kinds of warnings on travel or places to go. I didn’t care. I didn’t care whether I lived or died and so I was going to do whatever I wanted whenever I wanted. And when you take those kinds of chances, you have a greater likelihood of dying.”
—Bill Maruyama, Lawyer
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 addition to the fact that the methods men use to attempt suicide are generally more lethal than those methods used by women, there may be other issues that protect women against suicide death. In light of research indicating that suicide is often associated with depression,19 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, which may be life saving.
More research is needed to understand all aspects of depression in men, including how men respond to stress and feelings associated with depression, how to make them more comfortable acknowledging these feelings and getting the help they need, and how to train physicians to better recognize and treat depression in men. Family members, friends, and employee assistance professionals in the workplace also can play important roles in recognizing depressive symptoms in men and helping them get treatment.
Substance Abuse and Mental Health Services Administration
National Mental Health Information Center
P.O. Box 42490
Washington, DC 20015
Web site: http://www.mentalhealth.samhsa.gov
SAMHSA’s National Mental Health Information Center provides the public information on mental health services and referrals to Federal, State, or local resources for more information and help. SAMHSA is an agency of the U.S. Department of Health and Human Services.
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