Male depression: Don't ignore the symptoms

Interesting article I found:

Are you irritable, isolated and withdrawn? Do you find yourself working all the time, drinking too much alcohol, using street drugs, or seeking thrills from risky activities?

If so, perhaps you're being chased by what Winston Churchill called his "black dog," a depression that at times became debilitating. Churchill attempted to ward off his black dog with compulsive overwork and massive amounts of brandy. Your coping strategy may be reckless driving, casual sex or shutting yourself off from the world.
But none of these can keep the dog at bay for long. Even if untreated depression isn't exacerbated by alcohol and drugs, it's a serious medical disorder. It darkens your thoughts, undermines your personal and professional life, and places you at increased risk of other illnesses. Most disturbing, the risk of suicide is four times as great among depressed men as among depressed women.

Male depression: Often undiagnosed
Each year, depression affects about 6 million American men and 12 million American women. But these numbers may not tell the whole truth. Because men are generally less likely to consult doctors, a great deal of male depression may go undiagnosed.
Many men learn to overvalue independence and self-control during childhood. They're taught that it's unmanly to express pain, weakness, uncertainty, helplessness and sadness. They tend to see illness — especially emotional illness — as a threat to their masculinity. So they deny or hide their problems until an intimate partner's insistence or a catastrophic event, such as job loss or arrest, forces them to seek medical attention.

When they do go to doctors, depressed men are more likely to focus on physical complaints — headaches, digestive problems or chronic pain, for example — than on emotional suffering. So they and their doctors may be unlikely to make the connection between such symptoms and depression. Even if their doctors recognize the problem and say what it is, depressed men may resist mental health care, partly due to fear that the stigma of mental illness might damage their careers, jeopardize their health insurance benefits and cost them the respect of family and friends.

Characteristics of male depression
Most men are trained to focus on achievement and success, so they feel under constant pressure to perform well. But if they experience setbacks at home or in the workplace, they may keep their distress to themselves. Women — including those who focus on achievement and success — usually feel free to seek help. This may account for the lingering perception that depression is primarily a "women's disease."
In both men and women, common signs and symptoms of depression include feeling down in the dumps, sleeping poorly, and feeling sad, guilty and worthless. Depressed men, however, have bouts of crying less often than depressed women. Instead, depressed men are more likely to:

• Become angry and frustrated
• Behave violently
• Take serious risks, such reckless driving and extramarital sex
• Avoid family, friends and pleasurable activities
• Complain of fatigue
• Lose interest in work, hobbies and sex

A history of alcohol or drug abuse is common among men with depression, although there's debate over whether substance abuse is a cause or result of being depressed. Substance abuse can definitely mask depression, making the condition more difficult to diagnose.

Swedish researchers have identified a "male depressive syndrome" that includes increased susceptibility to stress, sudden spells of anger, lower impulse control, anti-social behavior, indecisiveness, and feelings of being burnt out and empty. But standard diagnostic tests may not detect these atypical signs and symptoms. So if you notice these characteristics developing in yourself, you should bring them to your doctor's attention.

Conditions associated with male depression
Depression is associated with many life-threatening medical conditions that are likely to shorten men's lives. These include heart disease, stroke, cancer, HIV/AIDS, diabetes and Parkinson's disease.

Depression is also strongly associated with post-traumatic stress disorder (PTSD), a debilitating condition that can occur after a traumatic event such as a personal assault, natural disaster, accident, terrorism or military combat. Men are more likely to be victims of criminal violence and accidents, which are leading causes of PTSD.

Loss of libido is a symptom of depression in both sexes, but it seems to have a greater impact on men, particularly if it's accompanied by erectile dysfunction (ED). In fact, ED from a physical cause may take such an emotional toll on a man that it causes depression. Additionally, because many depressed men have low testosterone levels and ED, it has been proposed that underproduction of testosterone may be a cause rather than an effect of depression. Men with depression, ED and low testosterone may become less depressed after treatment of their sexual dysfunction and low hormone levels.

Job stress a common trigger
Everyone is susceptible to depression in the wake of a major life stress, such as the end of an important relationship, the death of a loved one, relocation or financial problems. Men, however, may be more vulnerable than women to depression triggered by job-related stresses such as:

• Having no control in decisions affecting responsibilities
• Unrelenting and unreasonable demands for performance
• Lack of effective communication and conflict-resolution methods among co-workers and employers
• Lack of job security
• Night-shift work, excessive overtime, or both
• Excessive time spent away from home and family
• Wages that don't reflect the level of responsibility

Men may feel more threatened than women do by rapid social, political and economic change. When such change affects traditional male roles in the home and workplace, men may experience a profound loss of identity, status and dignity, which increases their risk of depression and other mental illnesses. In eastern and central European countries where poorly regulated capitalism replaced communism almost overnight, stress and mental illness took a serious toll in men. Their life expectancy decreased as much as 13 years while the life expectancy of women did not change. Similarly, male suicide rates soared during the Great Depression of the 1930s, when vast numbers of American men were unemployed.

Consequences of untreated male depression
Depression may have a profound impact on every aspect of life. It may directly affect your health by keeping your stress response continually activated, a state that can damage many organs, including the heart. It may even shorten your life. In a given year, depressed men are more than twice as likely as nondepressed men to die of any cause. Depressed women also have an increased risk of dying, compared to nondepressed women, but the difference is not as great as in men. Although the reasons for this difference are unclear, depressed men's self-destructive behavior — from excessive drinking to reckless driving to suicide — may contribute to it.
Depression also increases your risk of divorce and your children's risk of becoming depressed themselves. At work, depression makes you less productive, limits your earning potential and increases your risk of losing your job.

Men, depression and suicide
Although women are twice as likely to have depression, men are four times as likely to suffer its worst consequence: suicide. More than 90 percent of people who commit suicide have a history of depression, or another mental or substance-abuse disorder, often in combination. Starting in adolescence, men are far more likely than women to take their own lives. Older men, particularly white men over age 85, have the highest suicide rate. Although women attempt suicide three times as often as men, they are far less likely to complete it. Men's greater likelihood of using lethal means such as firearms accounts, in part, for the difference, but other factors also are involved.

One such factor may be men's tendency to move from suicidal thoughts to suicidal actions faster than women. Months or years of thinking about suicide typically culminate in the development and enactment of a plan. Men take an average of 12 months to go from contemplating to attempting suicide, compared to 42 months for women. During this process, men are less likely than women to show warning signs such as suicidal threats. Because the window of opportunity is so short, doctors and mental health professionals may have little chance to recognize and treat a man's depression before he commits suicide.

Getting treatment
If you or someone close to you is considering suicide, seek help immediately from your doctor, the nearest hospital emergency room, or emergency services (911).
If you suspect you have depression, schedule a physical examination with your family doctor. Conditions such as a viral infection, thyroid disorder and low testosterone levels can produce symptoms similar to depression. If your doctor rules out such conditions as a cause of your symptoms, the next step may be a depression screening.
Treatment may include short-term psychotherapy, antidepressant medications or both. For severe depression, especially if it's recurrent, a combination of psychotherapy and medication may be necessary.

Two forms of short-term psychotherapy (10 to 20 weeks) have proved beneficial in depression. One form, cognitive-behavioral therapy, helps you change negative thinking and behavior. The other, interpersonal therapy, helps you work through troubled relationships.

Antidepressant medications include selective serotonin reuptake inhibitors (Prozac, Zoloft and others), tricyclic antidepressants (Norpramin, Pamelor, and others) and mixed reuptake antidepressants (Wellbutrin, Effexor). Any antidepressant can cause sexual side effects. In men, these side effects may include problems achieving and maintaining erections. Work with your doctor to find a medication that effectively treats your symptoms while causing a minimum of sexual side effects that may worsen your depression.

If antidepressants don't work, you may respond to electroconvulsive therapy (ECT), which uses electricity to induce brain seizures that relieve depression. Today's ECT procedure is safe and effective, and its side effects are usually mild.

Self-help strategies
With appropriate medical treatment, you may notice that your sleep and appetite improve before your mood improves. But feelings of worthlessness, helplessness and hopelessness may gradually fade as you realize that they have more to do with your depression than with your actual life circumstances. Meanwhile, here are some things you can do on your own to speed your recovery:

• Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
• Break large tasks into small ones, set priorities, and do what you can as you can.
• Spend time with people in whom you can confide.
• Engage in pleasurable activities such as mild exercise, going to a movie or ballgame, or participating in religious or social events.
• Let your family and friends help you.
• Avoid making important decisions such as changing jobs or getting married or divorced until after the depression lifts.
• Remember, positive thinking replaces negative thinking.

For men and women, aerobic exercise can improve mood by raising brain levels of mood-enhancing chemicals. Aerobic exercise can also boost self-esteem by promoting weight loss and improved muscle tone. Yoga — which involves rhythmic stretching movements and controlled breathing — may help relieve men's depressive symptoms by reducing tension and anger.

Looking ahead
Researchers are discovering important genetic differences in the way depression affects men and women. For example, only three out of a group of 19 different depression-associated regions identified on human chromosomes are common to both sexes. The other 16 are specific to either men or women. Also, a recently identified gene associated with both depression and alcohol dependence may partially explain why the two conditions often occur together. These discoveries may lead to the development of antidepressant drugs that target the specific aspects of brain function linked to different symptoms of depression. One such drug may control the irritability, compulsive behavior and social isolation that typify depression in men. Another may quell the hopelessness, guilt and feelings of inadequacy that overwhelm many depressed women (and men). Specialized drugs will make it easier for your doctor to select the one that's likely to work best for you.

Remember, you don't need to suffer depression silently or alone. If you can muster the courage to admit you are depressed, chances are good that your family and friends will applaud you. Appropriate treatment can help you regain the outlook you need to enjoy life and meet its inevitable challenges.

Content by Mayo Clinic

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